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Health Access and Perceptions of Newly Arrived Refugees in Philadelphia

Philadelphia Refugee Health Collaborative

Jessica Lee

on 13 January 2015

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Transcript of Health Access and Perceptions of Newly Arrived Refugees in Philadelphia

Funded by PA Department of Health,
Office of Health Equity's Refugee Health Program

Refugee Sample
Interview Themes
Health Access
Health Care Utilization
Resettlement Agency Support
Health Clinic Care
Perceived Health Status
Behavioral Risk Factor Surveillance System
Discussion & Next Steps
Scheduling appointments as a major barrier to care.
Increasing efficacy of refugee health orientation.
Module system.
Continuity of care-- "resident run" clinic model.
Post-8 months of RMA.
Preferred Communities funding. How to best utilize new capacity.
Community members as health navigators.

Bhutanese, Iraqi, Burmese, Eritrean, and Sudanese refugees
83 total participants
5% of refugees resettled in Philadelphia since June 2012
52% male, 48% female
Average age = 28
Age range = 4 months – 83 years old
31% of participants under 18 years old
93% participants insured through RMA, 7% participants uninsured

1) gather feedback from recently arrived refugees in Philadelphia on their experience in accessing health care and services to inform resettlement agency practices in supporting access to care.

2) gather feedback from recently arrived refugees on their experience in utilizing health care and to inform clinic practices in providing accessible and culturally competent care.

3) collect information from PRHC clinics and resettlement agencies to understand health services provided for newly arrived refugees.

1. In-depth interviews with 83 newly arrived refugees were conducted.
Interview questions focused on the refugees’ perceived health access, health services utilization, and support received from resettlement agency staff and health clinic staff.

2. Open-ended surveys administered to the refugee health coordinator of
each PRHC resettlement agency.
Questions focused on health services and the health orientation.

3. Telephone calls were placed to each PRHC health clinic to understand
the appointment scheduling system.

About 5,793 refugees resettled in Philadelphia from Jan. 2003 - Sept. 2013. Almost 800 refugees arrive in Philadelphia per year.
(PA Resettlement Program, 2013)
Health Access and Perceptions of Newly Arrived Refugees in Philadelphia
September 2013

Health Care Utilization
12% of the respondents reported that they have one person they think of as their personal doctor or health care provider.
77% reported that they have more than one person.
11% of respondents stated that they do not have a personal doctor or medical provider.
All interviewees had a routine check up within the past year during their domestic screening.
Resettlement Agency Support
Nearly all interviewees expressed appreciation for the health support services provided by their agency.
Services included escorts, scheduling appointments, advocacy.
Interviewees reported an average of 3 escorts per client to various medical appointments.
Many respondents reported a wish for increased escorting to medical appointments.
Many reported feeling dependent on their agency to schedule medical appointments.
75% of interviewees recalled little to no information from the refugee health orientation provided by the resettlement agencies.
Health Access
The most often reported barrier to health care was the respondents’ inability to schedule their own medical appointments.
Clinics’ automated telephone system was perceived as a significant barrier.
77 interviewees had health insurance through Refugee Medical Assistance (RMA). 6 respondents lacked health coverage.
All 6 uninsured interviewees reported that they were unable to see a doctor when they needed to in the past 12 months.
Nearly 50% of the clients interviewed expressed mild to severe concern over what to do after their RMA ends and many believed health coverage would be unaffordable.
Health Clinic Care
Respondents overall reported feeling very pleased with their health clinics and doctors.
Participants were especially pleased with the care provided by pediatricians.
Burmese and Bhutanese respondents reported especially positive perceptions of PRHC clinics.
3 respondents expressed complaints about the health care they received.
Interviewees reported phone interpretation at medical appointments to be sufficient.
Perceived Health Status

Health Care Access

1. Do you have any kind of health care coverage, including health insurance, prepaid plans such
as HMOs, government plans such as Medicare, or Indian Health Service?
NO: PA 16%, PRHC sample 7.2%

2. Do you have one person you think of as your personal doctor or health care provider?
NO: PA 13%, PRHC sample 11% (12% yes only one, 77% yes more than one)

3. Was there a time in the past 12 months when you needed to see a doctor but could not because of cost?
YES: PA 13%, PRHC sample 7%

4. About how long has it been since you last visited for a routine checkup?
WITHIN THE PAST 2 YEARS: PA 83%, PRHC sample 100% (within the past 1 year)
The most common reasons stated for improvement in health status are:
U.S. healthcare system
availability of fresh food
less psychological stress
Calls to Health Clinics
Telephone calls were placed to each clinic.
Schedulers were asked whether phone interpreters were available to callers seeking to schedule appointments.
Resettlement Agency Surveys
Open-ended surveys were completed by the health coordinator of each PRHC agency.
Duration of health services ranges from 3 to 8 months for all refugees.
All provide assistance with scheduling appointments and escorting clients to appointments.
All agencies provide extra services for clients with special medical needs; only 1 has funding.
2 agencies reported that all clients are given a discrete health orientation; the third agency reported that they include health information in the R&P orientation.
On a scale of 1 to 10, priority of health for refugees is 8 on average.
2 agencies report a need for more support for health team.
Example: Scheduling Appointments
One client (fluent in English) expressed difficulty in scheduling appointments because of pronunciation/intonation differences in language and phone reception.
He cannot understand recorded instructions and has trouble expressing himself over the phone.
He would prefer to make appointments in person, but clinic staff always refers him to the phone service.
Example: Insurance
Only one family was actively looking into options to ensure coverage, largely because they are caring for elderly family members with many medical needs.
Health Access cont.
50% of respondents reported concern about what to do about health insurance, even though no questions were directly asked about this.
Many clients view the 8 month RMA period as the only time they can see a doctor.
Sample by Resettlement Agency and Clinics
Philadelphia Refugee Health Collaborative
Full transcript