To understand health care needs of immigrants is a very important task because they are still increasing in numbers. In fact, the number of immigrants is increasing so rapidly that by the year 2005, immigrants had made up 12% of the US population (Kaushal and Kaestner, 2007). The percentage is increasing each day, and there is no sign that the situation is going to change. The highest number of US immigrants comes from Latin America, and many of these immigrants are undocumented. To address health care needs of immigrants is very challenging due to a number of issues such as federal and state policies restricting them from having access to health care, and their heterogeneity. Therefore, this group of the population can be referred to as a vulnerable one because they are likely to deal with a great number of social, psychological, and physical health problems and insufficient health care.
Their vulnerability is affected by numerous factors such as social and political marginalization, lack of societal and socioeconomic resources, limited English proficiency, and immigration status. The main purpose of this section is to address health care utilization among immigrant women in the United States. This will be achieved by means of presenting an overview of work done previously that provides the required background for the purposes of this research. It will concentrate on various issues associated with health care utilization among immigrant women in the United States. The section will begin with a thorough coverage of topics connected with health care utilization among immigrant women in the US, which will assist in setting the context of this research.
Health Insurance of Immigrant Women
Welfare reform introduced in the 1990s changed health insurance coverage among immigrants. All immigrants were affected by the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). This act deprived immigrants of some benefits. As a result, the immigrant use of Medicaid, cash assistance, Supplemental Security Income, and Food Stamps drastically reduced (Kaushal and Kaestner, 2007). This welfare reform left many children and women without health insurance. The declining use of Medicaid has led immigrant women to turn to private insurance. The problem with private insurance is that it is very costly, thus, leaving most immigrant women without health insurance, as most of them are low income earners.
For this group of immigrants, the loss of health insurance has reduced utilization of medical care. Changes in health insurance coverage do not only influence the use of medical care, but it also affects the health of immigrant women. According to Kaushal and Kaestner (2007), these changes in health insurance coverage, employment, and other life circumstances have affected the use of medical care as well as health of low income immigrants. Before the introduction of PRWORA, immigrant mothers and their children were more likely to get public health insurance and less likely to be without any as compared to the post-PRWORA period (Kaushal and Kaestner, 2007). The adverse effects of PRWORA are likely to hurt the economic progress of low income immigrant population, thus, failing to implement the intended objectives of the 1996 policy. The main goal of this policy was to increase the economic independence of immigrants and eliminate their dependence on the state; however, it failed.
Immigrants’ poor health conditions will definitely impede their success in the labor market as well as hamper their progress towards economic independence. Therefore, the welfare reform has caused some noticeable problems connected with medical care utilization and health insurance of low income families such as those of immigrant women.
Health Care Utilization Patterns
Most researches conducted on utilization of health care services show that immigrants do not receive timely health care as compared to native born citizens (Ivanov and Buck, 2002). One research suggested that this happens due to the fact that most immigrant women are experiencing a low acculturation level. For instance, women with poor English language skills rarely use health care services (Ivanov and Buck, 2002). However, other studies do not agree with the low acculturation level being a predictor of utilization of health care services among immigrant women. They suggest that most immigrant women prefer culturally-based health care sources such as teas and herbs, thus, postponing seeking health care services till they exhaust all customary practices.
According to Ivanov and Buck (2002), health behaviors are culture-specific. This is the reason why most immigrants access the US health care system depending on patterns of utilization in their countries of origin. Therefore, all immigrants should not be expected to access and utilize health care services in the same manner. All policies related to immigrants and refugees should take into consideration the obstacles to accessing health care services experienced by various immigrant groups. Also, the cost has been noted to be a major contributing factor to hinder health care, considering that some of these women do not have health insurance cover (Ivanov and Buck, 2002). Most of them spend their money on housing and food, which consequently leaves them with nothing for health care, in particular, preventive care. Some immigrant women do not consider health services offered in the United States convenient because they are not allowed to see their physicians of choice, as they were accustomed to doing in their countries of origin. This statement was confirmed by a research conducted on women from the former Soviet Union who were not satisfied with US health care services, since they were never allowed to see their physicians of choice.
Numerous studies have documented lower access to health care among immigrants in the United States. Foreign-born individuals use fewer health care services, they are less likely to be insured, and they do not receive timely cancer screenings as compared to the native-born population (Lebrun and Dubay, 2010). In particular, immigrant women make less adequate use of parental care, as well as mammography screenings and Pap smears. Lebrun and Dubay (2010) identify insurance status differences between native born and foreign born people within the United States as the key factor that contributes to the disparities across the nation in having regular access to health care needs.
Health insurance coverage plays an important role in ensuring immigrants’ access to care. The majority of the US population is able to receive insurance coverage through employers. However, many immigrants cannot receive this type of service because they normally have low- paying jobs that cannot offer employer-sponsored insurance. This means that most of them remain uninsured as a result of this. Beside the insurance status, other issues such as economic status and education levels also contribute to health care disparities in the United States (Lebrun and Dubay, 2010).
Lebrun (2012) divided factors that influence health care utilization among immigrant population into three broad categories, namely, enabling factors, predisposing factors, and need for services. Predisposing factors can further be disintegrated into the social structure and demographic characteristics that influence how someone uses health care services. These factors may include race/ethnicity, marital status sex, and age among others (Lebrun, 2012). Enabling factors can be described as community-level and individual-level resources that allow access to health care services. Enabling factors include health insurance coverage, education, and the level of income. Acculturation-related factors can also be classified as enabling factors (Lebrun, 2012). Need for services factors have to do with underlying health needs or a specific disease profile that motivate someone to access medical services.
According to Lebrun (2012), increased duration of residence of immigrants also contributes to the utilization of health care services. Improved access to preventive and primary health care among immigrants in the United States is connected with increased duration of residence. More established immigrants have routine medical checkups, obtain mental health consultation, have a regular medical doctor, receive immunizations, use dental or vision services, and receive cancer screenings, which is not the case for recent immigrants (Lebrun, 2012). The longer length of stay leads to an increase in human capital and material goods, which facilitates access to health care services. Some of the benefits associated with longer length of stay include naturalized citizen status or documented immigrant status, insurance coverage, proficiency in the country’s official language of communication, beliefs and knowledge about health care and health, and so on.
The relationship between the length of stay and access to health care services is affected by governmental policies. For instance, PRWORA, the 1996 Illegal Immigration Reform, and Immigrant Responsibility Act prevent legal immigrants from using Medicaid for a period of five years when they arrive in the US (Lebrun, 2012). Such restrictive policies may even discourage other eligible immigrants from applying for public programs, thus, increasing the chances that they may take time before utilizing the health care or even ignore it.
Parental care utilization has varied widely depending on socioeconomic, racial-ethnic, and cultural backgrounds of mothers in the US (Korinek and Smith, 2011). Immigrant women have displayed a low level of parental care utilization as compared to native-born women. The legal status directly influences the utilization of health care. This is because being undocumented limits access to insurance and public health assistance programs (Korinek and Smith, 2011). It also determined employment positions and the ability of making claims on public institutions. The denial of service to noncitizen mothers of citizen children is likely to heighten the number of children and mothers at risk of poor health outcomes during pregnancy, infancy, and early childhood. As births to foreign women rise, their health and that of their children will have a significant bearing on public health, which will become a major challenge to healthcare provision in the future (Korinek and Smith, 2011). Therefore, there is a need to have integrative policy programs that will deal with health care utilization of this group to avoid future problems.
Arab Americans are among the largest number of immigrants in the United States, but very little research has been published concerning their health beliefs, practices, behaviors, and status (Shah et al., 2008). To make matters worse, very little is known about their mortality and cancer incidence. The language barrier is one of the major and pervasive obstacles to health care access by Arab Americans. Many Arab immigrant women prefer to speak Arabic and use Arabic-speaking health care providers. Some of them have been in the United States for a long period of time and they can even speak English, but they do not prefer to use it. In fact, many Arab immigrant women cannot fully explain their symptoms and health concerns using English (Shah et al., 2008). Their reliance on the Arabic language is a major problem not only in health care services, but it is also a problem connected with information access, as there are few Arabic resources in the United States.
Most women are forced to bring their children or husbands to act as interpreters during their medical visits. Some women are not comfortable with discussing their female specific health issues in the presence of their male counterparts. Another issue that bothers this group of immigrants is discrimination due to the fact that most of them are Muslims. Discrimination against Muslims increased after the 9/11 bombing. This discrimination is practiced everywhere including health care settings (Shah et al., 2008). The majority of Arab women put aside their own health needs to take care of their families. Also, they do not seek childcare, as this is not supported by their culture. Besides the language barrier problem, Arab women are faced with other issues such as time, discrimination, and beliefs about illness causation that may not be identified or addressed by health care providers.
Legitimacy of Studies Conducted on Health Care Utilization among Immigrants
Most of the studies related to health care utilization among immigrants have been based on individual perceptions (Bender et al., 2001). Health research reports are generally based on individual perceptions due to the fact that many health care providers are not well-equipped for collecting data or designing studies about immigrant populations. The major challenge for researchers who try to gather data from immigrants face is the language barrier that exists between them.
Other challenges that are encountered by researchers include cultural backgrounds, literacy levels, social desirability, interviewer-interviewee rapport, and lack of suitable background information (Bender et al., 2001). In most cases, literacy levels affect both data collection and recruitment. For instance, it would be very hard for a researcher to collect data by the use of either questionnaire or interview methods from an individual with low-literacy skills. Also, such participants may not be willing to be tape-recorded, thus, making the issue of data collection very complicated.
Rapport between the interviewer and the interviewee also affects the validity and quality of data. If researchers begin a talk with immigrants without first creating a trustful friendly atmosphere, the interviewer may not get honest answers, particularly, about some sensitive topics like reproductive health care (Bender et al., 2001). The researcher will end up using the wrong information, which will lead to drawing wrong conclusions. Therefore, it is very important to create a favorable atmosphere before conducting an interview so that your correspondents can trust you and give honest answers that will lead to a valid conclusion. It is very difficult to assess social desirability; a bias towards it limits the quality of data collected (Bender et al., 2001).
The majority of immigrant women do not use health care services as they are supposed to do. This will definitely affect the public health if the situation is not addressed properly. It is not their choice not to use health care services, but it depends on several factors. Some of the factors that contribute to the low level of health care utilization include social and political marginalization, lack of societal and socioeconomic resources, limited English proficiency, and immigration status among others. Parental care utilization affects even citizens because children born by immigrant women are considered citizens of the United States. This is a clear indication that the public health is at risk, as these children do not have full access to health care. Policies restricting parental care should be regulated to ensure that the future generation has full access to health care services. Any factor that causes health disparities should be accounted for in order to improve health care access among vulnerable population.