What is a refugee?
A refugee is defined by the United States government as “a person who has fled his or her country of origin because of past persecution or a well-founded fear of persecution based upon race, religion, nationality, political opinion, or a membership in a particular social group.” A refugee is unique and different from an immigrant. A refugee is not a person who “has left his or her home only to seek a more prosperous life, also known as an economic migrant” and does not include people “fleeing civil wars and natural disasters.”
Where do they come from?
The data indicates that during fiscal year 2008, the United States resettled over 60,000 refugees from over 75 different countries. The top 10 nations (with the percent of all refugees) represented are as follows: Bhutan (9 percent), Burma (21 percent), Burundi (5 percent), Cuba (7 percent), Iran (9 percent), Iraq (23 percent), Somalia (4 percent), Thailand (9 percent), former U.S.S.R (4 percent), and Vietnam (2 percent).
What is our country’s commitment to refugees?
Refugees apply to and are interviewed by the U.S. Citizenship and Immigration Services for inclusion within the U.S. refugee resettlement program. By accepting refugees into its program, the United States accepts responsibility for addressing their various needs, including health care, until they are sufficiently resettled and can care for themselves.
What is Pennsylvania’s involvement in refugee resettlement efforts?
The state of Pennsylvania is strongly involved in refugee resettlement efforts; in fiscal year 2008, Pennsylvania was the 11th ranked state in resettlement efforts, accepting nearly 3 percent of the country’s refugees.
From October 2008 to September 2009, Pennsylvania counties resettled more than 2,200 refugees. Greater than three-quarters of Pennsylvania refugees are settled in four Pennsylvania counties--Philadelphia (23 percent), Erie (21percent), Lancaster (17 percent), and Allegheny (16 percent). The top three countries represented by Pennsylvania refugees are Bhutan, Burma, and Iraq.
Why is refugee health care important?
Ensuring proper refugee health care is critical from both a public health and a social responsibility perspective. Refugees come from areas of the world endemic to communicable disease such as tuberculosis, HIV, and Hepatitis B. Additionally, up to 86 percent of a refugee population may suffer from posttraumatic stress disorder and other mental health disorders. Therefore, it is critical to provide adequate health care and screening services to this population to improve their quality of life and to also protect the American public from communicable diseases.
How are refugee health care services currently provided?
State-operated refugee resettlement programs are the primary administers of federal assistance for refugees during their first few months of resettlement. In fiscal year 2007, the Office of Refugee Resettlement (ORR) appropriated $265,546,000 for transitional and medical services. Pennsylvania received $3,797,000 of this appropriation to cover the medical costs of its refugee population.
Refugee families with children under the age of 18 qualify for the Temporary Assistance for Needy Families (TANF) program; refugees who are aged, blind, or disabled can receive assistance from the Supplemental Security Income (SSI) program. Refugees in both of these categories can also be enrolled in the state’s Medicaid program to cover their health care expenses. However, the ORR does not reimburse the state for its TANF, SSI, or Medicaid refugee-related expenses.
Refugees who meet income and resource eligibility standards for the above mentioned assistance programs, but for other reasons do not qualify, can receive benefits from the Refugee Cash Assistance (RCA) and Refugee Medical Assistance (RMA) programs. Eligibility for RCA and RMA, however, is limited to the refugee’s first eight months beginning with the date of entry into the United States. Generally, the ORR reimburses States for the full cost of the RCA and RMA programs.
What are the problems with the current refugee health care system?
Refugees covered by RMA only have coverage during their first eight months of resettlement. These first months are hectic and it can be difficult for refugees to learn how to navigate the U.S. medical system; by the time many refugees learn the system their coverage has elapsed. In fact, many physicians report that eight months may not be a sufficient allocation of health care coverage to meet their unique health needs.
Each state of the union has its own unique refugee health care program; the lack of a national standard of care has created disparities in care between states. Because there is no national standard in place, some states fail to provide adequate access to quality health care.
Both refugee patients and their physicians report cultural competency as a major impediment to quality care. The lack of cultural awareness makes it difficult for physicians to provide appropriate care in a culturally sensitive manner.
Because of the challenges of providing appropriate refugee care, refugee patient visits require more time than normal patient visits and thus increase physician expenses. Physicians do not receive increased compensation for these refugee visits.
Finally, government-mandated provision of costly language translation services further exacerbates the physician’s cost of caring for refugee populations.
More Resources
Information in this question and answer series was drawn from:
USCIS - Questions & Answers: Refugees. USCIS
Office of Refugee Resettlement: Data. Administration for Children and Families Home Page
Pennsylvania Refugee Resettlement Program
Carballo M and Nerukar A (2000) “Panel Summary from the 2000 Emerging Infectious Diseases Conference in Atlanta, Georgia: Migration, Refugees, and Health Risks”
Bolton E. “PTSD in Refugees. (National Center for PTSD)”
Report to Congress- FY 2007 Office of Refugee Resettlement
U.S. Health Resources and Services Administration
Vergara A, et al (2003) A Survey of Refugee Health Assessments in the United States. Journal of Immigrant Health, 5(2): 67-73.
Kennedy J, Seymour D J, Hummel B J (1999) A Comprehensive Health Screening Program. Public Health Reports, 114(5): 469-477.
Minnesota Immigrant Health Task Force (2005) Immigrant Health, A Call to Action: Recommendations from the Minnesota Immigrant Health Task Force. Minneapolis, MN: Minnesota Department of Health.