The U.S. Health System and Immigration: An Institutional Interpretation1


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     The study on which this article is based was supported by a Senior Investigator Award from the Robert Wood Johnson Foundation. The authors thank the Foundation and its officers for their generous backing. They acknowledge with gratitude the assistance of Lisa Konczal, Barry University; Leah Varga, University of Miami; and Margarita Cervantes and Cristina Escobar, research associates of Princeton’s Center for Migration and Development, who conducted part of the fieldwork for this study. David Mechanic and the editors of SF offered helpful comments. None of the above bear any responsibility for the contents.


We examine the institutions that comprise the U.S. health system and their relationship to a surging immigrant population. The clash between the system and this human flow originates in the large number of immigrants who are unauthorized, poor, and uninsured and, hence, unable to access a system largely based on ability to pay. Basic concepts from sociological theory are brought to bear on the analysis of this clash and its consequences. Data from a recently completed study of health institutions in three areas of the United States are used as an empirical basis to illustrate various aspects of this complex relation. Implications of our results for theory and future health policy are discussed.