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      Access to health care for uninsured Latina immigrants in South Carolina

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          Abstract

          Background

          South Carolina is considered a “new destination” state for Latino immigrants. Language barriers, transportation difficulties, low socioeconomic status, inflexible work schedules, different cultural norms, and anxiety and fear related to the current anti-immigrant political climate all negatively impact Latino immigrants’ frequency of contact with the health care system, and consequently they suffer poor health outcomes. The study objective was to explore uninsured Latina immigrant women’s access to health care and alternative treatment strategies in coastal South Carolina.

          Methods

          The study design was a qualitative interview design. Thirty women participated in semi-structured interviews in community sites. Thematic analysis identified salient categories of topics across interview participants.

          Results

          The themes were organized into four primary categories including: 1) Barriers and Facilitators to Healthcare, 2) Health Behaviors and Coping Mechanisms, 3) Disease Management Strategies, and 4) Cultural Factors. Participants demonstrated determination for accessing care but reported that their primary health care access barriers included the high cost of services, lack of health insurance, family and work responsibilities, and language barriers. Coping mechanisms included activating their social networks, visiting family and friends and assisting one another with navigating life challenges.

          Conclusion

          Participants overcame obstacles to obtain healthcare for themselves and their family members despite the multiple barriers presented. Social networks were leveraged to protect against some of the negative effects of financial barriers to health care access.

          Electronic supplementary material

          The online version of this article (10.1186/s12913-018-3138-2) contains supplementary material, which is available to authorized users.

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          Most cited references20

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          Structural vulnerability and health: Latino migrant laborers in the United States.

          Latino immigrants in the United States constitute a paradigmatic case of a population group subject to structural violence. Their subordinated location in the global economy and their culturally depreciated status in the United States are exacerbated by legal persecution. Medical Anthropology, Volume 30, Numbers 4 and 5, include a series of ethnographic analyses of the processes that render undocumented Latino immigrants structurally vulnerable to ill health. We hope to extend the social science concept of "structural vulnerability" to make it a useful concept for health care. Defined as a positionality that imposes physical/emotional suffering on specific population groups and individuals in patterned ways, structural vulnerability is a product of class-based economic exploitation and cultural, gender/sexual, and racialized discrimination, as well as complementary processes of depreciated subjectivity formation. A good-enough medicalized recognition of the condition of structural vulnerability offers a tool for developing practical therapeutic resources. It also facilitates political alternatives to the punitive neoliberal policies and discourses of individual unworthiness that have become increasingly dominant in the United States since the 1980s. Copyright © 2011 Taylor & Francis Group, LLC
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            Immigrants and health care: sources of vulnerability.

            Immigrants have been identified as a vulnerable population, but there is heterogeneity in the degree to which they are vulnerable to inadequate health care. Here we examine the factors that affect immigrants' vulnerability, including socioeconomic background; immigration status; limited English proficiency; federal, state, and local policies on access to publicly funded health care; residential location; and stigma and marginalization. We find that, overall, immigrants have lower rates of health insurance, use less health care, and receive lower quality of care than U.S.-born populations; however, there are differences among subgroups. We conclude with policy options for addressing immigrants' vulnerabilities.
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              Barriers to health care for undocumented immigrants: a literature review

              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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                Author and article information

                Contributors
                (850) 599-3254 , john.luque@famu.edu
                soulen@musc.edu
                davilac@musc.edu
                cartmelk@musc.edu
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                2 May 2018
                2 May 2018
                2018
                : 18
                : 310
                Affiliations
                [1 ]ISNI 0000 0001 2214 9445, GRID grid.255948.7, Institute of Public Health, Florida A&M University, Science Research Center, ; 1515 South MLK Blvd. Suite 207B, Tallahassee, FL 32307 USA
                [2 ]ISNI 0000 0001 2189 3475, GRID grid.259828.c, Department of Public Health Sciences, , Medical University of South Carolina, ; Charleston, SC USA
                [3 ]ISNI 0000 0001 2189 3475, GRID grid.259828.c, College of Nursing, , Medical University of South Carolina, ; Charleston, SC USA
                Author information
                http://orcid.org/0000-0002-8085-4641
                Article
                3138
                10.1186/s12913-018-3138-2
                5930513
                29716586
                a381a8c0-4c6d-4591-a724-f72de3f46c8c
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 13 June 2017
                : 22 April 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100006108, National Center for Advancing Translational Sciences;
                Award ID: UL1 TR 001450
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Health & Social care
                Health & Social care

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