untreated. All of these consequences may create additional barriers to successful adjustment by immigrants to their new society.
Health insurance provides an important degree of financial access to health care services. Numerous studies have demonstrated that children who have neither private health insurance or Medicaid or any other public coverage receive fewer physician visits overall, fewer visits for the care of chronic conditions, and fewer preventive health care services compared to insured children (Newacheck et al., 1996; Stoddard et al., 1994; Wood et al., 1990; Brown, 1989).
Other factors also influence access. Having a regular provider of care provides a connection to the health care system, facilitating both access to services and continuity of care. Having a regular provider has consistently been found to increase a person's use of health care services (Berk et al., 1995; Andersen and Davidson, 1996). Whether health care services are geographically available to children also has been found to affect their use of ambulatory care services and rates of avoidable hospitalizations (Andersen and Davidson, 1996; Valdez and Dallek, 1991). Cultural factors, including language barriers and customs, affect access for immigrant and other ethnic and racial minority population groups (Aday et al., 1993; Board on Children and Families, 1995).
Despite these benefits, the provision of publicly funded health care services to noncitizens in the United States has become a highly charged policy and political issue. The dispute has focused on both legal immigrants' entitlement to federal health and welfare programs and undocumented, or illegal, immigrants' use of government-funded health and educational services (Fix and Passel, 1994; U.S. General Accounting Office, 1995; Clark et al., 1994). Although recent major changes in federal law will affect legal and undocumented immigrants' entitlement to health care services and other programs, few studies have examined immigrants' access to health insurance coverage and health care services (Thamer et al., 1997; Edmonston, 1996).
The research and theoretical literature on access to health care has focused considerable attention on disparities by ethnicity and race. Latinos have very high uninsured rates, followed by Asians, African Americans, and non-Latino whites (Mendoza, 1994;