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Immigrant Healthcare Questioned

August 5, 2010

Study Raises Questions About
Quality of Immigrant Healthcare

“Rationing by Inconvenience”

A letter in today’s New England Journal of Medicine raises serious questions about the impact of Massachusetts’ state-subsidized health insurance program on the likelihood that immigrants will receive adequate healthcare.
            The authors report that under “Commonwealth Care,” approximately 30,000 legal immigrants were involuntarily transferred last fall from the state program to a new private insurance plan, CeltiCare, at a saving to the state roughly $2,600 per person. These savings, however, were achieved by excluding some of the hospitals and community health centers most frequently used by immigrants, including the authors’ employer, the Cambridge Health Alliance (CHA).
            The study identified 1325 patients who had visited a CHA primary care provider during the year before being moved to CeltiCare. For 73% English was not their primary language. At least 38% had hypertension, diabetes mellitus, and/or a psychiatric disorder. Checking the list of 217 adult primary care providers listed by CeltiCare, within 5 miles of CHA’s ZIP Code, the authors found that “25% could not be reached at the telephone number provided. Of those available by telephone, only 37% were actually accepting new CeltiCare patients, and the average wait for an appointment was 33 days. In all, only 60 providers were accepting new CeltiCare patients, and only 38 could provide service for even one of the three major linguistic minorities.” The authors conclude:

“…we believe that patients who were switched from Commonwealth Care to CeltiCare had inadequate access to primary care three months into this new program. We fear that such “rationing by inconvenience”  shuts patients out of care to the detriment of their health but to the benefit of CeltiCare’s bottom line. Policymakers, in Massachusetts and nationally, should reassess the role of profit-driven insurers in the provision of safety-net care.”

Immigrants’ Experience with Publicly Funded Private Health Insurance N Engl J Med 2010; 363:598; August 5, 2010, Ruth Hertzman-Miller MD, MPH; Malgorzata Dawiskiba MD; and Cassie Frank MD

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