Health Care Expenditures of Immigrants in the United States: A Nationally Representative Analysis

Department of Medicine, Division of Geriatric and General Internal Medicine, University of Southern California, 2020 Zonal Ave, IRD 627, Los Angeles, CA 90033, USA.
American Journal of Public Health (Impact Factor: 4.55). 09/2005; 95(8):1431-8. DOI: 10.2105/AJPH.2004.044602
Source: PubMed


We compared the health care expenditures of immigrants residing in the United States with health care expenditures of US-born persons.
We used the 1998 Medical Expenditure Panel Survey linked to the 1996-1997 National Health Interview Survey to analyze data on 18398 US-born persons and 2843 immigrants. Using a 2-part regression model, we estimated total health care expenditures, as well as expenditures for emergency department (ED) visits, office-based visits, hospital-based outpatient visits, inpatient visits, and prescription drugs.
Immigrants accounted for $39.5 billion (SE=$4 billion) in health care expenditures. After multivariate adjustment, per capita total health care expenditures of immigrants were 55% lower than those of US-born persons ($1139 vs $2546). Similarly, expenditures for uninsured and publicly insured immigrants were approximately half those of their US-born counterparts. Immigrant children had 74% lower per capita health care expenditures than US-born children. However, ED expenditures were more than 3 times higher for immigrant children than for US-born children.
Health care expenditures are substantially lower for immigrants than for US-born persons. Our study refutes the assumption that immigrants represent a disproportionate financial burden on the US health care system.

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    • "Data also challenge the popular belief that immigrants consume more than their fair share of societal resources. For example, Mohanty et al. (2005) showed that healthcare expenditures for immigrants living in the USA were 55 % lower than for their US-born counterparts: these ratios held for both uninsured and publicly insured groups. Similarly, in a study of 20 EU countries, Barrett and Maıˆtre (2013) found that, with the exception of Portugal, immigrants were less likely than native-born people of working age to be receiving sickness or disability support. "
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    • "In our multivariate analyses, we adopt the following variables, which have been used extensively in the previous literature (Mohanty et al. 2005; Ku 2009). These variables include respondents' age, gender, race/ethnicity (white, Latino, African American, Asian American, other race), marital status (married), education (no high school degree, high school degree, college degree, and advanced degree), interview language (English vs. other), citizenship/immigration status (U.S.-born, U.S.-naturalized, non-U.S. "
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    ABSTRACT: To examine the association between the Great Recession of 2007-2009 and health care expenditures along the health care spending distribution, with a focus on racial/ethnic disparities. Secondary data analyses of the Medical Expenditure Panel Survey (2005-2006 and 2008-2009). Quantile multivariate regressions are employed to measure the different associations between the economic recession of 2007-2009 and health care spending. Race/ethnicity and interaction terms between race/ethnicity and a recession indicator are controlled to examine whether minorities encountered disproportionately lower health spending during the economic recession. The Great Recession was significantly associated with reductions in health care expenditures at the 10th-50th percentiles of the distribution, but not at the 75th-90th percentiles. Racial and ethnic disparities were more substantial at the lower end of the health expenditure distribution; however, on average the reduction in expenditures was similar for all race/ethnic groups. The Great Recession was also positively associated with spending on emergency department visits. This study shows that the relationship between the Great Recession and health care spending varied along the health expenditure distribution. More variability was observed in the lower end of the health spending distribution compared to the higher end.
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    • "Two factors have been suggested as the main reasons why immigrants have lower medical expenditures than U.S.-born individuals: immigrants are relatively healthier, and they may have less access to health insurance [19,35]. Welfare reform legislation, such as the Illegal Immigration Reform and Immigrant Responsibility Act, has substantially restricted recent immigrants’ eligibility for governmental health services [20]. "
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    ABSTRACT: Background No national study has investigated whether immigrant workers are less likely than U.S.-workers to seek medical treatment after occupational injuries and whether the payment source differs between two groups. Methods Using the 2004–2009 Medical Expenditure Panel Survey (MEPS) data, we estimated the annual incidence rate of nonfatal occupational injuries per 100 workers. Logistic regression models were fitted to test whether injured immigrant workers were less likely than U.S.-born workers to seek professional medical treatment after occupational injuries. We also estimated the average mean medical expenditures per injured worker during the 2 year MEPS reference period using linear regression analysis, adjusting for gender, age, race, marital status, education, poverty level, and insurance. Types of service and sources of payment were compared between U.S.-born and immigrant workers. Results A total of 1,909 injured U.S.-born workers reported 2,176 occupational injury events and 508 injured immigrant workers reported 560 occupational injury events. The annual nonfatal incidence rate per 100 workers was 4.0% (95% CI: 3.8%-4.3%) for U.S.-born workers and 3.0% (95% CI: 2.6%-3.3%) for immigrant workers. Medical treatment was sought after 77.3% (95% CI: 75.1%-79.4%) of the occupational injuries suffered by U.S.-born workers and 75.6% (95% CI: 69.8%-80.7%) of the occupational injuries suffered by immigrant workers. The average medical expenditure per injured worker in the 2 year MEPS reference period was $2357 for the U.S.-born workers and $2,351 for immigrant workers (in 2009 U.S. dollars, P = 0.99). Workers’ compensation paid 57.0% (95% CI: 49.4%-63.6%) of the total expenditures for U.S.-born workers and 43.2% (95% CI: 33.0%-53.7%) for immigrant workers. U.S.-born workers paid 6.7% (95% CI: 5.5%-8.3%) and immigrant workers paid 7.1% (95% CI: 5.2%-9.6%) out-of-pocket. Conclusions Immigrant workers had a statistically significant lower incidence rate of nonfatal occupational injuries than U.S.-born workers. There was no significant difference in seeking medical treatment and in the mean expenditures per injured worker between the two groups. The proportion of total expenditures paid by workers’ compensation was smaller (marginally significant) for immigrant workers than for U.S.-born workers.
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