Immigrants and health care: sources of vulnerability

Sep 12 2007

Expanding opportunities for immigrants to obtain legal residency and citizenship may be the best option to offer them better access to health care, according to an article published today by the RAND Corporation in the journal Health Affairs.

“Immigrants now make up 12 percent of the U.S. population,” said Kathryn Pitkin Derose, the lead author of the article and a policy researcher at RAND, a nonprofit research organization. “Ultimately, the health of this large segment of our population will affect the health of the nation.”

The article from RAND Health, “Immigrants and Health Care: Sources of Vulnerability,” appears in a special issue of Health Affairs that looks at a how to improve healthcare for vulnerable populations.

The researchers note that immigrants vary on numerous factors that affect their access to, and quality of, health care. Those factors include: socioeconomic background, immigration status, limited English proficiency, residential location, and stigma and marginalization.

For example, previous studies have found that while immigrants have lower rates of health insurance coverage than native-born residents, 65 percent of undocumented immigrants are uninsured, compared to 15 to 20 percent of naturalized citizens.

Further, although limited English proficiency is related to poorer access to and lower quality of health care, what language is spoken may be an intervening factor. For example, the researchers cite a previous study that found that among those with limited-English proficiency, Spanish-speaking women in California were more likely to receive a Pap test over a three-year period, compared to women who spoke Vietnamese, Cantonese, Mandarin or Korean.

And while immigrants overall are less likely than native-born citizens to have graduated from high school and are more likely to work in low-paying occupations, there are striking variations among immigrant subgroups. The proportion of Asian immigrants living below the federal poverty level, for example, is 11 percent, similar to that of U.S. citizens, but is 22 percent for Latin American immigrants.

In reviewing these and other research conclusions, the article suggests several policy options for improving access to and quality of health care for immigrants, including:

• Expand access to health insurance by reauthorizing and expanding programs like the State Children's Health Insurance Program, or SCHIP, and extend the eligibility to the parents of children eligible for Medicaid (a federal health care program for low-income people) and SCHIP.
• Address limited-English proficiency by enforcing laws designed to ensure hospitals and clinics located in areas with a large number of immigrants have staff who can speak the predominant languages in that area.
• Expand and strengthen the medical safety net. Because many immigrants are flocking to areas that have not traditionally had large immigrant populations, policies that support the expansion of safety net programs such as community health centers would make it easier for immigrants to receive health care.
• Revise laws that restrict immigrants' access to government-sponsored or government-subsidized health insurance programs because they put immigrants at risk for poor health care.

Over the last decade, the United States has seen its immigrant population grow and branch out away from traditional immigration centers. Twenty-two states with relatively low percentages of immigrants saw their populations grow by more than 90 percent between 1990 and 2000. Currently, approximately a third of immigrants are naturalized citizens, a third are legal permanent residents and a third are undocumented.