Barriers to health care for undocumented immigrants: a literature review

Abstract

With the unprecedented international migration seen in recent years, policies that limit health care access have become prevalent. Barriers to health care for undocumented immigrants go beyond policy and range from financial limitations, to discrimination and fear of deportation. This paper is aimed at reviewing the literature on barriers to health care for undocumented immigrants and identifying strategies that have or could be used to address these barriers. To address study questions, we conducted a literature review of published articles from the last 10 years in PubMed using three main concepts: immigrants, undocumented, and access to health care. The search yielded 341 articles of which 66 met study criteria. With regard to barriers, we identified barriers in the policy arena focused on issues related to law and policy including limitations to access and type of health care. These varied widely across countries but ultimately impacted the type and amount of health care any undocumented immigrant could receive. Within the health system, barriers included bureaucratic obstacles including paperwork and registration systems. The alternative care available (safety net) was generally limited and overwhelmed. Finally, there was evidence of widespread discriminatory practices within the health care system itself. The individual level focused on the immigrant’s fear of deportation, stigma, and lack of capital (both social and financial) to obtain services. Recommendations identified in the papers reviewed included advocating for policy change to increase access to health care for undocumented immigrants, providing novel insurance options, expanding safety net services, training providers to better care for immigrant populations, and educating undocumented immigrants on navigating the system. There are numerous barriers to health care for undocumented immigrants. These vary by country and frequently change. Despite concerns that access to health care attracts immigrants, data demonstrates that people generally do not migrate to obtain health care. Solutions are needed that provide for noncitizens’ health care.

Compassionate care provision: an immense need during the refugee crisis: lessons learned from a European capacity-building project

“…The two-day ECM hosted by University of Crete, was attended by sixty-nine (69) international, regional, and local experts, across disciplines, and with a focus on refugee and migrant care from fourteen (14) countries. Participants were chosen on the basis of their experience and knowledge in the field of primary care and/or care for refugees.…”

“…The literature search and interviews with experts found that in order to provide compassionate care crucial problems and barriers occur at the levels of professional, patient, and organisation. Many studies identified the training of professionals in culturally sensitive aspects of care as a core enabler or a critical element of improvement interventions [6,[12][13][14][15].…”

Disclosure of patients’ data to the UK Home Office must stop

“…4 Yet, fear of deportation has been documented as a serious barrier in 65% of research studies on access to healthcare by undocumented migrants. 5 The risk of deterring people from seeking treatment has now been recognised by the prime minister in the wake of the Grenfell Tower tragedy; she told the House of Commons that "I would also like to reassure people that we will not use this tragic incident as a reason to carry out immigration checks [and] will make sure that all victims, irrespective of their immigration status, will be able to access the services they need, including healthcare and accommodation." 6 Reassurances of this kind, however, are no substitute for a legal guarantee of the human right to health, which the UK has signed up to in international law.…”

Latina young adults' use of health care during initial months in the United States

“…Recent increased migration rates around much of the world resulted in immigration policies by numerous governments to inhibit migration, including limiting access to health care for immigrants [e.g., Canada, Costa Rica, several European countries, the United States (US), and Scandinavia; Hacker, Anies, Folb, & Zallman, 2015]. Insufficient health care can put migrants at great risk.…”

“…Moreover, 39% of foreign-born, non-citizen Latinos and almost half of undocumented Latinos lack insurance due in part to ineligibility for the ACA and other government assistance (Krogstad & Lopez, 2014). Thus, Latina immigrants often lack a regular health care provider during their initial months in the US due to inability to afford care, as well as barriers such as (b) unfamiliarity with the US health care system, (c) preference for alternative forms of treatment, (d) difficulties due to language and cultural differences, (e) discrimination, and/or (f) unauthorized immigration status and fear of deportation (De Jesus & Miller, 2015; Escarce & Kapur, 2006; Gurman & Becker, 2008; Hacker, et al, 2015; Marshall, Urrutia-Rojas, Mas, & Coggin, 2005). These obstacles are especially problematic for Latina young adults in the US given that medical practitioners recommend that Latina young women receive regular cancer screening due to the disproportionately high prevalence rates in the US (Bickell, 2002; Nodora et al, 2015; Zhan & Lin, 2014).…”