For Undocumented Immigrants, Barriers to Healthcare Access Impact Health-Seeking Behaviors

U-M researchers are shedding light on the healthcare challenges faced by southeast Michigan’s immigrant population and the policies—from local and state-level to federal—that impact health-seeking behaviors among the undocumented.

A team from the School of Public Health conducted interviews with nearly two dozen Latinx patients at regional health clinics to learn firsthand about care access issues. Their findings—that increased immigration enforcement results in many deferred doctor visits—mirror national trends and demonstrate that challenges aren’t limited to the biggest cities and border states: Latinx in Detroit and Ann Arbor face the same issues as those in Dallas and Albuquerque.

The most common theme was a fear of contact with law enforcement while traveling to or from the clinic. To many, the risk of an encounter was simply not worth it.

“Our study participants’ narratives document multiple barriers to health care services, many notably exacerbated by increasingly restrictive immigration policies and heightened punitive interior enforcement practices under the Trump administration,” writes the team, led by Monika Doshi, assistant professor of Behavioral and Social Sciences in Brown University’s School of Public Health.

Their paper appeared in February in Qualitative Research in Health. While some patients spoke about financial pressures, lengthy wait times, or a lack of available Spanish-speaking translators, the most common theme was a fear of contact with law enforcement while traveling to or from the clinic. To many, the risk of an encounter was simply not worth it.

• “You don’t go to the doctor unless it’s like an absolute emergency,” one patient reported. “We were basically raised to avoid any type of interaction with anything that would put us in the database.”
• Said another: “People are being picked up coming out of the doctor, gas stations, in front of schools. There are no limits.”
• And a third: “All the people that I know have more fear of immigration (la migra) than of the police. If they tell me the clinic is surrounded, I will lose my appointment. I will not go to the appointment.”

Participants were recruited from three outpatient health clinics—two in Washtenaw County and one in Detroit—that serve large Spanish-speaking populations. US Census Bureau figures show a growing number of Latinx in Michigan, rising from 4.4% of the population in 2010 to 5.6% in 2020.

In Detroit, even as the overall population shrank, the Latinx population grew by a few thousand from 2010 to 2020, causing the Latinx share of the population to increase from 6.8% to 8.1%. More than 50,000 Latinx live there, according to the latest census data, a figure that likely underestimates the true population. (City and state leaders are contesting the official tally, citing evidence that residents in low-income neighborhoods were undercounted.)

Doshi and her colleagues also contrasted the patient perceptions against the views of their providers based on interviews with practitioners, administrators, and staffers at the same clinics. That study, published in 2020 in PLoS One, showed that providers, too, recognized the chilling effect of increased enforcement on their patients.“I think they’re scared to drive this particular intersection. Seems to be almost a weekly or daily occurrence of where people are getting pulled over,” one participant told the researchers. “It’s like a half mile from our clinic, so I think that’s kind of a deterrent.”

While patient and provider perceptions were broadly aligned, the team’s research did highlight some differences. Providers, for example, cited their clients’ limited knowledge of the US healthcare system and cultural emphasis on reactionary—rather than preventive—care seeking as perceived reasons for putting off doctor visits.

“This divergence between client experiences and provider perceptions likely results from the common focus of medical training on ‘treating the problem’ and also signals limitations of the abbreviated nature of medical appointments in building trust, rapport, and understanding,” the researchers said.

While health clinics don’t control federal policies, there are steps they could take to alleviate some of their Latinx patients’ concerns. Expanded transportation services, as well as a greater emphasis on patient-centered care that aligns culturally and linguistically with their clients needs, could help patients get to their appointments and feel comfortable once there, the authors note.

“Some of the aforementioned strategies, however, are resource intensive and may not be easily attainable for many organizations that are historically underfunded,” writes the team. “Thus, organizations will need to prioritize, as well as lobby for appropriate support, to continuously improve their ability to meet the health care needs of their clients, especially those most vulnerable, including their need to be treated with dignity and respect.”