Confronting Common Perceptions About Immigrants’ Health Care

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A new study by UC Irvine Professor Leo Chavez shows that contrary to commonly held assumptions about immigrants draining health care resources, Latinos in Orange County are less likely to seek medical care than white residents, with undocumented residents using even fewer services due to lack of insurance.

And when they do seek medical care, undocumented residents are more likely to use public clinics, outpatient hospital services and private doctors than emergency rooms, according to Chavez’s findings, which were published recently in the journal Social Science & Medicine.

Chavez, an anthropologist, took time recently to discuss his findings, our perceptions and the challenges facing Orange County in the post-health care reform era.

Q: Could you summarize some of your more surprising findings?

A: I was interested in the question of what kind of medical services undocumented immigrants use. Primarily, public opinion is that they tend to overuse medical services. The first thing I found is that contrary to public opinion, many undocumented immigrants were much less likely than everyone else to seek medical services. Even if they did get sick or have an injury, they tried to deal with it at home.

Q: Because of lack of insurance?

A: There’s a direct correlation between those who sought medical services and whether they had insurance. In our system, the door to health care is opened by a third party payment guarantee.

Q: What else did you learn?

The second issue is: Are undocumented immigrants overwhelmingly going to emergency rooms as primary care, since they don’t have great access to other care? Are they going to an emergency room when they have a cold or need a bandage put on their finger? That’s another surprising finding. Basically, undocumented immigrants will use ERs, but that’s the least they’ll use. They use various types of health clinics and private doctors.

Q: Why a private doctor?

A: Private doctors don’t ask you for information about yourself if you just bring in a wad of cash. “How much is it, ninety bucks? Bandage my arm.” That avoids a lot of the surveillance at a hospital. Also, if you go to a hospital with something that’s not an emergency, you’re not necessarily going to get care.

Q: Can you explain that?

A: What is defined as an emergency can be broad if you are flush with money. Or say you’re a county hospital and take care of indigents — [something] we don’t have here in Orange County. So the more economically stressed you are as a hospital, the more narrowly you define what it means to be an emergency. At some point, it can be defined as a life-or-death situation. If you’re not at a point where we’re worrying about you surviving, come back when it is. And they are going to ask you for insurance or a way to pay for services once they stabilize you.

Q: Can you give examples of the kinds of problems people try to self-treat?

A: In past studies we’ve come across a lot of stories. … I’ve interviewed people who were injured on the job. They have a broken wrist, and instead of going to get medical assistance they keep working until the pain is too strong, go back to Mexico and get it set. Virus and bacterial infections are dealt with by over-the-counter medicine. Home medicines are huge. There are teas for colds and different illnesses. In my research, I met a woman with a huge lump in her breast and no insurance. …

People in my study would say, we have to make a decision. We have X resources, no insurance. We need food for the kids, backpacks, even if we are sick as a dog. … Health care is one of a string of priorities. Your own personal health is often not as important as food or rent.

As a result, problems that could be taken care of relatively easily become festering problems. Pap exams, breast exams, prostate exams, all the preventive health care measures — people don’t get them, and you wind up dealing with more severe problems. Even a chest cold can go to a secondary infection, and you wind up with pneumonia.

Q: Where do undocumented immigrants get their health insurance when they have it?

A: Our research showed that about 25 percent of undocumented immigrants get some private insurance through their employer, but it is often very limited. … Most immigration laws state that the undocumented don’t have access to public insurance programs for the low income. The exception is pregnant women; they can get some pre- and post-natal care.

Q: Some experts say that Latinos use fewer health services because of the “Latino health paradox” in addition to lack of insurance. Can you talk about that?

A: You’re not going to cross the desert in 110 degrees Fahrenheit if you’re weak. Immigration is a selective process. It’s for people who are relatively hearty and optimistic. They think they’re going to create a better life. You select the relatively younger people. Older people and the infirm typically stay back home and don’t make the trip. Latinos are a relatively healthy and young population. Because of this, and because immigrants often bring healthy eating habits and behaviors, they tend to reduce the statistics on mortality rates. Mortality in breast cancer rates in Orange County have gone down, for example, perhaps in part because of growth in the Latino population.

Q: Yet diabetes, obesity and other chronic illnesses occur at high rates among low-income immigrants and their families.

A: If you’re Vietnamese or Mexican, you come to the U.S. with certain prophylactic behaviors and beliefs. You don’t eat — because you can’t afford it — a whole lot of fatty, rich food. You eat less meat. Here, pretty soon you can afford the kind of fat level intake we as Americans love. Your kids start dragging you into McDonald’s. Making immigrants into good Americans is really bad for your health. Good, hearty bodies get worn down from diet and work. And then because of a lack of access to medical care, people begin to have worsening health problems, like an increase in low birth-weight babies. Very few Mexican women have babies with low birth weight, but over time that changes.

Q: So the protections of the paradox can wear off in a person’s lifetime?

A: Say you come at 19 years old. You’re young and healthy and eat a good diet. Then 20 years later, you’re smoking, eating McDonald’s hamburgers, a lot of meat and fat in your diet, a more Americanized diet. It doesn’t take long for the body to react. … The body can change relatively quickly. … The Latino health paradox doesn’t last a lifetime.

Q: What happens to breast cancer rates among immigrant women?

A: Latinos and Asians have lower rates of breast cancer, but that changes over time. Women change their diets, and the rates go up. Breast cancer seems to have 20-25 percent attributed to genetics. All the rest is behavior. It tends to be related to being heavier, more fatty food, exposure to estrogen. Women who have more babies and have them younger have lower rates, but as Latinas live in the U.S., they are having fewer babies. Latinas under 44 have less than two babies per woman. All these up the risk factors for cancer.

Q: What policy decisions ahead could affect undocumented immigrant health care?

A: The Obama administration said that undocumented immigrants will be out of the system [an insurance exchange under federal health care reform]. What’s going to happen when they can’t access programs in the new health care reform law? We don’t know what’s going to happen. In two years I’d be looking to see how many have access to government-sponsored medical clinics. There’s a lot of work to do in the post-health care reform period and little data. How is Orange County going to adapt to a system that keeps out this group of people?

— AMY DePAUL

 

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