There is an urgent need for the Latino community and its benefactors (providers) to find
strategic allies who understand the importance and public health benefits of providing insurance
for all children. While the current healthcare facilities for uninsured children in Allegheny and
Washington counties (i.e. Monthly Free Pediatric Clinic, Lincoln-Lemington, Washington’s
Hospital Family Practice, Squirrel Hill Health Center and East Liberty Healthcare Center) have
done a commendable job, there is a need for more sustainable options. The population of Latinos
in Allegheny and Washington counties is growing and a strategic plan needs to be prepared to
address the health needs of the undocumented children from these families. Rather than focus on
expansion of existing services, efforts should be concentrated on making undocumented children
eligible for health insurance.
A comparative study done by Newacheck (1998) found that
“health insurance is a powerful predictor of children’s degree of access to and use of primary care, including such aspects as entry into the health care system, identification of a regular clinician, level of satisfaction with care, whether care is delayed or missed, and the amount of physicians’ services received” (p.517).
Another study that analyzes the impact of the California insurance program for children
“Healthy Kids” shows that in addition to cutting uncompensated ambulatory care costs, Healthy
Kids could also reduce uncompensated care for hospitalization and emergency department use
of a health insurance plan for children who live in Pennsylvania, and one that does not have
citizenship as a requirement.
Another relevant topic in which providers in Allegheny and Washington counties could
focus advocacy efforts, is the need for professional interpreters at various healthcare sites.
Different studies identify language as a barrier to provide effective service and care to immigrant
Latino children (Caraway and Timmins 2002; Flores, Abreu et al. 2005); in the area covered in
this research, it became apparent that interpreters ought to be available at low-cost health centers
and FQHC where Latinos go. Advocacy efforts to have professional interpreters ought to be
done at least in the following levels: (1) at the doctor’s office during the medical appointment
and (2) with administrative staff in charge of making appointments and explaining financial
matters. Funding could come from grants focused on improving healthcare access for minorities.
Future research on uninsured Latino children should compare healthcare access of
uninsured and insured Latino children. Some of the indicators that it should focus on are: last
time they went to see a doctor in the last month and year, visits to the ER, missed school days,
delayed care, and other related topics.
From another perspective, several studies have looked at the relationship between social
integration and mental and physical health status in adults. It would be relevant to study if lack of
health insurance in children has a relationship to their social integration (among their peers) or if
parent’s social support network has an impact on children’s well-being. In order to assess this,
the first step would be to measure the social support of parents of Latino children and divide
them into two or three groups according to their level of social support. Afterwards, their
children’s health status would be measured and compared among the different groups of parents’
Another topic in need of further study is how the current –fragile– network is preserved
and enlarged even in the face of frequent changes. Provider might change jobs and positions,
others might leave and information about how to help uninsured children needs to be constantly
updated and shared to serve newcomers.
The parents I interviewed were the ones that are somehow connected to and informed
about the existing pediatric options for their uninsured children; yet, many of these children had
not always received timely care, and had not see a doctor as regularly as the parents would like
to. Thus, a weakness of this study is that it focused on those parents that were “connected” to the
existing support network formed by social and health services providers. A future study should
try to look for those families that are not –yet– tapped into the existing network of services, and
focus on the health implications of not knowing about the available health care options. The
perspectives of “unconnected” Latino families were not part of this research and we do not know
about the health status of undocumented children at the margins of health care. One challenge
would be to find these families.
Another limitation is the small size of the sample. This research however, provides a first
glimpse into an important area of research: decision-making health care decisions for immigrants
and their children. Another study should focus on Federally Qualified Health Centers in order to
understand the way in which they are tailoring their services to Latino children.
To have a better understanding of the actual health impacts of not being insured due to
immigration status, a study could be done comparing insured and uninsured Latino children in
the counties of Allegheny and Washington. It could follow two groups of children for a year,
controlling for things such as children ages, parents’ English proficiency, time in the USA,