Churning Health Care: How Brokered Access Influences Services for Unauthorized Latina/o Immigrants

• In Event: 074 - Regular Session. Health Care and Care Delivery 2

Abstract

Drawing from nearly two years of fieldwork in Federally Qualified Health Care Centers (FQHCs)in the San Francisco Bay Area, this article extends prior research by examining access for the unauthorized. I show that brokers enable access through coaching and myth-busting, but they also hinder it through interrogation and bureaucratic neglect. The widespread dependence on brokerage, I argue, leads to ersatz brokerage, such as when well-meaning providers and volunteers begin to navigate the healthcare system for the undocumented without the appropriate linguistic resources or coordination. Results show that this new form of brokerage generates churning in the system—that is, hospitals send patients to the clinics and the clinics send patients back to the hospitals. Understanding the brokerage processes that both include and exclude vulnerable populations from needed services enhances theories of access and can help design and implement more equitable and efficient policies aimed at reducing health disparities by documentation status.

Author

• Laura Lopez-Sanders, University of North Carolina-Chapel Hill