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The Health Care System and Immigrant Health

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The Center for Immigrant Health NYU School of Medicine ... Haitian Creole (89,085) Language Barriers: Impact on Health Care. Less likely to receive care ... – PowerPoint PPT presentation

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Title: The Health Care System and Immigrant Health


1
The Health Care System and Immigrant Health
Francesca Gany, M.D., M.S.
2
The Center for Immigrant Health NYU School of
Medicine
  • Network of over 1000 community members,
    providers, researchers, policymakers engaging in
    creative strategies
  • Mission To facilitate the delivery of
    linguistically, culturally, and epidemiologically
    sensitive healthcare services to newcomer
    populations. To eliminate ethnic and racial
    disparities in health care.

3
The Center for Immigrant Health NYU School of
Medicine
  • We realize our mission through
  • Research
  • Outreach And Education
  • Information Dissemination
  • Program Development
  • Advocacy

4
PARTNERS
5
Why Immigrant Health?
  • Health Status Deteriorates with Increasing Length
    of Stay
  • Specific Health Care Barriers
  • The Demographics Demand an Immigrant-specific
    Focus

6
Who is an Immigrant?
  • An immigrant is a person who is not born in the
    U.S. and who enters the country with the intent
    to remain for an indefinite period of time
  • Naturalized Citizen
  • Legal Permanent Resident (Green Card)
  • Refugee/Asylee
  • PRUCOL
  • Undocumented Person (most often overstay the
    authorized period of visit)

7
U.S. Immigrants
  • Over 1 million arrive in the U.S. each year
  • Over 28 million Americans were born abroad
  • 11 of the U.S. population is foreign-born
  • 47 born in Latin America
  • 26 born in Asia
  • 16 born in Europe

Source U.S. Census Bureau, Population Profile of
the United States 2000 (Internet Release).
8
From Where Do Recent Immigrants Come?
  • In 2001, five nations of the world constituted
    40 of countries of origin for legal immigration
    to the U.S.
  • Mexico (206,426)
  • India (70,290)
  • China (56,426)
  • Philippines (53,154)
  • Vietnam (35,531)

Source Annual Report Legal Immigration, Fiscal
Year 2001. U.S. Dept. of Justice Immigration and
Naturalization Services.
9
New York City Immigrants
  • Over 100,000 documented immigrants arrive each
    year
  • NYCs immigrant population grew from 2.1 million
    (1990) to 2.9 million (2000) 38 increase
  • 36 of the NYC population (8 million) is foreign
    born

Source U.S. Census Bureau. Population and
Housing Profile  New York City, New York. 2002
American Community Survey Profile.
10
From Where Do NYC-based Recent Immigrants Come?
  • Immigrants in NYC represent a slightly different
    mix of nationalities
  • Dominican Republic
  • China
  • Jamaica
  • Guyana
  • Mexico

Source Annual Report Legal Immigration, Fiscal
Year 2001. U.S. Dept. of Justice Immigration and
Naturalization Services.
11
How Has This Changed?
  • The has changed from 10 years ago, when the top
    countries of origin were
  • Dominican Republic
  • China
  • Jamaica
  • Italy
  • Soviet Union

Source Annual Report Legal Immigration, Fiscal
Year 2001. U.S. Dept. of Justice Immigration and
Naturalization Services.
12
The New York City Picture A Look At the Boroughs
  • Queens more than 1,000,000 (707,153)
  • Brooklyn 931,800 (672,569)
  • Manhattan 452,400 (383,866)
  • Bronx 385,800 (274,793)
  • Staten Island 72,700 (44,550)
  • ( ) population in 1990

13
The Health Care System and Health Disparities
  • Data Gaps
  • Structure of care
  • Financing/legal
  • Accommodation of cultural and linguistic
    diversity
  • Racism

14
Data Gaps
  • Large Datasets Data not collected by meaningful
    categories
  • Lack of disaggregated data, e.g. category Asian
    American

15
Data Suggested Categories
  • Country-of-Origin New in the Census
  • Number of Years in the United States
  • Dominant Language
  • English Ability
  • Parents Ethnicity
  • Acculturation Index

16
Flow of Care/Structure of Care
17
Flow of Care/Structure of Care
  • Haphazard, Varies by Locality
  • Multiple potential sources of care, no roadmap,
    no orientation
  • Out-patient community-based provider, faculty
    practices, managed care groups or staff model
    facilities, neighborhood family health center,
    municipal and voluntary hospital clinic systems,
    ER
  • In-patient voluntary system, for-profit,
    municipal
  • Pharmacy system not centralized and costly

18
Health Screening
  • Not mandatory for adults except for documented
    immigrants, refugee assessments done abroad
  • No mandatory follow-up once the immigrant arrives
    here
  • Children have requirements for school

19
Facilities Often Not Receptive
  • Hours of Operation
  • Location
  • Staff Attitudes
  • Multiple Points to Navigate
  • The Language Barrier Spoken and Written
  • Racism

20
Windows of Opportunity
21
Financial/Legal
22
Immigrant Eligibility for Government Health Care
Benefits
  • Medicaid and Child Health Plus (A)
  • Family Health Plus
  • Child Health Plus (B)
  • Prenatal Care Assistance Program (PCAP)
  • Emergency Medicaid
  • Public Hospitals and Community Based Clinics
  • Medicare
  • Additional Safety Net Services/Block Grants

23
Public Charge Issue and Clarification
  • Immigration law term
  • People who must depend on public benefits
    for income
  • Can affect immigrants entry, status, adjustment,
    and may even lead to deportation.
  • Justice Department Clarification 1999
  • Medicaid (except long-term care) and CHIP not
    subject to possible repayment
  • Utilization will not lead to public charge
    determination

24
Immigration Concerns and Priorities
  • Confidentiality
  • Deportation
  • Adjustment of Status
  • Family Member Sponsorship

25
Sponsorship
  • Sponsor Deeming
  • Deem sponsors resources accessible to the
    immigrant applying for Medicaid
  • Sponsor Liability
  • State can require sponsor to repay the
    money spent when the immigrant used Medicaid
  • To date, New York has not put either into
    practice.

26
Language Access
27
United States Census
  • 1990 Census
  • 31 million spoke a language other than English
  • 14 million considered limited English proficient
  • 2000 Census
  • 47 million speak a language other than English
  • 21 million considered limited English proficient

28
LEP Change by State

Source The Access Project National Health Law
Program
29
Languages Spoken in NYC
  • 24 total NYC population cannot speak English
    very well
  • 12 total NYC population speaks English not
    well or not at all
  • Top 6 languages spoken at home (NYC overall)
  • Spanish (1,832,402)
  • Chinese (323,517)
  • Russian (194,696)
  • Italian (139,698)
  • French (105,994)
  • Haitian Creole (89,085)

30
Language Barriers Impact on Health Care
  • Less likely to receive care
  • Less likely to understand care
  • Increased risk of medical errors
  • Reduced quality of care
  • Increased risk of unethical care
  • Less satisfied with care

31
Legislative and Compliance Issues
  • Title VI of the Office of Civil Rights Act of
    1964
  • Hill Burton Act
  • Health Care Financing and Administration
  • Joint Committee on Accreditation and Health Care
    Organizations
  • Executive Order No. 13166 (Improving Access to
    Services for Persons with Limited English
    Proficiency)
  • New Statute in California

32
Who Usually Interprets?
33
Training of Interpreters is Key
34
False Fluency
  • .or limited Spanish proficient

35
Potential Systemic Solution
  • RSMI

36
Solutions
  • Universal Access
  • Community-based Partnerships with Government,
    Academia, and Provider Systems
  • Joining Forces to Develop and Disseminate
    Creative Solutions

37
For More Information
  • www.med.nyu.edu/cih
  • Ph (212) 263-8783
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