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Impact of United States 2017 Immigration Policy changes on missed appointments at two Massachusetts Safety-Net Hospitals



Studies have shown mixed findings regarding the impact of immigration policy changes on immigrants’ utilization of primary care.


We used a difference-in-differences analysis to compare changes in missed primary care appointments over time across two groups: patients who received care in Spanish, Portuguese, or Haitian Creole, and non-Hispanic, white patients who received care in English.


After adjustment for age, sex, race, insurance, hospital system, and presence of chronic conditions, immigration policy changes were associated with an absolute increase in the missed appointment prevalence of 0.74 percentage points (95% confidence interval: 0.34, 1.15) among Spanish, Portuguese and Haitian-Creole speakers. We estimated that missed appointments due to immigration policy changes resulted in lost revenue of over $185,000.


We conclude that immigration policy changes were associated with a significant increase in missed appointments among patients who receive medical care in languages other than English.

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This study was funded by the Cambridge Health Alliance Foundation and the Pisacano Leadership Foundation of the American Board of Family Medicine.

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Correspondence to Lara Z. Jirmanus MD, MPH.

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Jirmanus, L.Z., Ranker, L., Touw, S. et al. Impact of United States 2017 Immigration Policy changes on missed appointments at two Massachusetts Safety-Net Hospitals. J Immigrant Minority Health 24, 807–818 (2022).

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  • Immigrants
  • Healthcare Access
  • Primary care
  • Immigration Policy
  • Fear
  • Missed appointments
  • Massachusetts
  • Limited English proficiency