Refugee Health Care
As of 2019, there were over 3 million refugees and asylum seekers that have been resettled in the United States (click here to see how resettlement is distributed throughout the United States). While successful resettlement is a step forward in the lives of those who have been forced from their countries of origin, it does not necessarily signify the end of a refugee’s struggles. Difficulties navigating new cultural, financial, and employment landscapes, language barriers, and limited access to consistent transportation are all factors that impact a refugee’s life in the place they have been resettled in. These same factors can also have harsh implications for a refugee’s access to quality health care.
Health Care Resources and Overview
The Refugee Act of 1980 formed the basis for the United States’ policies and procedures when determining not only who is eligible to receive asylum-seeker or refugee status, but also what services and protections should be provided to those who are accepted into the country. Among the services and protections outlined are a guaranteed 8 months of full medical coverage, which is designed to treat health problems that refugees are dealing with at the time of their arrival, allow them to receive requisite vaccinations, and help establish health care pathways in their location of resettlement. After the full coverage of those 8 months post-resettlement, refugees are then typically funneled into the standard American health care and insurance system. Any additional federal assistance in establishing care and paying medical bills typically comes from programs such as Medicaid or the Children’s Health Insurance Program (CHIP).
In addition, each individual state has its own policies and programs to support immigrant and refugee health care, and charities may also offer funds or partner with willing practices to provide services to those who cannot otherwise access them.
Barriers to Health Care
Even with the government and private assistance available to refugees, maintaining one’s health can prove to be extremely difficult. Often, living in close quarters, having limited access to quality food and other resources, and coming from turbulent environments can put refugees at heightened risk of experiencing acute health problems. Many refugees also arrive at their resettlement destination with disabilities and chronic illnesses that need management, or they have specific health-related conditions that directly relate to the environment and culture of their country of origin (eg, if a woman is from a place that practices female circumcision, this may affect several aspects of her reproductive and general health). The level of care that such conditions may require is not always achievable. This is due to a number of barriers that stand between refugees and adequate health care, including:
Lack of Coverage
- After the 8 months of government-paid medical care, refugees may apply for Medicaid or CHIP, but these programs have requirements that an individual might not meet, and not all practices accept these or other financial supports, creating a cost for care that is unrealistic for a person to meet.
Lack of Transportation
Even in instances where a refugee might be able to cover their medical costs with insurance or out of pocket, the ability to find reliable transportation can rely heavily on public transport or the availability of family/community members to take them to their appointments. This is especially true if the patient needs to see a specialist that they need to traverse a great distance to be treated by.
Language
English is not always a first language or a language that a refugee is fluent in upon their arrival in the United States. Being able to communicate what ails them or being able to understand a medical professional who is telling them what is going on/what they should be doing is a key part of the health care process. Therefore, if the nearest care centers do not have adequate translation capabilities, or if the patient does not believe they will, they are unlikely to seek care.
Lack of Faith in the Provider
There are several cultural and personal factors that can negate a refugee’s trust in a provider and prevent them from seeking care. Mistrust in a provider does not always mean that a person does not believe that the treatment or skill level of the provider will be enough to take care of the problem the patient is having (though it sometimes does). It can also mean that the patient does not trust that they will not be discriminated against or that they will not be detained/deported because of their status as a foreigner, regardless of whether or not they are documented.
Creating More Accessible Health Care
In order to overcome the aforementioned barriers to health care for refugees in the United States, significant changes will need to be enacted. Changes on a federal level might include extending the period during which a refugee is eligible for public health insurance or providing less crowded housing during the resettlement process. Health care systems can help reduce barriers by keeping translation staff on hand, accepting Medicaid, CHIP, or charity payments, as well as training staff on cultural sensitivity and building trust with their patients.
Additional Learning
Interested in refugee issues? The UNHCR provides a gambit of information on the topics of refugee rights, resettlement, health care and more. Check out their page here.
This blog was written by STM Learning’s editorial staff for educational purposes only. It is not intended to give specific medical or legal advice. For expert information on the discussed subjects, please refer to STM Learning’s publications.
