Survey Identifies Health Care Use and Needs of Undocumented Hispanic Immigrants
From 1996 to 1999, researchers from the People-To-People Health Foundation (commonly known as the Project HOPE Center for Health Affairs) conducted a survey on:
- The level of health care services currently being used by undocumented Latino immigrants in El Paso and Houston, Texas.
- The barriers to care they face.
- The likely effects of denying services to this population.
The study consisted of in-depth interviews of households having undocumented immigrants.
- The population of undocumented Latino immigrants was relatively young in Houston, 59 percent were between the ages of 18 and 34 and in El Paso 39 percent were in this age group.
- Ninety-nine percent of the undocumented Latinos in El Paso, and 86 percent of those in Houston, emigrated from Mexico.
- No respondent at either site reported coming to the United States for health or social services.
- Family incomes of undocumented Latinos in both cities were quite low, with almost half reporting annual family incomes of $5,000 or less, and more than 90 percent reporting incomes under $20,000.
- Use of ambulatory care services was very low compared to that of the overall US population.
- The rates of hospitalization of undocumented Latinos were similar to overall Latino and US populations; hospitalizations for childbirth, however, were higher among undocumented Latinos.
- Excluding the undocumented Latinos from receiving government-funded health care services is unlikely to reduce the level of immigration and may affect the well-being of citizen children living in immigrant households.
The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $451,207.
In 1994, California voters approved a state referendum that would deny undocumented immigrants access to publicly funded health care. Although its implementation was suspended by the courts, its passage reflected a growing public debate in many states about the provision of health and other services to undocumented residents. Yet, despite the heightened level of public interest in the costs of illegal immigration, there was little evidence about the use of medical care by undocumented populations. This grant from RWJF funded a study to provide empirical evidence about the level of health care services used by undocumented Latino immigrants living in Texas, the barriers to care they face, and the likely effects of denying health care services to this population. This study was designed in conjunction with a companion study of Fresno and Los Angeles counties in California funded by the Henry J. Kaiser Family Foundation.
This study, which was conducted by the People-To-People Foundation (commonly known as The Project HOPE Center for Health Affairs), involved the collection of primary data through a household survey in Houston and El Paso, Texas, with interviews conducted by a Texas-based, Latino-owned firm. Respondents were administered a questionnaire asking about their health status, use of health care services, reasons for immigrating to the United States, and beliefs about the health care delivery system. A total of 440 interviews were completed, with 232 and 208 interviews conducted in Houston and El Paso, respectively. The response rate was 83 percent in El Paso and 55 percent in Houston, for an overall response rate of 68 percent. (The researchers speculate that the large difference in response rate between the two cities may be because there is more fear of participating in a survey in Houston, which has a smaller concentration of undocumented immigrants.)
The findings presented here from the researchers' article published in the July/August 2000 issue of Health Affairs.
- The population of undocumented Latino immigrants was relatively young. In Houston, approximately 59 percent of the population were between the ages of 18 and 34, with 1 percent over the age of 65. In El Paso, 39 percent were in the 18 to 34 age group and 3 percent were over 65.
- 99 percent of the undocumented Latinos in El Paso, and 86 percent of those in Houston, immigrated from Mexico.
- No respondent at either site reported coming to the United States for health or social services. Finding work was reported as the most important reason for entering the United States for undocumented immigrants in Houston, with 57 percent citing work as the main reason for coming. In El Paso, 27 percent reported that work was the main reason for immigrating, while 49 percent indicated that they immigrated to be united with family and friends.
- Family incomes of undocumented Latinos were quite low; in both cities almost half reported annual family incomes of $5,000 or less, and more than 90 percent reported incomes under $20,000.
- Use of ambulatory care services was very low compared to the overall US population. Slightly more than one-third of persons surveyed had one physician visit or more during the year prior to the interview compared to about three-quarters of the overall US population. (If a physician was seen in an emergency room, that was considered an ambulatory visit.)
- The rates of hospitalization of undocumented Latinos were similar to overall Latino and US populations. Hospitalizations for childbirth, however, were higher among undocumented Latinos. Undocumented Latinos have an overall rate of childbirth-related hospitalization of 4.4 percent compared to 2.6 percent of the overall Latino population and 1.7 percent of the total US population.
The researchers concluded from these findings that excluding undocumented Latinos from receiving government-funded health care services is unlikely to reduce the level of immigration and may affect the well-being of children who were born here and are US citizens living with their immigrant parents.
The researchers believe this study represents the first multi-site study of this population using in-person interviews in which the persons interviewed are representative of the whole population of undocumented Latinos and therefore the findings are generalizable to the whole population. The grantee's companion study of Fresno and Los Angeles counties in California produced similar findings to the Texas study.
The principal investigators made presentations at two conferences about the methodologies of this study. The first presentation, describing the field operations and complexities involved in interviewing undocumented immigrants, was made at the Annual Conference of the American Association for Public Opinion Research in St. Louis, Missouri in May 1998. The second presentation, which examined the extent of telephone coverage bias that might have existed if telephone interviews were conducted in place of in-person interviews, was made at the Annual Meeting of the American Statistical Association in Dallas, Texas, in August 1998. The investigators' article, "Health Care Use and Undocumented Latino Immigrants in California and Texas," is being published in the July/August 2000 issue of Health Affairs. Another article on the relationship between fear about immigration status and inability to obtain care is under review.
AFTER THE GRANT
Project HOPE will continue analyzing this data using internal resources.
GRANT DETAILS & CONTACT INFORMATION
Survey of Undocumented Hispanic Immigrants' Access to Health Care Services
People-To-People Health Foundation, Inc. (Millwood, VA)
Dates: February 1996 to May 1999
Claudia L. Schur, Ph.D.
Marc L. Berk, Ph.D.
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Berk M, Schur C, Chavez L and Frankel M. "Health Care Use and Undocumented Latino Immigrants." Health Affairs, 19(4): 5164, 2000. Abstract available online.
Berk ML and Schur CL. "The Effect of Fear on Access to Care among Undocumented Latino Immigrants." Journal of Immigrant Health, 3(3): 151156, 2001. Abstract available online.
Presentations and Testimony
Cynthia Good, Rosario Jacinto, and Marc Berk, "Surveying Rare Populations with Probability Sampling: The Case of Interviewing Undocumented Immigrants," presented at the American Association for Public Opinion Research Annual Conference, May 1998, St. Louis, MO.
Marc Berk, Cynthia Good, and Martin Frankel, "Phone Coverage Among Undocumented Immigrants: The Project HOPE Hispanic Immigrant Survey," presented at the Annual Meeting of the American Statistical Association, August 1998, Dallas.
Report prepared by: Bill Berlin
Reviewed by: David Kales
Reviewed by: Molly McKaughan
Program Officer: Elize Brown