title: Barriers to health care for undocumented immigrants: a literature review.
abstract: With the unprecedented international migration seen in recent years, policies that limit health care access have become prevalent. Barriers to health care for undocumented immigrants go beyond policy and range from financial limitations, to discrimination and fear of deportation. This paper is aimed at reviewing the literature on barriers to health care for undocumented immigrants and identifying strategies that have or could be used to address these barriers. To address study questions, we conducted a literature review of published articles from the last 10 years in PubMed using three main concepts: immigrants, undocumented, and access to health care. The search yielded 341 articles of which 66 met study criteria. With regard to barriers, we identified barriers in the policy arena focused on issues related to law and policy including limitations to access and type of health care. These varied widely across countries but ultimately impacted the type and amount of health care any undocumented immigrant could receive. Within the health system, barriers included bureaucratic obstacles including paperwork and registration systems. The alternative care available (safety net) was generally limited and overwhelmed. Finally, there was evidence of widespread discriminatory practices within the health care system itself. The individual level focused on the immigrant's fear of deportation, stigma, and lack of capital (both social and financial) to obtain services. Recommendations identified in the papers reviewed included advocating for policy change to increase access to health care for undocumented immigrants, providing novel insurance options, expanding safety net services, training providers to better care for immigrant populations, and educating undocumented immigrants on navigating the system. There are numerous barriers to health care for undocumented immigrants. These vary by country and frequently change. Despite concerns that access to health care attracts immigrants, data demonstrates that people generally do not migrate to obtain health care. Solutions are needed that provide for noncitizens' health care.
authors.affiliation: Allegheny County Health Department, Pittsburgh, PA, USA ; Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Hacker
authors.affiliation: Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Anies
authors.affiliation: Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA ; Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Folb
authors.affiliation: Institute for Community Health, Cambridge, MA, USA ; Cambridge Health Alliance, Cambridge, MA, USA ; Harvard School of Medicine, Boston, MA, USA.
authors.forename: Leah
authors.initials: L
authors.lastname: Zallman
keywords: access; deportation; health care; immigration and migration; undocumented immigrants