Barriers to Health Care Access for Refugees in Cache County, Utah

Open Access

Abstract

The United States has a rich history of resettling refugees. The United States resettled hundreds of thousands of refugees at the conclusion of World War II, and has resettled more than 3 million refugees since 1975 (Refugee Council USA, 2016). A refugee is a forcibly displaced person who will not or cannot return to their country of origin because of fear of physical harm or persecution (United Nations, 1951). Refugees are distinct from other forms of immigrants in many ways: refugees do not choose their country for resettlement, they receive government assistance upon arrival, their residency and work permits are in effect indefinitely, and English-speaking ability does not play a part in the resettlement process. Because of the United States' open refugee resettlement policies, refugees make up an integral part of an ever-diversifying U.S. population, and will continue to do so for many years. Upon resettlement, refugees often lack access to basic social services, in particularly, to health care (Bulman and McCourt, 2002). The United States has generous policies to assist refugees when they arrive, but because of their ability to speak English and discrepancies in the cultural understanding of health care many of the services are underutilized (Finney Lamb & Smith, 2006; Lloyd 2014). Not only are refugees less able to access care, but they are more likely to have preexisting health conditions. For example, a survey of incoming refugees in Denmark found that 64% of newly-arrived refugees had one or more physical illnesses - and they did not even attempt to account for the incidence of mental illness (Kristensen and Mandrup, 2005). Research on refugee access to health care has been conducted predominantly in the United States, the United Kingdom, and Australia. The studies conducted outside of the United States can provide important insight into universal barriers for refugees, but they deal with very different healthcare systems and often investigate different refugee populations. The studies which have been conducted in the United States address a wide array of refugee populations spread throughout very different regions of the United States (Mirza 2014; Wagner and Thiruchandurai 2013). Diversity in research within the United States is vital because of the large number of refugees that the United States accepts each year and because of the widely varying circumstances for refugees in different regions of the country. The ability for refugees to access health care varies widely from rural to urban areas and from state to state depending on policies (Mirza 2014). Larger hospitals in urban areas are more likely to be equipped with more extensive translational services than practices in rural areas tend to employ, and the state legislation concerning refugees varies drastically from state to state which can drastically affect health outcomes. These diverse studies help to assess the impact of the legislation implemented on both the federal and state levels. Numerous federal health programs, such as the Affordable Care Act and Medicaid, have the potential to drastically affect the health experiences for refugees, but as mentioned above, a significant amount of health care policy for refugees is determined on the state level. This study is important, because the majority of the studies which have been conducted in the United States tend to focus on large cities and this is an opportunity to examine the experience of refugees in a more rural area. It is also a unique opportunity to evaluate the impact and unused potential of Utah's progressive refugee legislation.