Latino immigrants health care access in Cataluña, Spain: The discourse of patients and providers
Introduction This collaborative qualitative research project involves individual and group interviews with immigrant patients, their families, and clinical providers about their health care experiences in a region in Spain and to compare it to the clinical and patient discourses data obtained in my research with Latino immigrants in Massachusetts. Drawing from the strengths of an academic program in a large urban teaching hospital and its network of agencies in Barcelona, this study explores access and quality to health care for the purpose of expanding the cross-cultural dimensions of my research work in the areas of health, multicultural family work, and immigrant families. Methodology To explore the barriers, challenges, and solutions to immigrant health care access, the author interviewed government officials, non-governmental professionals, community activists, health care providers and administrators, and patients in the City of Barcelona. The methodology included an extensive review of the epidemiological and qualitative oriented research literature, in-depth individual and group interviews, observations of clinical interviews in a hospital setting, observations at primary care centers, and other ethnographic observations. Transcripts of digitally and audio taped interviews and field memos constituted the data to analyze in the early stages of the project. Computer assisted data qualitative analysis software NVivo 2.0 was employed to aid in the data analysis. The Family Therapy School located at the Hospital de la Santa Creu i Sant Pau affiliated to the Autonomic University of Barcelona was the primary setting from which to launch the fieldwork. To locate health service providers and develop trust within the health system, the researcher observed therapeutic sessions, provided consultation, and gave lectures early on to graduate students and faculty of the School. Acknowledgments Fulbright Commission Escola de Terapia Familiar, Hospital de la Santa Creu i Sant Pau Autonomous University of Barcelona Results Residence registration is mandatory and facilitates access to health care. Electronic medical records is widely available at primary care facilities. Community health and family medicine care allow for quick and easy access to patients in their neighborhoods. Primary care physicians visit the elderly, the severely disabled, or severely ill at their homes. “ Long waiting lists” for specialized procedures are often the concern of patients in the systems but not of recent immigrants. The media reports often on the subject of lack of access to specialized procedures and the lack of trained physicians. How is the health care financed? Doctors, researchers, administrators, politicians and policy makers, and patients did not address the financial dimension of health care. Their reaction to questions about health care financing suggest different assumptions about how to pursue health care policies. During the fieldwork period, Spain elected a socialist government, a bombing by a terrorist cell mobilized millions, and the expanded demand for Cataluña’s autonomy highlighted the ongoing social and political dilemmas of immigration health care policy. The discourse about immigrants’ rights was in flux as new forms of racism emerged as a result of the 2004 bombing in Madrid as well as the aspirations of the richest autonomous communities (Cataluña and the Vasc Country) to host immigrants in an appreciative embrace. Undocumented immigrants are provided health care if they arrive to a community health care facility or outpatient facility. However, chronic illness management, a strength of the system overall, is not as efficient in the case of undocumented immigrants since they use the system during emergency procedures rather than routine care. For Latino immigrants, the language barriers are not as core as in the United States. However, the perception that racism and classism persists among administrative health care personnel was often present in the interviews. Major barriers have been identified, among them the lack of language literacy and bilingual capacities of providers and/or patients, lack of coordination among providers, and geographical location. S ocioeconomic differences have also been identified as a major barrier. Community activists were less enthusiastic about the advances of the health care system. According to immigrant coalitions, immigrants were unable to secure ongoing integrated services. Despite these concerns, my observations of mental health services suggested a deep concern for the health care of individual and families under the care of health care professionals. Conclusions The study investigated health care access of immigrant Latinos in Barcelona, the largest urban enclave of Cataluña. This research highlights the discursive complexity associated to health care for Latino immigrants and of conducting reliable cross-cultural research in an evolving policy and political situation. The findings suggest that bilingual skills seem less important for Latino immigrants in Spain in comparison to Latinos in the U.S. However, immigrants’ needs become less visible as the health system re-design viable mechanisms of care. The study suggests the importance of intercultural and inter-institutional initiatives, setting up easy access to neighborhood primary care centers, the incorporation of integrated mental health assistance, among others. Like findings in the U.S., the discourse about barriers to care for immigrants in Spain has been categorized as internal (i.e., negative past experiences) and external (i.e., institutional neglect). The principles that guide the health care of immigrants in the Cataluña context have potential application in the pursue of eliminating health disparities in the U.S. Gonzalo Bacigalupe, EdD, MPH Department of Counseling and School Psychology, University of Massachusetts Boston Literature cited Carrasco-Garrido, P., De Miguel, A. G., Barrera, V. H., & Jimenez-Garcia, R. (2007). Health profiles, lifestyles and use of health resources by the immigrant population resident in Spain. Eur J Public Health, 17 (5), 503-507. Gushulak, B.D.,, & MacPherson, D.W. (2006). The basic principles of migration health: Population mobility and gaps in disease prevalence. Emerging Themes in Epidemiology 2006, 3:3. Romero-Ortuño, R. (2004). Access to health care for illegal immigrants in the EU: should we be concerned? European Journal of Health Law 11: 245-272, 2004. Unidad de Estudios Humanitarios (Ed.). (2004). Movimientos de poblacion: Migraciones y accion humanitaria [Population movements: Migration and humanitarian action] . Barcelona, Spain: Icaria. Blah, blah, blah (G). For further information Please contact: Professor Gonzalo Bacigalupe University of Massachusetts Boston Graduate College of Education Department of Counseling & School Psychology 100 Morrissey Bvld., Boston MA 02125. [email_address] www.faculty.umb.edu/gonzalo_bacigalupe Latino immigrants health care access in Catalu ñ a, Spain: The discourse of patients and providers <ul><li>The WHO for the 21st Century Model guides the Catalan Health Service ( www10.gencat.cat) </li></ul><ul><li>Primary health care aimed at the community and families, supported by a flexible and receptive hospital system. </li></ul><ul><li> </li></ul><ul><li>Process of participation involving relevant parties in the development of health (at home, school, work and in the local and regional community), promoting joint decision-making, implementation and openness. </li></ul><ul><li> </li></ul><ul><li>Multi-sector strategies for tackling health issues, taking into account the physical, economic, social and cultural environments and sex and ensuring the assessment of their impact on health. </li></ul>Background Immigrants and refugees from Latin America are an expanding population in Spain and the European Union (Romero-Ortuño, 2004; Unidad de Estudios Humanitarios, 2004). Spain, in a few decades from being a country of emigrants to Latin America to become a host country for Latino immigrants. Epidemiological studies have shown a change in the social determinants of health including health care access among the migrant population's place of origin and its destination. “Present and future health challenges related to migration may be more effectively addressed through collaborative global undertakings” (Gushulak & MacPherson, 2006). In Spain, health care access is universal, a constitutional right. The research literature demonstrates the relevance of health insurance to ensure access to health care. The expansion of insurance coverage alone, however, is not sufficient to eliminate current disparities in access to care. When researchers compare people from different racial/ethnic backgrounds that have insurance and/or belong to the same social class, research has confirmed that racial and ethnic health disparities continue to exist. Spanish researchers have identified health inequalities as related to class, internal migration , and economic immigration . The recent immigrant life-style is comparatively better than of the host country population (i.e., alcohol and tobacco consumption). Fears of overutilization of health care by the immigrant population are not supported by epidemiological evidence ( Carrasco-Garrido, De Miguel, Barrera, & Jimenez-Garcia, 2007) .