1. Beyond Access to Care: Health Care Experiences Among Mexican Migrants
1st World Congress on Migration, Ethnicity, Race and Health
17-18 May 2018, Edinburgh
Beyond Access to Care: Health Care Experiences Among Mexican Migrants
Ana P Martinez-Donate, PhD
Dornsife School of Public Health, Drexel University

2. Mexico – US Migration 11.7 million Mexican-born immigrants in the U.S.
15% of Mexico’s labor force
More socially vulnerable compared to other immigrants or the US-born population
53% unauthorized
28% living in poverty
56% no health insurance
69% limited English proficiency
High volume of circular migrants moving back and forth between the two countries
(Migration Policy Institute, 2016; CONAPO, 2008)

3. Migration Phases & Vulnerability
2. Transit
3. Host Community
4. Interception/
deportation
5. Return
1. Pre-departure
Protective & Risk Factors:
Cross-cutting
Context/phase specific
(Haour-Knipe et al., 2013; Zimmerman et al. 2011)

4. Objective
To examine the quality of, and satisfaction with, health services received by Mexican im/migrants at different migration phases and contexts.
Emphasis on circular im/migrants

5. Methods

6. Study Design & Setting
Cross-sectional, probability survey of migrant flows in Tijuana, Mexico, 2013
Northbound (with and w/o migration experience)
Southbound (voluntary return and deportees)
Sampled at airport, central bus station, deportation station
N=2,285, 58% response rate
1,541 stayed >=30 days in key migration context
754 received health services

7. Health Care Experience Measures*
Health Care Experiences
Care Facility
Insurance
Satisfaction
Linguistic Barriers
Health Literacy Barriers

8. Migration Contexts & Phase
Sending Communities (Mexico)
New Migrant
Repeat Migrant
Northbound Flow
Pre-migration phase
Return phase
Receiving Communities (U.S.)
Voluntary Return
Deported
Southbound Flow
Destination phase
Detention/deportation phase

9. Results

10. Demographic & Migration Profile
Most (66-93%) are male
Average age is years
Low education (20-75% have high school degree or higher)
Over half are married (51-61%)
A small fraction belongs to indigenous community (1-7%)
Over 10 years of residence in the U.S. (42-79%)
Most plan to return to the U.S. (58-91%)
Many have a previous history of deportation (18-56%)

11. Received Health Services During Last 12 Months (%)
Mexico
In the U.S.

12. Had Insurance At Time of Service (%)
MEXICO
U.S.
AOR*=0.37, 95% CI (.14, .96)
AOR*= % CI (.07, .23)
*Adjusted for gender, age, ethnicity, health status, and time.

13. Type of Health Care Facility (%)
MEXICO
U.S.
AOR*=3.50, 95% CI (1.34, 9.15)
AOR*=3.79, 95% CI (1.75, 8.16)
AOR*=34.8,
95% CI (11.9, 100)
*Adjusted for gender, age, ethnicity, health status, and time.

14. Linguistic Barriers in the U.S. (%)
AOR*=2.43, 95% CI (1.07, 5.53)
*Adjusted for gender, age, ethnicity, health status, and time.

15. Provider Used Words They Did Not Understand (%)
MEXICO
U.S.

16. Did Not Understand Treatment Instructions (%)
MEXICO
U.S.
AOR*=6.19, 95% CI (2.27, 16.8)
*Adjusted for gender, age, ethnicity, health status, and time.

17. Did Not Receive the Service They Needed (%)
MEXICO
U.S.
AOR*=3.20, 95% CI (1.15, 8.92)
*Adjusted for gender, age, ethnicity, health status, and time.

18. Rated Services Received as “Excellent” (%)
MEXICO
U.S.

19. Conclusions
Health care access, quality, and satisfaction vary by migration phase and context.
Sending communities, returnees:
< Health insurance
> Care in safety net clinics
In receiving communities, deportees:
> Care in safety net clinics or detention centers
> Language and literacy barriers
< Satisfaction with services

20. Implications
Efforts to promote timely and quality healthcare across the migration continuum are imperative.
Insurance continuity
Linguistic and health literacy barriers
Other sources of low satisfaction
Special attention must be paid to im/migrants at risk for, or subject to, deportation.

21. Limitations Self-selection of study participants
Data are based on self-report
Limited to Tijuana
Limited to migrants who travel by ground
We don’t observe non-returning migrants
Oversampling of circular migrants

22. Acknowledgements Co-authors
X Zhang, University of Wisconsin, Madison
JE Gonzalez-Fagoaga, University of Arizona
S Guendelman , University of California, Berkeley
C Amuedo-Dorantes, San Diego State University
N Verdecias, Drexel University
MG Rangel, Mexico-US Border Health Commission
Funding from The Eunice Kennedy Shriver NIH/NICHD (R01HD046886)
For more information, visit:

23. Questions?

24. Appendix

25. Sociodemographic Profile
In Mexico
In the U.S.
Pre-migration
(N=208)
Return
(N=77)
Destination
(N=297)
Detention/
Deportation
(N=172)
Male, %
66.1
75.4
67.7
92.8
Age,, Mean (SD)
39.9 (13.9)
48.7 (15.9)
45.6 (14.0)
36.3 (10.0)
>= High School, %
74.7
43.8
30.9
20.1
Married, %
52.1
56.7
61.0
50.8
Indigenous ethnicity, %
1.3
0.9
6.7
2.7

26. Sociodemographic Profile
In Mexico
In the U.S.
Pre-migration
(N=208)
Return
(N=77)
Destination
(N=297)
Detention/
Deportation
(N=172)
Male, %
66.1
75.4
67.7
92.8
Age,, Mean (SD)
39.9 (13.9)
48.7 (15.9)
45.6 (14.0)
36.3 (10.0)
>= High School, %
74.7
43.8
30.9
20.1
Married, %
52.1
56.7
61.0
50.8
Indigenous ethnicity, %
1.3
0.9
6.7
2.7

27. Migration Profile In Mexico In the U.S. Pre-migration (N=208) Return
Destination
(N=297)
Detention/
Deportation
(N=172)
Years in the U.S., %
<5 years
5-9 years
>=10 years
N/A
44.1
14.5
41.5
13.2
7.7
79.2
4.3
23.1
72.5
Plans to return to U.S., %
91.0
58.0
Previously deported, %
27.9
17.6
55.6

28. Migration Profile In Mexico In the U.S. Pre-migration (N=208) Return
Destination
(N=297)
Detention/
Deportation
(N=172)
Years in the U.S., %
<5 years
5-9 years
>=10 years
N/A
44.1
14.5
41.5
13.2
7.7
79.2
4.3
23.1
72.5
Plans to return to U.S., %
91.0
58.0
Previously deported, %
27.9
17.6
55.6