Ventanillas de Salud: Desafíos en el acceso a servicios de salud de inmigrantes mexicanos en EE.UU.
Ventanillas de Salud: Defeating challenges in healthcare access for Mexican immigrants in the United States
https://doi.org/10.21670/ref.2001043
Palabras clave:
Acceso a la salud, consulados, seguro médico, atención preventiva, detección temprana de enfermedades crónicas no transmisibles, clínicas comunitarias, Ventanillas de Salud, inmigrantes mexicanos en EE.UU.Resumen
En 2010 el Affordable Care Act (ACA) brindó mayor acceso a la salud en Estados Unidos, pero los inmigrantes aún enfrentan dificultades, particularmente los indocumentados. Para brindar acceso a servicios de salud a sus connacionales, el gobierno mexicano creó el programa Ventanillas de Salud (VDS). El artículo analiza cambios en el sistema de salud de Estados Unidos a partir del ACA y el papel de las VDS. La metodología cualitativa incluye: revisión de literatura, entrevistas a líderes comunitarios y miembros del gobierno mexicano y cuestionarios enviados a cuatro VDS: Arizona, Florida, Idaho y Texas. Los resultados demuestran que las vds proveen información confiable, acceso económico a servicios de salud, detección temprana de enfermedades crónicas y no transmisibles, especialmente para inmigrantes indocumentados. Se presentan recomendaciones de política pública basadas en evidencias. Las limitaciones radican en que los datos de las cuatro VDS no son representativos de todo el programa.Abstract The 2010 Affordable Care Act (ACA) improved access to healthcare in the United States. However, immigrants —especially those undocumented— still faced difficulties, which have increased during the Trump administration. In order to bring access to health services to its nationals, the Mexican government has implemented the Health Windows Program (Ventanillas de Salud, or VDS). The article reviews changes in the U.S. healthcare system from the ACA to date, and assesses the role of VDS. The methodology is qualitative, consisting of a literature review, interviews with community leaders and Mexican government officials, and questionnaires sent to four VDS: Arizona, Florida, Idaho and Texas. Results show that VDS provide reliable and affordable access to basic healthcare services, and detection of chronic and non-communicable diseases, especially within undocumented immigrants. Public policy recommendations are offered based on these findings. Limitations of the study include the data collected, which is non-representative of all VDS.
Citas
Adams, R. (2018). Immigration Crackdown Raises Fears of Seeking Health Care. https://www.rollcall.com/news/politics/immigration-crackdown-raises-fears-seeking-health-care
Amadeo, K. (2018). Donald Trump on Health Care How Trump's Health Care Policies Will Raise Premium Prices for You. https://www.thebalance.com/how-could-trump-change-health-care-in-america-4111422
American Psychological Association (APA). (2018). Stress in America. Generation Z. https://www.apa.org/news/press/releases/stress
Barnett, J. C. & Vomovitsky, M. (2016). Health Insurance Coverage in the United States 2015. U. S. Department of Health and Human Services. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64
Becerra, D., Androff, D. K., Ayón, C. & Castillo, J. T. (2012). Fear vs. Facts: Examining the Economic Impact of Undocumented Immigrants in the U.S. Journal of Sociology and Social Welfare, 39(4), 111-135.
Campbell, G. A., Sanoff, S. & Rosner, M. H. (2010). Care of the Undocumented Immigrant in the United States with ESRD. American Journal of Kidney Diseases, 55(1), 181-191. https://doi.org/10.1053/j.ajkd.2009.06.039 DOI: https://doi.org/10.1053/j.ajkd.2009.06.039
Castañeda, H. & Melo, M. A. (2014). Health Care Access for Latino Mixed-Status Families: Barriers, Strategies, and Implications for Reform. American Behavioral Scientist, 58(14). DOI: https://doi.org/10.1177/0002764214550290
Chen, J., Vargas-Bustamante, A., Mortensen, K. & Ortega, A. N. (2016). Racial and Ethnic Disparities in Health Care Access and Utilization under the Affordable Care Act. Medical Care, 54(2), 140-146. DOI: https://doi.org/10.1097/MLR.0000000000000467
Consejo Nacional de Población. (2012). Migración y salud. Jóvenes mexicanos inmigrantes en Estados Unidos. Secretaría de Gobernación. http://www.conapo.gob.mx/en/CONAPO/Migracion_y_Salud_Jovenes_inmigrantes_mexicanos_en_Estados_Unidos
Consulado General en Little Rock. (2019). Ventanillas de Salud. Secretaría de Relaciones Exteriores. https://consulmex.sre.gob.mx/littlerock/index.php/proteccion/ventanillas-de-salud
Consulado General en Nueva York. (2019). Ventanilla de Salud. Secretaría de Relaciones Exteriores. https://consulmex.sre.gob.mx/nuevayork/index.php/espanol/programas/ventanilla-de-salud
Consumer News and Business Channel. (2018, February 9). Trump Administration May Make It Harder for Immigrants Who Use Public Benefits. https://www.cnbc.com/2018/02/09/trump-administration-may-target-immigrants-who-use-food-aid-other-benefits.html
Délano, A. (2018). From Here and There: Diaspora Policies, Integration and Social Rights beyond Borders. Oxford University Press.
Department of Homeland Security (DHS). (2019). Annual Report. Migration Enforcement Actions 2017. https://www.dhs.gov/immigration-statistics/enforcement-actions
Department of Homeland Security v. New York. (2020, January 20). 589 U. S. ____ 2020. https://www.supremecourt.gov/opinions/19pdf/19a785_j4ek.pdf
General Assembly. (1948). Universal Declaration of Human Rights. United Nations. https://undocs.org/en/A/PV.183
General Assembly. (2015). Transforming our World: The 2030 Agenda for Sustainable Development. United Nations. https://undocs.org/en/A/RES/70/1
Gómez, O., Sesma, S., Becerril, V., Knaul, F. M., Arreola, H. & Frenk, J. (2011). Sistema de salud de México. Salud Pública de México, 53. http://saludpublica.mx/index.php/spm/article/view/5043/10023 DOI: https://doi.org/10.1590/S0036-36342011000500003
Gzesh, S. & Schiavon, J. A. (2018). La protección consular mexicana ante la administración Trump: Recomendaciones de acción inmediata (Documentos de Política Migratoria 02). CIDE, El Colegio de México, PUED-UNAM y Fundación Vidanta. https://migdep.colmex.mx/publicaciones/DPM-02.pdf
Hernández, D. (2015). Protección consular mexicana. Miguel Ángel Porrúa.
Instituto de los Mexicanos en el Exterior (IME). (2016). Ventanilla de Salud. https://www.gob.mx/ime/acciones-y-programas/ventanilla-de-salud
Jost, T. (2018). The Affordable Care Act under the Trump Administration. https://www.commonwealthfund.org/blog/2018/affordable-care-act-under-trump-administration
Kemmick, J., Alcalá, H. E., Roby, D. H., Grande, D. T., Alberto, C. K., McKenna, R. M. & Ortega, A. N. (2019). Disparities in Pediatric Provider Availability by Insurance Type after the ACA in California. Academic Pediatrics, 19(3), 325-332. https://doi.org/10.1016/j.acap.2018.09.003 DOI: https://doi.org/10.1016/j.acap.2018.09.003
Kennedy, K. (2018, January 21). Deportation Fears Have Legal Immigrants Avoiding Health Care. Associated Press News. http://www.apnewsarchive.com/2018/Deportation_fears_have_legal_immigrants_avoiding_health_care/id-9f893855e49143baad9c96816ec8f731
Luthi, S. (2020, January 28). Supreme Court Allows Trump to Enforce ‘Public Charge’ Immigration Rule. The Justices Lifted a Nationwide Injunction Against a Sweeping Policy Targeting Poor Immigrants. Politico. https://www.politico.com/news/2020/01/27/supreme-court-enforce-trump-immigration-rule-106520
Martínez, A. D., Ruelas, L. & Granger, D. A. (2018). Household Fear of Deportation in Relation to Chronic Stressors and Salivary Proinflammatory Cytokines in Mexican-Origin Families Post-SB 1070. SSM-Population Health, 5, 188-200. DOI: https://doi.org/10.1016/j.ssmph.2018.06.003
Matus, M., Ramírez, R. Castillo, E. & Cariño, G. L. (2016). Salud mental y tecnologías móviles en comunidades indígenas transnacionales. Frontera Norte, 28(56). 135-163.
Melo, M. A. (2017). Enacting Life: Dialysis Among Undocumented Mexican Immigrants in the U.S.-Mexico Borderlands (Dissertation for doctor degree). University of Texas at San Antonio. ProQuest, 10619059.
Merriam-Webster. (n. d.). Generation Z. https://www.merriam-webster.com/dictionary/Generation%20Z
Mines, R., Nichols, S. & Runsten, D. (2010). California's Indigenous Farmworkers. Final Report of the Indigenous Farmworker Study (IFS). http://www.indigenousfarmworkers.org/IFS%20Full%20Report%20_Jan2010.pdf
Mosler, E., Dag, J. & Laczko, F. (2018). Global Migration Indicators 2018: Insights from the Global Migration Data Portal. Berlin: Global Migration Data Analysis Centre (GMDAC), International Organization for Migration. https://publications.iom.int/system/files/pdf/global_migration_indicators_2018.pdf
Moya, L., Ayón, C. & Gurrola, M. (2013). Estamos Traumados: The Effect of Anti-Immigrant Sentiment and Policies on the Mental Health of Mexican Immigrant Families. Journal of Community Psychology, 41(8), 1005-1020. DOI: https://doi.org/10.1002/jcop.21589
Obamacare Facts (2018). Obamacare Facts: Facts on the Affordable Care Act. http://obamacarefacts.com/obamacare-facts/
Office of the Assistant Secretary for Planning and Evaluation. (2016). Impacts of the Affordable Care Act’s Medicaid Expansion on Insurance Coverage and Access to Care. ASPE Issue Brief. https://aspe.hhs.gov/sites/default/files/pdf/205141/medicaidexpansion.pdf
Office of the High Commissioner for Human Rights. (1966). International Covenant on Economic, Social and Cultural Rights. Pub. L. No. Resolution 2200A (XXI). United Nations.
Organization for Economic Cooperation and Development (OECD). (2019a). Health at a Glance 2019. https://www.oecd-ilibrary.org/sites/4dd50c09-en/1/1/1/index.html?itemId=/content/publication/4dd50c09-en&mimeType=text/html&_csp_=82587932df7c06a6a3f9dab95304095d&itemIGO=oecd&itemContentType=book#foreword-d1e15
Organization for Economic Cooperation and Development (OECD). (2019b) El gasto en salud superará el crecimiento del PIB en 2030. https://www.oecd.org/centrodemexico/medios/elgastoensaludsuperaraelcrecimientodelpiben2030.htm
Ortega, A. N., McKenna, R. M., Chen, J., Alcalá, H. E., Langellier, B. A. & Roby, D. H. (2017). Insurance Coverage and Well-Child Visits Improved for Youth under the Affordable Care Act, but Latino Youth Still Lag Behind. Academic Pediatrics. https://doi.org/10.1016/j.acap.2017.07.006 DOI: https://doi.org/10.1016/j.acap.2017.07.006
Pan American Health Organization (PAHO). (2018). Health of Refugees and Migrants: Regional Situation Analysis, Practices, Experiences, Lessons Learned and Ways Forward. World Health Organization.
Parmet, W. E. (2018, January 18). Immigration and Health Care under the Trump Administration. Health Affairs. https://www.healthaffairs.org/do/10.1377/hblog20180105.259433/full/
Protecting Immigrant Families. (2019, April 18). Trump’s Public Charge Proposal is Hurting Immigrant Families Now. Even Though DHS's Proposed Regulation is Not Final. https://protectingimmigrantfamilies.org/wp-content/uploads/2019/05/PIF-Documenting-Harm-Fact-Sheet-Final-4.18.19.pdf
Puhl, E. (2019). Totality of the Circumstances: Assessing the Public Charge Ground of Inadmissibility. Immigrant Legal Resource Center. https://www.ilrc.org/sites/default/files/resources/total_circum_assess_pub_charge_inadmis-20190503.pdf
Rangel, M. G., Tonda, J., Zapata, G. R., Flynn, M., Gany, F., Lara J., Shapiro, I. & Rosales, C. B. (2017). Ventanillas de Salud: A Collaborative and Binational Health Access and Preventive Care Program. Frontiers in Public Health. https://doi.org/10.3389/fpubh.2017.00151 DOI: https://doi.org/10.3389/fpubh.2017.00151
Rangel, M. G., Zapata, R., González, J. E., Tonda, J. & Cortés, P. (2016). Ventanillas de Salud: A Program Designed to Improve the Health of Mexican Immigrants Living in the United States. Migración y Salud, 95-102.
Rodríguez, R. (2014): Metodología de la Investigación. McGraw Hill.
Secretaría de Relaciones Exteriores. (2014). Normas para la realización del programa de consulados móviles en sus modalidades de “Consulados móviles”, “Jornadas sabatinas, dominicales o en días inhábiles”, “Consulados sobre ruedas” y “Actividades de documentación entre semana fuera de la oficina consular”. https://sre.gob.mx/images/stories/docnormateca/dgsc/2014/norm2801.pdf
Secretaría de Relaciones Exteriores. (2019). Ventanilla Virtual de Salud Mental. https://embamex.sre.gob.mx/alemania/index.php/es/proteccion-consular/ventanilla
The Henry J. Kaiser Family Foundation. (2013). Key Facts on Health Coverage for Low-Income Immigrants Today and Under the Affordable Care Act. http://kff.org/disparities-policy/fact-sheet/key-facts-on-health-coverage-for-low/
The Henry J. Kaiser Family Foundation. (2017). Summary of the American Health Care Act. http://files.kff.org/attachment/Proposals-to-Replace-the-Affordable-Care-Act-Summary-of-the-American-Health-Care-Act
United Nations. (2018). Global Compact for Safe, Orderly and Regular Migration. https://refugeesmigrants.un.org/sites/default/files/180713_agreed_outcome_global_compact_for_migration.pdf
U.S. Department of Health and Human Services. (2015). What is the Difference Between Medicare and Medicaid? http://www.hhs.gov/answers/medicare-and-medicaid/what-is-the-difference-between-medicare-medicaid/index.html
U.S. Department of Health and Human Services. (2019). (Formal communication issued on March 5, 2019). https://delauro.house.gov/sites/delauro.house.gov/files/HHS_UAC_Reallocation_352019.pdf
U.S. Citizen and Immigration Services. (2019). Final Rule on Public Charge Ground of Inadmissibility. https://www.uscis.gov/legal-resources/final-rule-public-charge-ground-inadmissibility
Valdovinos, R. (2019, May 13). Paper Presented at Primer Coloquio de Estudios sobre Diásporas, Roundtable 2 “Ejercicio transnacional de derechos sociales y políticos”. Universidad Iberoamericana at Mexico City and El Colef.
Valle, V. M. & Ortiz, C. B. (2015). Mexican Immigrants’ Access to Healthcare on the U.S.-Mexican Border. Voices of Mexico, 100 (Special Section). http://www.revistascisan.unam.mx/Voices/pdfs/10022.pdf
Vera, E. (2019, May 14). Paper presented at Primer Coloquio de Estudios sobre Diásporas, Roundtable 4: “Políticas públicas y buenas prácticas”. Universidad Iberoamericana at Mexico City and El Colef.
White House. (2017, January 25). Executive Order: Enhancing Public Safety in the Interior of the United States. https://www.whitehouse.gov/presidential-actions/executive-order-enhancing-public-safety-interior-united-states/