Stratified citizenship, stratified health: Examining latinx legal status in the U.S. healthcare safety net.
Stratified citizenship, stratified health: Examining latinx legal status in the U.S. healthcare safety net.
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DOI：
10.1016/j.socscimed.2018.10.024
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发表时间：
2019-01
期刊：
影响因子：
--
通讯作者：
Shim JK
中科院分区：
文献类型：
--
作者：
Van Natta M;Burke NJ;Yen IH;Fleming MD;Hanssmann CL;Rasidjan MP;Shim JK
我们的论文探讨了法律地位分层如何影响美国医疗安全网中低收入慢性病患者的健康和医疗保健。我们利用两年多在城市安全网诊所进行的人种学实地调查数据，研究了复杂护理管理 (CCM) 团队通过初级护理综合支持稳定慢性病失控患者所做的努力。我们表明，分层的公民身份和地理差异对应于不同的医疗保健可能性。我们建议将移民作为健康的结构性决定因素，以解释公民身份的复杂性、分层性和不断变化的性质。我们还强调了地方、州和联邦政策之间的地理差异和相互作用如何支持这样一种观念，即公民身份是分层的，具有独特的健康可能性和限制。虽然每个研究地点的县级健康计划都包括具有不同法律地位的居民，但缺乏正式的法律地位仍然是护理的重大障碍。许多移民无法充分利用初级和专科护理，导致不必要的发病和死亡。在某些情况下，患者返回原籍国后死亡。虽然 CCM 团队提供了令人印象深刻的支持来帮助移民患者应对医疗保健和移民官僚机构的要求，但法律和地理分层限制了他们解决这些患者社会背景的更广泛方面的能力。
Our paper explores how legal status stratification shapes the health and health care of low-income patients with chronic illnesses in the U.S. healthcare safety net. Drawing on data from over two years of ethnographic fieldwork at urban safety-net clinics, we examine e fforts by Complex Care Management (CCM) teams to stabilize patients with uncontrolled chronic illnesses through primary care-integrated support. We show that stratified citizenship and geographic variability correspond to different possibilities for health care. We suggest an approach to immigration as a structural determinant of health that accounts for the complex, stratified, and changing nature of citizenship status. We also highlight how geographical differences and interactions among local, state, and federal policies support the notion that citizenship is stratified across multiple tiers with distinctive possibilities and constraints for health. While county-based health plans at each of the study sites include residents with varying legal status, lack of formal legal status remains a substantial obstacle to care. Many immigrants are unable to take full advantage of primary and specialty care, resulting in unnecessary morbidity and mortality. In some cases, patients have returned to their country of origin to die. While CCM teams provide an impressive level of support to assist immigrant patients in navigating healthcare and immigration bureaucracies, legal and geographic stratification limit their ability to address broader aspects of these patients’ social context.
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