Culturally Competent Care Elusive for 3 in 10 Immigrant Patients

Three in 10 of the immigrant patients who have accessed healthcare in the US have experienced more than one challenge in accessing culturally competent care, with another quarter saying they’ve experienced healthcare discrimination, according to new surveying from KFF and the LA Times.

The survey of more than 3,300 immigrants—naturalized citizens, lawfully present immigrants, and likely undocumented immigrants—provided a glimpse into the overall immigrant healthcare experience. While many immigrant respondents reported overall good health (79 percent said they were in good or excellent health), they noted serious lapses in the healthcare industry in serving a traditionally underserved population.

Notably, 29 percent of immigrants said it’s hard to obtain respectful and culturally competent care. Around a fifth (17 percent) said their provider did not take the time to listen to their concerns or ignored the concerns, 15 percent said doctors did not explain things in an understandable manner, and 12 percent said they’d been disrespected by front office staff.

For folks with limited English proficiency (LEP), 17 percent noted that interpreter services were not available or not provided in a timely manner.

Each of these obstacles was more likely among Black, Hispanic, uninsured, and likely undocumented immigrants, the survey showed.

Meanwhile, experiences of discrimination based on several factors were a reality for 25 percent of immigrant patients, regardless of immigration status. For 16 percent, discrimination was due to their insurance status or ability to pay, while 15 percent faced unfair or different treatment due to their accent or ability to speak English, and 13 percent for their race, ethnicity, or skin color.

Experiences of discrimination were around double as likely for Black patients than for White, and the proportion was also high among Hispanic immigrant adults. This was also true for folks who were uninsured, had lower incomes, and had LEP.

Still, immigrant respondents said they were generally in good health, with 15 percent saying they were in excellent health, 32 percent reporting very good health, and 32 percent reporting good health. Larger shares of low-income, Hispanic, and likely undocumented immigrants reported fair or poor health.

This links up with the number who said they’ve accessed healthcare in the past year; 77 percent said they’ve had a provider visit, and that number swells to 84 percent when including folks who tried to obtain an appointment.

The rate of healthcare access was generally even across income, race or ethnicity, and language proficiency. However, rates were markedly lower for people who are likely undocumented immigrants (63 percent accessed care) and insurance status (48 percent of uninsured accessed care).

Community health centers are doing a lot of the work in connecting immigrant patients to care. Nearly eight in 10 immigrant adults said they have a usual source of care that is not the emergency department; 30 percent said that usual source of care is the community health center. CHC access was more common among uninsured, low-income, likely undocumented immigrants, and immigrants with LEP.

Like their native-born counterparts, immigrants do face obstacles to accessing care, not least of which include cost barriers. One in five immigrant adults said they’ve had trouble paying for healthcare in the past year, and 22 percent said they skipped or postponed care. Among the uninsured, a third skipped or postponed care due to cost.

Other care access barriers included inconvenient appointment times or locations, healthcare navigation woes, and not being able to speak with someone in their preferred language or access an interpreter. All said, 40 percent of the immigrant adults who skipped or postponed care said their well-being worsened because of it.

It would benefit the healthcare industry to consider mechanisms to increase health insurance coverage among all adults while also incorporating culturally competent and language-concordant care. But larger national politics might stand in the way of expanding that insurance coverage.

For one thing, many immigrant adults do not know how to access social services like Medicare or Medicaid and even worry that enrollment could affect their immigration status.

The majority of immigrant adults, regardless of immigration status, are unsure about public charge rules, which state that use of public services like Medicare/Medicaid and food and housing assistance could impact immigration status, with 58 percent saying as much.

To be clear, likely undocumented immigrants are usually not entitled to public services; however, many of their children are US-born citizens and may be entitled to these benefits. Still, likely undocumented immigrants, plus those with LEP, are more likely to fear public charge rules.

For this reason, 8 percent of immigrant adults have avoided applying for healthcare, food, and housing assistance for which they are eligible. This is significantly more common among likely undocumented immigrants, 27 percent of whom said they’ve avoided enrollment in public assistance.

“Given lower incomes among immigrant families and difficulties paying for basic needs such as monthly bills, food, housing, and health care assistance programs could reduce financial stress and facilitate access to care for them and their children,” the researchers explained.

“Partly reflecting this fear as well as language barriers and eligibility restrictions, immigrant adults are no more likely than their U.S.-born counterparts to say they or someone living with them received government assistance with food, housing, or health care despite having lower incomes and facing financial challenges.”