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      Barriers to health care for undocumented immigrants: a literature review

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          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.

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          Health care access, use of services, and experiences among undocumented Mexicans and other Latinos.

          We compared access to health care, use of services, and health care experiences for Mexicans and other Latinos by citizenship and immigrant authorization status. We acquired data from the 2003 California Health Interview Survey, with 42,044 participants representative of noninstitutionalized households. Participants were differentiated by ethnicity/race, national origin, and citizenship/immigration authorization status. Outcome measures included having a usual source of care, problems in obtaining necessary care, use of physician and emergency department care, and 3 experiences with health care. Multivariate analyses measured the associations of citizenship/immigration authorization status with the outcome measures among foreign-born Mexicans and other Latinos vs their US-born counterparts. In multivariate analyses, undocumented Mexicans had 1.6 fewer physician visits (P < .01); compared with US-born Mexicans; other undocumented Latinos had 2.1 fewer visits (P < .01) compared with their US-born counterparts. Both undocumented groups were less likely to report difficulty obtaining necessary health care than US-born Mexicans (odds ratio, 0.68; P < .01) and other US-born Latinos (odds ratio, 0.40; P < .01), respectively. Undocumented Mexicans were less likely to have a usual source of care (odds ratio, 0.70; P < .01) and were more likely to report negative experiences than US-born Mexicans (odds ratio, 1.93; P < .01). Findings were similar for other undocumented Latinos, with the exception of having a usual source of care. Patterns of access to and use of health care services tended to improve with changing legal status. In this large sample, undocumented Mexicans and other undocumented Latinos reported less use of health care services and poorer experiences with care compared with their US-born counterparts, after adjustment for confounders in multivariate analyses.
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            Health and access to care for undocumented migrants living in the European Union: a scoping review

            Background Literature on health and access to care of undocumented migrants in the European Union (EU) is limited and heterogeneous in focus and quality. Authors conducted a scoping review to identify the extent, nature and distribution of existing primary research (1990–2012), thus clarifying what is known, key gaps, and potential next steps. Methods Authors used Arksey and O’Malley’s six-stage scoping framework, with Levac, Colquhoun and O’Brien’s revisions, to review identified sources. Findings were summarized thematically: (i) physical, mental and social health issues, (ii) access and barriers to care, (iii) vulnerable groups and (iv) policy and rights. Results Fifty-four sources were included of 598 identified, with 93% (50/54) published during 2005–2012. EU member states from Eastern Europe were under-represented, particularly in single-country studies. Most study designs (52%) were qualitative. Sampling descriptions were generally poor, and sampling purposeful, with only four studies using any randomization. Demographic descriptions were far from uniform and only two studies focused on undocumented children and youth. Most (80%) included findings on health-care access, with obstacles reported at primary, secondary and tertiary levels. Major access barriers included fear, lack of awareness of rights, socioeconomics. Mental disorders appeared widespread, while obstetric needs and injuries were key reasons for seeking care. Pregnant women, children and detainees appeared most vulnerable. While EU policy supports health-care access for undocumented migrants, practices remain haphazard, with studies reporting differing interpretation and implementation of rights at regional, institutional and individual levels. Conclusions This scoping review is an initial attempt to describe available primary evidence on health and access to care for undocumented migrants in the European Union. It underlines the need for more and better-quality research, increased co-operation between gatekeepers, providers, researchers and policy makers, and reduced ambiguities in health-care rights and obligations for undocumented migrants.
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              Right of access to health care for undocumented migrants in EU: a comparative study of national policies.

              The aim of this article is to characterize policies regarding the right of access to health care for undocumented migrants in the 27 Member States of the European Union and to identify the extent to which these entitlements are congruent with human rights standards. The study is based on a questionnaire sent to experts, non-governmental organizations and authorities in the Member States between April and December 2009, as well as on available reports and official websites. Primary sources were also consulted as regards legislation. Right of access to health care differs considerably between Member States. States can be grouped into 3 clusters: in 5 countries undocumented migrants have the right to access care that is more extensive than emergency care; in 12 countries they can only access emergency care and in 10 countries not even emergency care can be accessed. These variations are independent of the system of financing or the numbers of undocumented migrants present. Rather, they seem to relate to the intersection between practices of control of migration, the main types of undocumented migrants present and the basic norms of the welfare state-the 'moral economy' of the work society. International obligations articulated in human rights standards are not fully met in the majority of Member States. A more complete understanding of the differing policies might be obtained by considering the relationship between the formal and informal economy, as well as the role of human rights standards within the current 'moral economy'.
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                Author and article information

                Journal
                Risk Manag Healthc Policy
                Risk Manag Healthc Policy
                Risk Management and Healthcare Policy
                Risk Management and Healthcare Policy
                Dove Medical Press
                1179-1594
                2015
                30 October 2015
                : 8
                : 175-183
                Affiliations
                [1 ]Allegheny County Health Department, Pittsburgh, PA, USA
                [2 ]Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
                [3 ]Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA
                [4 ]Institute for Community Health, Cambridge, MA, USA
                [5 ]Cambridge Health Alliance, Cambridge, MA, USA
                [6 ]Harvard School of Medicine, Boston, MA, USA
                Author notes
                Correspondence: Karen Hacker, Allegheny County Health Department, 542 4th Street, Pittsburgh, PA 15219, USA, Tel +1 412 578 8008, Fax +1 412 578 8325, Email khacker@ 123456achd.net
                Article
                rmhp-8-175
                10.2147/RMHP.S70173
                4634824
                26586971
                88ba85cf-4a6b-4fd4-a6e7-a4c5a1224c46
                © 2015 Hacker et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Review

                Social policy & Welfare
                undocumented immigrants,health care,access,deportation,immigration and migration

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