Today I am traveling for my latest meeting for my health policy fellowship. Our meeting this time is regarding vulnerable populations. Mainly the immigrant population. Regardless on how you feel about the immigration debate, there is an impact on the health care system with the introduction of immigrants.
25% of the population under 18 are the children of hispanic immigrants. In fact, if it weren’t for their immigration, the United States population would not be increasing, it would actually be decreasing which has some frightening consequences economically. And while their parents on average are actually healthier than the typical US citizen, after 10 years in this country, the children of immigrants especially the ones borne here have the same bad habits (in many cases worse) than those born to American citizens. Add to that a language barrier and the difficulty for care increases.
However, much you hear the screaming about illegals filling up the emergency rooms and utilizing services that they didn’t pay for, they actually use the emergency room less as adults and about the same for their children under 6. Many of the families have only one parent employed in a low wage, high risk job, that has little to no benefits, so the family stays in a low socio-economic status. And contrary to popular belief most are not immediately eligible for Medicaid. There are a few exceptions. One in the case of an emergency. Another is pregnancy. Why pregnancy? Because paying for prenatal care is a lot less expensive than paying for a baby who is borne with birth defects and other issues that are the result of lack of prenatal care. Either way, the taxpayers are paying for it currently, why don’t at least do it a less expensive way.
The problem with denying care on the basis of immigration status is that then they will wait until the problem is worse and is no longer simply. It is the same theory for those that are cash pay and try to pay their bills, but cannot afford medical care. They wait until they cannot wait any longer and then when they do seek care through the emergency room, they are sicker and harder to treat.
What is the answer? I am not entirely sure. As a physician, I don’t ask immigration status. Being in private practice, I ask for method of payment whether insurance, medicare, medicaid or cash. Most children of immigrants tend to be relatively well behaved compared to some that are running through the rooms screaming. So their appearance in my clinic is not alarming. However, I often have concerns about understanding. Often an older sibling comes into translate and my electronic medical record has spanish translated information sheets. I only know a smattering of spanish. Enough to ask about pain and fever. Enough to get a child to open their mouths. I have tried to learn more, but my time to do so is limited.
However, the language barrier causes enough issue, what is really going on with the patient. I remember as a student, we had a vietnamese women having pelvic pain who didn’t speak english. Her son was the only available translator. For cultural reasons, the patient was not willing to discuss issues like menstrual cycle, child birth or other female issues through her son (though I don’t know many American women who would either). So the information available was very limited, only that she was having pain. I don’t remember entirely what happened with that woman, being a student, I rotated every month, but I remember feeling frustrated about the lack of communication, and ability to find out what was going on with her. The use of children as interpreters is not always the best situation, and there is not always another choice.
As a physician it is my job to treat and to be compassionate. To figure out ways to best treat my patients. It is not always necessary to order the most expensive test, or necessarily to do anything, sometimes just listening or trying to speak their language is a start.
I don’t know what the answer to the immigration debate is. I cannot fault a man who wants a better life for his family. I cannot fault someone who works hard to provide a better life for his children, there are too many in this country who are happy enough to life off of the system. If you knew how many requests for disability exams we get a week for both kids and adults in my office, you would find it hard to condemn someone who decided they were living in the wrong country. I am not saying blanket immunity is the answer, only that maybe we need to fix the immigration system so that those that want to work have an easier entry into the country, and easier access to health care