Civic Stratification and the Exclusion of Undocumented Immigrants from Cross-border Health Care

J Health Soc Behav. 2015 Dec;56(4):438-59. doi: 10.1177/0022146515610617. Epub 2015 Nov 18.


This paper proposes a theoretical framework and an empirical example of the relationship between the civic stratification of immigrants in the United States, and their access to healthcare. We use the 2007 Pew Hispanic Center/Robert Wood Johnson Foundation Hispanic Healthcare Survey, a nationally representative survey of U.S. Latinos (N = 2,783 foreign-born respondents) and find that immigrants who are not citizens or legal permanent residents are significantly more likely to be excluded from care in both the United States and across borders. Legal-status differences in cross-border care utilization persisted after controlling for health status, insurance coverage, and other potential demographic and socioeconomic predictors of care. Exclusion from care on both sides of the border was associated with reduced rates of receiving timely preventive services. Civic stratification, and political determinants broadly speaking, should be considered alongside social determinants of population health and health care.

Keywords: access to care; civic stratification; immigrant health; political determinants of health; social determinants of health.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Emigration and Immigration*
  • Female
  • Health Care Surveys
  • Health Services Accessibility*
  • Hispanic or Latino*
  • Humans
  • Insurance Coverage*
  • Male
  • Medical Tourism*
  • Middle Aged
  • Undocumented Immigrants*
  • United States