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Investigating Health Insurance Disparities Among Latino Immigrants in Puerto Rico

People walking in downtown San Juan, PR

July 15, 2021

A new study led by Alexandra C. Rivera-González, a PhD student in the department of Health Management and Policy (HMP) at the Dornsife School of Public Health (DSPH), titled “The Other U.S. Border: Health Insurance Coverage Among Latino Immigrants in Puerto Rico” was recently published in Health Affairs’ July 2021 issue. This research examines health insurance disparities among Latino immigrants in Puerto Rico.

Puerto Rico, a territory of the United States, is historically a popular destination for Dominican, Cuban, Mexican, and other Latino people to migrate to in the Caribbean. There is also a large undocumented Latino immigrant population on the island, especially from the Dominican Republic. Despite this significant migration to Puerto Rico, U.S. border and immigrant health research has largely been overlooked.

Rivera-González and fellow researchers analyzed data from a Puerto Rico Community Survey that spanned six years and found that among non–Puerto Rican Latinos ranging from ages 18–64, Dominicans had a significantly lower probability of having any health insurance compared to other Latino groups.

Rivera-González said, “As a Puerto Rico native, I knew the island’s Latino immigrant profile was very different from the U.S. mainland, but I never expected to find such clear and alarming between-group health care inequities. The lack of research on Latino immigrants in Puerto Rico is astonishing and reinforces the importance of our work."

Puerto Rico’s fragile economic status and recent public health disasters like earthquakes and the ongoing COVID-19 pandemic have also left this population particularly vulnerable. It is critical that health care access barriers are addressed.

Alex Ortega, PhD, a professor in the department of HMP at DSPH and advisor to Rivera-González, is senior author of this study. He points out the stark differences between Latino immigrants in Puerto Rico and those in the continental U.S.

“Even though there is U.S. Immigration and Customs Enforcement (ICE) on the island and immigrants in Puerto Rico are subjected to U.S. federal laws, Latino immigrants in Puerto Rico have a different experience than U.S. mainland Latino immigrants given their shared Spanish language and culture with island Puerto Ricans,” Ortega said. "Despite these social advantages in Puerto Rico, Latino immigrants on the island face health care inequities largely due to lack of insurance coverage." 

These findings can help inform local and federal policy makers as well as public health professionals who aim to eliminate care disparities and develop population health initiatives targeted for immigrants on the island. 

According to Rivera-González, “With this study, we not only hope to establish a baseline for the much-needed work on immigrants in Puerto Rico and border health but also bring awareness to an issue that has been extensively overlooked yet requires immediate action. Providing health insurance is merely a first step towards improving population health and protecting the basic human rights of immigrants, particularly undocumented immigrants, in Puerto Rico.”

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Additional co-authors of this study include Jim P. Stimpson, PhD, professor in the department of HMP at DSPH, Dylan H. Roby, PhD, associate professor in and associate chair of the department of Health Policy and Management at the University of Maryland School of Public Health, Glorisa Canino, PhD, professor in the department of Pediatrics and director of the Behavioral Sciences Research Institute in the School of Medicine, University of Puerto Rico, Jonathan Purtle, DrPH, MPH, associate professor in the department of HMP at DSPH, and Scarlett L. Bellamy, ScD, professor in the department of Epidemiology and Biostatistics at DSPH.