Assessment of Perspectives on Health Care System Efforts to Mitigate Perceived Risks Among Immigrants in the United States

Abstract

IMPORTANCE Increases in the enforcement of immigration policies, deportations, and rhetoric critical of immigration during and after the 2016 US presidential election have been associated with a decrease in health-seeking behaviors and an increase in adverse health outcomes among immigrants. Efforts to address the health care needs of immigrants after the 2016 presidential election have centered on individual-level patient-practitioner strategies or federal-and state-level policy changes. However, these approaches have not captured the role of health care systems and the range of health care facilities encompassed within them.OBJECTIVE To characterize policies and actions implemented by health care facilities to address immigration status-related stressors. DESIGN, SETTING, AND PARTICIPANTSThis exploratory qualitative study involved semistructured interviews in a purposive sample of health care facilities across 5 states (California, Texas, New York, Florida, and Illinois) with the largest populations of individuals with undocumented immigration status. Data from media sources and informational interviews with local immigration advocacy leaders were used to identify health care facilities that had implemented welcoming policies and strategies. Stakeholders, including administrators, frontline clinicians involved in policy implementation, and senior executive leaders, were interviewed. Interviews were conducted between May 1 and August 9, 2018, and were recorded, transcribed, and coded using constant comparative analysis. Data analysis was performed from MAIN OUTCOMES AND MEASURES Stakeholder perspectives on the range, scope and content of policies and actions implemented to address immigration-related stressors at health care facilities.RESULTS A total of 38 in-depth interviews were conducted spanning 25 health care facilities in 5 states; these facilities included 13 federally qualified health centers, 7 academic or private hospitals, and 5 public institutions. Interviewees described policies and actions that mitigated one or more of the following perceived risks: (1) risk of exposure to immigration enforcement personnel at or near facilities, (2) risk of immigration status-related information disclosure, (3) risk associated with patient-level stressors, (4) risk associated with practitioner-level stressors, and (5) coordination of risk mitigation. Most personnel at health care facilities emphasized that their policies and actions fit within a larger mission and history of addressing the social needs of diverse patients and mitigating risks for patients. CONCLUSIONS AND RELEVANCEHealth care facilities can implement both active and reactive measures to address perceived immigration-associated risks among patients and practitioners.Population health and immigration policies are at the forefront of current policy debates. An (continued) Abstract (continued) understanding of the ways in which health care facilities can serve to mitigate perceived risks among their patients and employees can be one step toward ...

Changes in Health Care Use Among Undocumented Patients, 2014-2018

“…In addition, more effort should be invested in ways to engender trust in this population, including investments in medicolegal partnerships, avoiding asking about immigration status, and improving telehealth and home visiting capacities. 35 …”

Health Professionals, Human Rights Violations at the US-Mexico Border, and Holocaust Legacy

“…1 Organizational Responses Health care organizations should develop, adopt-and train clinicians and staff in how to enact-policies 34 that protect patients' health rights and human rights concerning nondiscriminatory care access, interactions with state agents, not permitting searches of hospital rooms without a court-ordered warrant, and maintaining confidentiality and HIPAA compliance. Several models exist, 35,36,37,38,39 and they can be adapted to meet local needs.…”

The Case for Research-Informed Immigrant Health Policies Within Health Care Systems

“…Qualitative interviews can serve as a critical first step in the process for many research methodologies, including quality improvement studies, community-based participatory research, 6 and dissemination and implementation science. 7 Overall, the work of Saadi et al 4…”

“…We have also weighed the risk of recommending a needed social program to parents, such as public health insurance, when there is a concern that receiving the benefit could jeopardize the parents' immigration status in light of the new public charge rule. As physicians, we recognize the potential consequences of immigration policies for our patients' health and well-being and the challenges associated with trying to provide the best clinical procedures to handle the presence of immigration enforcement agents on the medical center campus; however, the work of Saadi et al 4 highlights the need for further systematic study, evaluation, and policy development.…”

“…The study by Saadi and colleagues 4 is also important because it exemplifies the ways in which one might begin to incorporate community voices in research. Immigration policies have potential consequences for the overall health of communities in which large numbers of immigrants with undocumented status reside.…”