This paper provides background information on existing refugee health policy as spelled out in the Refugee Act of 1980, consideration that issues in health and health care have received, and significant program development that has occurred in addressing health care problems. Following the introduction, Section II describes the following: (1) basic U.S. policy concerning the refugee public health system; (2) components of the system (at overseas camps, ports of entry, and local public health facilities); (3) evolution of the system and corrective actions taken since 1979 (screenings overseas and at ports of entry, data collection and information/records transfer, and domestic screening and assessments); and (4) continuing concerns about the system in terms of costs and ramifications for public health in the United States. Section III describes the domestic refugee health system in terms of basic policy, components (initial links to the health care system, follow-up treatment, and funding), and continuing concerns (the timeliness of the delivery of health services, the availability of appropriate services, and the use of the Medicaid financing mechanism and refugee dependency). Conclusions presented in section IV are that in order to address the issue of health care for refugees, there needs to be a better understanding of the problem, clarification of goals, analysis of alternatives, and discussion of the implications of proposed changes.