Vulnerable populations include children, the elderly, the homeless, those with chronic health conditions, economically disadvantaged, the racial and ethnic minorities, immigrants, and refugees. Vulnerability may arise from community, individual or larger population challenges. Immigrants have been identified as a vulnerable population, but there is heterogeneity in the degree to which they are vulnerable to inadequate health care. Factors that affect immigrants’ vulnerability, including socioeconomic background; immigration status; limited English proficiency; federal, state, and local policies on access to publicly funded health care; residential location; and stigma and marginalization. Overall, immigrants have lower rates of health insurance, use less health care, and receive lower quality of care than U.S.-born populations; however, there are differences among subgroups. Policy options for addressing immigrants’ vulnerabilities. Limited English proficiency is also likely to affect the quality of care immigrants receive; for instance, immigrants with limited proficiency report lower satisfaction with care and lower understanding of their medical situation. Those who need an interpreter but do not receive one fare the worst, followed by those who receive an interpreter and those who have a language-concordant provider or speak English well enough to communicate with the provider. Immigrants’ vulnerability can also be influenced by whether an immigrant’s U.S. residence is in a traditional or new destination for immigrants. New destinations are less likely than established destinations to have well-developed safety nets, culturally competent providers, and immigrant advocacy or community-based organizations. Latinos in areas with relatively small Latino populations rely more on emergency departments (EDs) for their care than do Latinos in areas with relatively large Latino populations, and physicians in communities with small Latino...
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