Table 1.
Different Classifications of Barriers to Care for Immigrant Populations, as identified by Hacker et al. (2015) and Derr (2016).
| Hacker et al. (2015)1 Barriers to Overall Health Care Access Among Undocumented Immigrants in Several Countries N = 66 | # (%) of Articles1 | Derr (2016)2 Barriers to Mental Health Care Access Among Documented & Undocumented Immigrants in the U.S. N = 23 | # (%) of Articles2 | ||||
|---|---|---|---|---|---|---|---|
| Level1 | Barrier | Description | Level2 | Barrier | Description | ||
| Policy Level | Laws | Legal barriers, such as laws precluding insurance eligibility | 50 (76) | Structural Level | Laws | No insurance | 4 (17) |
| Documentation Requirements |
Requiring documentation to access health care services; challenges for undocumented parents seeking to access care for their authorized children | 18 (27) | Documentation Requirements |
Anxiety among undocumented immigrants that documentation would be required to access health services | 1 (4) | ||
| System Level | Resource Limitations |
Employment conflicts, lack of transportation, and limited health care capacity (nonexistent or limited translation services; provider cultural competency; clinical funding cuts) | 24 (36) | Resource Limitations |
Apprehension of being absent from work, lack of transportation and/or inaccessibility, and limited health care capacity (such as lack of provider cultural competency and gender of provider). | 7 (30) | |
| Discrimination | Documentation status/nativity | 22 (33) | Discrimination | Structural Discrimination | 1 (4) | ||
| Complexity of Medical System/ Bureaucracy |
Bureaucratic requirements for immigrants and for providers that prevent access of/delivery of care | 17 (26) | Complexity of Medical System/ Bureaucracy |
Long wait required | 3 (13) | ||
| Individual Level | Enforcement/Deportation | Fear of authorities being contacted/fear of deportation | 43 (65) | Enforcement/ Deportation |
Fear of deportation among undocumented immigrants | 4 (17) | |
| Communication | Challenges of communication with providers, including language and cultural differences; concern about being understood | 24 (36) | Communication | Language barriers | 9 (39) | ||
| Financial Resources |
Concerns about ability to pay for services | 30 (45) | Financial Resources |
High price of services | 8 (35) | ||
| Not Familiar with Medical System |
Not having knowledge about how the health care system functions or how to navigate it; lack of awareness about services available/rights to health care | 22 (33) | Not Familiar with Medical System |
Lack of familiarity/understanding about available resources | 8 (35) | ||
| Shame/ Stigma | Concerns about feeling shame in accessing services and experiencing stigmatization for doing so | 7 (11) | Cultural Level | Shame/Stigma | Sigma related to cultural norms about mental health | 6 (39) | |
Source: Hacker, K., Anies, M, Folb, B.L., and Zallman, L. (2015). Barriers to health care for undocumented immigrants: A literature review. Risk management Healthcare Policy, 8:175–183.
The overall format for this table was also adapted from Table 1 (p. 177) from this source.
Source: Derr, A. S. (2016). Mental health service use among immigrants in the United States: A systematic review. Psychiatric Services, 67(3), 265. The review includes 62 articles in total, but only 23 were included in the discussion of barriers. Other cultural-level barriers that Derr (2016) identified, but are not included in Table 1 include: cultural norms related to mental illness (17%), preference for other types of services (9%), lack of trust in providers (9%), reliance on self or family (9%), and challenges with acculturation (4%); additional structural barriers not included in Table 1 include lack of collaboration between services and churches (4%) competing health demands (4%) and other barriers (4%) (p. 268).