The Pursuit of Health: Barriers to Healthcare Access for Refugees in the United States

Abstract

Background One person becomes forcibly displaced every two seconds. In 2017, there were 25.4 million refugees. To address this growing refugee crisis, international conventions have outlined the definition of what a refugee is and the protections that apply to them. The United States has a history of responding to the refugee crisis, with the 1980 Refugee Act establishing a standardized procedure for the admission of refugees into the country. With the current Trump administration adopting a more United States-centric approach to policy making, the administration has been less welcoming to refugees than recent past administrations. Refugees do receive assistance when they resettle in the United States, which includes support in procuring healthcare. However, they face numerous difficulties when accessing this healthcare. Objectives This thesis attempts to answer the question: what are barriers to healthcare access for refugees in the United States? This thesis focuses on refugees within the United States and, in particular, the health of these refugees. This thesis also aims to provide insight on this question to advise policymakers on what policies would best serve the health needs of refugees. Methods To answer this research question, this thesis utilized quantitative and qualitative approaches. This thesis used the 2016 Annual Survey of Refugees (ASR) to perform logistic regressions after selecting specific barriers to healthcare access from the survey questions. Additionally, I conducted an interview with the staff of a refugee resettlement agency in New Jersey. This interview complemented topics covered in the 2016 ASR and provided specific anecdotes of refugees accessing the healthcare system. Results In the logistic regression model, this thesis analyzed six variables: region of origin, area of resettlement, English-speaking proficiency, Legal Permanent Resident (LPR) status, employment, and annual income. There was not much variance in how region of origin affected healthcare coverage. However, there was more variance in the effect of where refugees resettled. Additionally, being proficient in English, having an adjusted LPR status, being employed, and having a higher income generally increased the likelihood that refugees would have healthcare. The interview corroborated many of the results from the logistic regression. The interview also highlighted the effects of cultural differences, perceived discrimination, and problems in navigating the healthcare system. Conclusion Refugees face significant barriers when accessing the healthcare system. Additionally, structural barriers exacerbate the effects of these barriers. Cultural differences were especially difficult for refugees to overcome. From these findings, policymakers should make efforts to ensure refugees can attain English-speaking proficiency and that policies at the system, provider, and individual level reduce gaps created by cultural differences.