Abstract
Current literature indicates an increased disease burden among refugees resettled worldwide as well as in the U.S. Both prevalence and incidence of infectious diseases, chronic diseases, and health conditions are high or higher compared to the general American population. The question raised is how well refugee populations have been responding to their medical expenses. The purpose of this study is through a systematic literature review to identify the challenges of accessing health insurance among U.S. refugees, and to advocate for a healthcare policy change. More than 400 peer-reviewed journal articles and book chapters obtained from major databases, and published between 2005 and 2018 were reviewed. Fourteen articles related to the U.S. refugees and health insurance, were included in the final analysis. Seven themes emerged. Results suggested that (1) Compared to the general or minority populations, U.S. refugees were more likely to be uninsured or underinsured; (2) Refugees demonstrated the unaffordability of medical co-payments; (3) There was a lack of full coverage of medical needs; (4) There was a lack of affordable private insurance plans; (5) There was a lack of understanding of the U.S. health insurance application; (6) U.S. refugees struggled to navigate both government and private health insurance; And (7) Refugees had difficulty in understanding the U.S. healthcare policies. More research is needed to specifically examine the accessibility and affordability of health insurance among multiethnic refugee populations in the U.S. Social determinants (e.g., employment, education, and income) should also be addressed in consideration of getting refugees fully insured.
Highlights
Overseas screening for tuberculosis among 378,506 refugees who arrived in the U.S from 1999 to 2005 from countries, including Ukraine, Vietnam, Somalia, Sudan, Bosnia and Herzegovina and others, as well as among 2,714,223 US-bound immigrants arrived in the U.S during the same time period, indicated that compared to the immigrant counterparts, the refugee participants had slightly higher smear-negative tuberculosis but had 3.4 times higher inactive tuberculosis prevalence rate [2]
In Misra et al study, 61% of refugee participants had some forms of healthcare coverage, majority of them had a “gold card,” which referred to a county indigent care program for refugees to access county health resources
Refugees had limited knowledge of health insurance regulations so they did not know what they could expect from having an insurance plan [25], which became a significant problem when the Affordable Care Act (ACA) was being promoted to the refugees [28]
Summary
There has been an increased burden of both communicable and noncommunicable diseases among refugees either overseas or in the U.S [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22]. Overseas screening for tuberculosis among 378,506 refugees who arrived in the U.S from 1999 to 2005 from countries, including Ukraine, Vietnam, Somalia, Sudan, Bosnia and Herzegovina and others, as well as among 2,714,223 US-bound immigrants arrived in the U.S during the same time period, indicated that compared to the immigrant counterparts, the refugee participants had slightly higher smear-negative tuberculosis but had 3.4 times higher inactive tuberculosis prevalence rate [2]. For the first eight months after arrival, the medical records showed that more than half of the adults had one or more chronic non-communicable health issues, such as depression, posttraumatic stress disorder (PTSD), hypertension, dyslipidemia, and impaired vision [4]. A recent study compared 490 refugee adults mainly came from Europe, Central Asia, Latin America, and the Caribbean and lived in the U.S for at least one year, with 3,715 aged-matched U.S immigrants. Literature emphasized a heavy presentation of mental disorders among different US-bound refugee populations across different age ranges due to pre-migration, migration, and post-migration traumas [6,7,8]
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