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Undocumented Immigration as a health issue and a nursing issue

Undocumented Immigration as a health issue and a nursing issue. By Brittany Pharo. Goals for Presentation. Briefly introduce data relating to the undocumented immigrant population.

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Undocumented Immigration as a health issue and a nursing issue

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  1. Undocumented Immigration as a health issue and a nursing issue By Brittany Pharo

  2. Goals for Presentation • Briefly introduce data relating to the undocumented immigrant population. • Discuss the barriers to health care, statistical usage of health care services, and health risks for the undocumented immigrant population. • Briefly compare laws and policies in the U.S. and internationally. • Understand that nurses and other healthcare workers play an important role in the advancement of health care services and policies for the undocumented immigrant.

  3. Undocumented Immigration: Intro • The United States has one of the highest, if not the highest, immigrant populations. • It is difficult to get accurate numbers of undocumented immigrants, but in 2012 there were an estimated 11.7 million undocumented immigrants (Edward, 2014). • The immigrant population, both documented and undocumented, have “higher rates of poverty and lower levels of education, lacks health care coverage, and receives fewer health services when compared with their U.S.-born counterparts” (Edward, 2014, p. 5). • Current U.S. laws and policies have exclusion criteria for undocumented immigrants that impacts their access to healthcare (Edward, 2014).

  4. Undocumented Immigration: Intro cont. • According to Stutz & Baig (2014), about “91% of children under 6 born to undocumented immigrants are US citizens by birth. The multigenerational nature of Latino families suggests that noncitizen parents are likely to remain in the US indefinitely with their citizen children. The increasing numbers of undocumented immigrants along with this population’s growing medical needs necessitates further examination into how to best provide medical care to this group” (p.765).

  5. Undocumented Immigrants and Health Care • All research on the subject indicates that there is a complex relationship with immigration, documentation status, level of health and access to health care (Messias, McEwen, & Clark, 2015). • There are many areas in which immigrants face vulnerabilities that can cause them to be at higher risk for health issues (Quesada, 2012). These areas include: “precarious living conditions, exploitative work conditions, low incomes, lack of health insurance, lack of transportation and restrictions on mobility, lack of proper housing, hunger, homelessness, language barriers, social stigmatization, restrictive and punitive immigration policies” (Quesada, 2012, p. 895). • Undocumented immigrants are faced with “multiple social, linguistic, economic, and structural barriers and challenges that impact their ability and willingness to access health care services. These include the availability of social and economic resources, English language proficiency, geographic location, restricted mobility, experiences of marginalization and stigma, and fear and mistrust of the health care system” (Messias, McEwen, & Clark, 2015, p. 89).

  6. Undocumented Immigrants and Health Care cont. • Much of the research indicates that “undocumented immigrants seek medical care less often than the general population” due to many reasons including, lack of health insurance, cost of healthcare and concerns over immigration status(Berlinger & Raghavan, 2013, p. 14). • Undocumented immigrants “are much less likely than U.S. born citizens to use primary and preventative medical services even after controlling for the effects of race/ethnicity, income, insurance status, and health status” (Sanchez, et al., 2011, p. 686). Therefore, they are much less likely to have primary care providers (Sanchez, et al., 2011). • Additionally, “Underutilization of preventive care has also been associated with poorer health outcomes such as longer stays in hospitals, more acute health crises, and higher mortality rates” (Ruiz-Casares, et al., 2010, p. 330). • This lack of use of preventative care can often lead to very expensive emergency room care (Stutz & Baig, 2014). Stutz & Baig (2014) go on to state that “Immigrants use emergency departments less frequently than American born individuals; however, they present after prolonged periods of time without primary care, leading to decompensated states of manageable chronic diseases” (p. 766).

  7. Current U.S. healthcare policy in Relation to Undocumented Immigrants • The Patient Protection and Affordable Care Act (PPACA) excludes undocumented immigrants from applying for or receiving health insurance or financial assistance for health insurance (Edward, 2014, and Rhodes, et al., 2015). • Sanchez, et al. (2011) states that “With the federal government’s health insurance reform efforts excluding this vulnerable population, state governments, particularly those with sizable immigrant populations, may feel greater pressure to cover them through state health policy efforts” (p. 684). • Emergency Medicaid is often available for undocumented immigrants with qualifying emergent conditions and treatment (Viladrich, 2012). Viladrich (2012) goes on to state that any “States that desired to grant benefits to this population not only would have to secure their own funding, but also pass their own laws to that end” (p. 823).

  8. Organizational Opinions on Undocumented Immigrants and Health Care • The International Council of Nurses (ICN), is a “federation of more than 130 national nursing associations”(McGuire, 2015, p. 2). “To further coordinate and cooperate with both governmental and nongovernmental agencies at both national and international levels, the ICN assists in developing health and social programs for migrants, refugees, and displaced persons that include emergency services; continuing care; and resettlement…” (McGuire, 2015, p. 2) • The American Nurses Association (ANA) issued a policy brief in 2010 addressing access to health care for undocumented immigrants in the U.S.. In the brief they state, “Affordable health services for all immigrants is not just a right, but provides cost-effective, preventive health care for the whole U.S. population” (ANA, 2010, p. 7). Additionally, the “ANA advocates that all immigrants have access to affordable healthcare without burdensome restrictions and the threat of deportation” (ANA, 2010, p. 7). The ANA also urges nurses to advocate for this goal and toward achieving national policies that assist in achieving this goal (ANA, 2010).

  9. Organizational Opinions cont. • The American College of Physicians (ACP), 2011, “called for a national policy on immigration and health care that: • protects taxpayers for subsidizing health care insurance for illegal immigrants, but allows such migrants to purchase coverage • gives U.S.-born children of illegal immigrants the same access to health care as other children • federal government support for organizations providing uncompensated care • acknowledgement of the risk of undocumented migrants avoiding health care for fear of apprehension • understanding of a physician’s ethical requirement to treat sick patients regardless of their legal status • policies that do not foster discrimination based on immigrant status for health care purposes”

  10. International Examples of Healthcare Policies related to Undocumented Immigrants • Europe has 5 different systems for undocumented immigrants for accessing healthcare (Ruiz-Casares, et al., 2010): • Sweden and Austria: “Undocumented migrants are not entitled to benefit from the public health system…may only access emergency care but have to pay for the incurred medical expenses. Notable exceptions are free healthcare to children of rejected asylum seekers in Sweden, and free testing (e.g., HIV) and treatment of some contagious diseases (e.g., TB) in Austria” (Ruiz-Casares, et al., 2010, p. 334). • Germany and Hungary: “Undocumented migrants do not have access to any publicly subsidized healthcare besides emergency care and a limited number of services. In Germany, these include accidents in the workplace, counseling and testing for infectious diseases…and maternity care and healthcare for children and for undocumented women from 6 weeks prior to delivery to 8-12 weeks after delivery only…In Germany…public institutions are obliged by law to denounce undocumented migrants seeking healthcare to the Foreigners’ Office…In Hungary, undocumented migrants may access other medical services on a payment basis” (Ruiz-Casares, et al., 2010, p. 334). • United Kingdom (UK) and Portugal: offer “Wider health coverage but whose highly ambiguous regulations and complicated procedures (e.g., required registration in Portugal) interfere with the enjoyment of these entitlements” (Ruiz-Casares, et al., 2010, p. 334). • UK: undocumented immigrants can see a general practitioner however any secondary care is not covered. Additionally, any undocumented pregnant women and children have to pay for any services that are not considered urgent (Ruiz-Casares, et al., 2010). • Portugal: Undocumented Immigrants who can prove they have resided in Portugal for 90 days or more are allowed to use public healthcare if they pay a fee except for “infectious diseases, maternity care, vaccination and family planning” (Ruiz-Casares, et al., 2010, p. 334). If they have no proof of residency, only emergency care is allowed for a fee. However, undocumented immigrant children have access to the public healthcare and education systems (Ruiz-Casares, et al., 2010).

  11. Internation Examples, cont. • Belgium, France, and the Netherlands: “undocumented migrants are treated in the mainstream health system yet services are processed through a “parallel” administrative and/or payment system” (Ruiz-Casares, et al., 2010, p. 334). • Belgium: Undocumented immigrants can access “urgent” healthcare services free of charge. Additionally, in some circumstances undocumented immigrants can get health insurance (Ruiz-Casares, et al., 2010). • France: After living there for 3 months, undocumented immigrants can use the public healthcare if they can prove they meet the minimum income level. If they don’t meet those criteria, then “they may only access free emergency care, treatment for contagious diseases, all types of healthcare for children, maternity care and abortion for medical reasons” (Ruiz-Casares, et al., 2010, p. 334). • The Netherlands: undocumented immigrants “since 1998…may only receive ‘care that is medically necessary’ (including maternity care and preventive care and vaccinations for children) or may ‘jeopardize public health.” (Ruiz-Casares, et al., 2010, p. 334). • Spain and Italy: offer “free access to healthcare to all, including undocumented migrants” (Ruiz-Casares, et al., 2010, p. 334). • Spain: “Undocumented minors and pregnant women can access the Spanish national health system free of charge under the same conditions as nationals. Since 2002, other undocumented migrants may access free health services upon registering in the local civil registry of their usual residence and obtaining a health card” (Ruiz-Casares, 2010, p. 334). • Italy: “Undocumented migrants may access certain free services such as emergency care, maternity care, and any care for children younger than 6 years. ‘Specialized care’ and outpatient treatment of contagious and chronic diseases are in most cases subject to a fee” (Ruiz-Casares, et al., 2010, p. 334).

  12. In Summary • The issue of undocumented immigration “has become a dauntingly complex challenge for community, state, federal, and global governing bodies” with the majority of this population seen in the western countries(Stutz & Baig, 2014, p. 765). • Sanchez, et al. (2011) state, “The undocumented population is of critical importance in the context of health care reform, given their low rates of health coverage, their low use of preventative health care services, and their health status” (p. 685). They go on to state that “Given that undocumented immigrants face specific health risks, lack of health insurance coverage, and receive minimal access to preventative care, it is clear that this population is among our society’s most vulnerable groups and would benefit from insurance coverage” (Sanchez, et al., 2011, p. 687). • Increasing the access to preventative health care services for this population will decrease the emergency care that they require, which will ultimately cost the taxpayers less money in the long run as most of the emergency visits are paid by emergency medicaid as the patient is unable to pay for it themselves (DuBard and Massing, 2007). • In the U.S. we continue to see the numbers of undocumented immigrants rise. This makes it crucial that the issue of access to health care and health care coverage is addressed to improve the ultimate health of this population. Additionally, if undocumented immigrants have access to preventative health care, the overall health of the communities will improve with access to vaccinations and other non-emergent health services (Edward, 2014).

  13. References • American College of Physicians (ACP) (2011). Illegal Immigrants should have Health Care Coverage. Retrieved from http://www.10news.com/news/group-illegal-immigrants-should-have-health-care-access • American Nurses Association (ANA) (2010). Nursing Beyond Borders: access to health care for documented and undocumented immigrants living in the US. Retrieved from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/Issue-Briefs/Access-to-care-for-immigrants.pdf. • Berlinger, N., & Raghaven, R. (2013). The ethics of advocacy for undocumented patients. Hastings Center Report, 43(1). doi: 10.1002/hast.126 • DuBard, C.A. and Massing, M.W. (2007). Trends in emergency medicaid expenditures for recent and undocumented immigrants. JAMA: Journal Of The American Medical Association, 297(110), 1085-1092. • Edward, J. (2014). Undocumented immigrants and access to health care: making a case for policy reform. Policy, Politics, & Nursing Practice, 15(1/2), 5-14. doi: 10.1177/1527154414532694 • Hilfinger, D.K., McEwen, M.M., & Clark, L. (2015). The impact and implications of undocumented immigration on individual and collective health in the United States. Nursing Outlook, 63(1), 86-94. doi: 10.1016/j.outlook.2014.11.004 • Hilfinger Messias, D.K., McEwen, M.M., & Boyle, J.S. (2015). Undocumented migration in the United States: and overview of historical and current policy contexts. Nursing Outlook, 63(1), 60-67. doi: 10.1016/j.outlook.2014.10.006 • McGuire, S. (2015). Ethical considerations for undocumented immigrants and health. Nursing Outlook, 63(1), 1-5. doi: 10.1016/j.outlook.2014.08.012 • Quesada, J. (2012). Special Issue Part II: illegalization and embodied vulnerability in health. Social Science & Medicine, 74(6), 894-896. doi: 10.1016/j.socscimed.2011.10.043

  14. References cont. • Rhodes, S.D., Mann, L., Siman, F.M., Eunyoung, S., Alonzo, J., Downs, M. &…Hall, M.A. (2015). The impact of local immigration enforcement policies on the health of immigrant Hispanics/Latinos in the United States. American Journal of Public Health, 105(2), 329-337. doi: 10.2105/AJPH.2014.302218 • Ruiz-Casares, M., Rousseau, C., Derluyn, I., Watters, C., & Crepeau, F. (2010). Right and access to healthcare for undocumented children: addressing the gap between international conventions and disparate implementations in North America and Europe. Social Science & Medicine, 70(2), 329-336. doi: 10.1016/j.socscimed.2009.10.013 • Sanchez, G.R., Sancez-Youngman, S., Murphy, A.R., Goodin, A.S., Santos, R., & Burciaga Valdez, R. (2011). Explaining public support (or lack thereof) for extending health coverage to undocumented immigrants. Journal Of Health Care For the Poort & Underserved, 22(2), 683-699. doi: 10.1353/hpu.2011.0043 • Stutz, M. & Baig, A. (2014). International examples of undocumented immigration and the affordable care act. Journal of Immigrant and Minority Health, 16(4), 765-768. doi: 10.1007/s10903-013-9790-z • Viladrich, A. (2012). Beyond welfare reform: reframing undocumented immigrants’ entitelment to health care in the United States, a critical review. Social Science & Medicine, 74(6), 822-829. doi: 10.1016/j.socscimed.2011.05.050

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