Connecting immigrant patient populations to preventive care access and chronic disease management starts with gaining trust and ends with cultural competency.

For the mostly immigrant population Silvia Posada sees at her organization, Essen Health Care, patient access to care—particularly preventive care and chronic disease management—isn’t a given.

Many of these patients don’t just walk into their regular, yearly physicals, and they aren’t always detecting chronic illness and keeping up with management, Posada, Essen’s senior vice president of network development, said. Immigrants face serious patient care access barriers, she emphasized, ranging from socioeconomic issues to health literacy to English language proficiency.

“Most of the Latinos that are in our community are immigrants and they come here and they right away enter into survival mode,” Posada said in an interview with PatientEngagementHIT. “How do I make enough money in order to be able to feed my family and at least have a roof over their head? That takes precedence over educating themselves on the opportunities and the access that is available in terms of getting care.”

According to Posada, a lot of immigrants don’t access medical care, especially primary and preventive care, because that just wasn’t the standard in their home countries. Healthcare was expensive over there, she said, and so when immigrants arrive in the United States it’s reasonable to assume healthcare access will be equally as cost-prohibitive.

In fairness, healthcare access can be extremely cost-prohibitive in the United States. People living in the US are more likely than those in any other similarly developed nation—mostly European countries and Australia and New Zealand—to forgo care because of high out-of-pocket costs.

But the image is starker in the less-developed nations many of the immigrant patients visiting the Bronx-based Essen come from.

“If you don’t have money, you don’t get to see a doctor,” Posada said. “It’s not a secret people die, either because they can’t get access to care—they can’t afford it—or they live in remote areas where they come from, so they can’t get healthcare. So, they come to the US with the same mentality and although the care is available, a lot of them don’t think that it’s not.”


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