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Health care for Immigrants

Many Americans believe that immigrants, especially undocumented immigrants, serve to drain resources from the health care system. This recent review adds to other research that provides evidence to the contrary.

Though some Americans may believe that immigrants are a burden by utilizing the health care system, research has shown that immigrants have less access to health insurance and use fewer health care resources than citizens.  This study sought to further examine the role that immigration plays in health care expenditures in the United States.

Source: Chris (Flickr/CC)

Source: Chris (Flickr/CC)

Immigrants were categorized as recent (being in the United States for fewer than 10 years) and established (more than 10 years).  Immigrants were less likely than US-born adults to report being in fair or poor health, to have one chronic health condition, or to have any activity limitation.  Immigrants were more likely to be uninsured than were US-born adults.  However 44 percent of recent immigrants and 63 percent of established immigrants were insured for the 12 months of the analysis period.

Data for this study were derived from the 2003 Medical Expenditure Panel Survey and is representative of the United States’ civilian non-institutionalized population. In univariate analysis, the average total annual medical expenditure of recent immigrants was less than half that of US-born adults ($1308 vs. $3156, p<0.001). The average total annual medical expenditure of established immigrants was about two-thirds that of US-born adults ($1950 vs. $3156, p<0.01).  Immigrants had lower public and private medical expenditures, lower medical utilization, fewer medical visits, fewer inpatient admissions, fewer outpatient hospital visits, and fewer emergency room visits.

5.1 percent of the national population of adults are recent immigrants. This immigrant population only incurs 2.3 percent of the total medical expenditures and 1.4 percent of the public medical expenditures.  11.6 percent of the national population of adults are established immigrants. The established immigrant population only incurs 7.8 percent of the nation’s total medical expenditures and only 8.9 percent of the nation’s public expenditures for health care.

On multivariate analysis, established immigrants were 26 percent less likely to have any medical expenses compared to the US-born population (OR 95% confident interval 0.58-0.94). Recent immigrants were 39 percent less likely to have any medical expenses compared to the U-born population (OR 95% confidence interval 0.45-0.81). Other statistically significant factors associated with decreased medical expenditures included non-white race, male gender, lower educational achievement, and income less than 400% of the federal poverty level.


Even when insured, immigrants incurred very low levels of medical expenditures relative to the US-born population.  This may speak to immigrants’ lower access to care or a lack of cultural competence (including language barriers) among health care providers. Medically under-served geographic areas are at the heart of the issue and should be addressed as the nation adopts a health reform plan.  Indeed, immigrants are not a burden to the health care system (although more analysis needs to be made along the divide between documented and undocumented non-citizens). A more fairly designed way of distributing health care resources should be afforded to these members of our society.

Am J Public Health. 2009. 99: 1322-1328.

This Policy Prescriptions® review is written by Kameron L. Matthews, MD, JD.


Kameron Matthews, MD, JD, FAAFP
About Kameron Matthews, MD, JD, FAAFP

Lead Analyst – Access to Care Kameron Matthews MD, JD is a board-certified family physician and currently serves as Deputy Executive Director of Provider Relations and Services in the Office of Community Care at the Veterans Health Administration in Washington, DC. She earned her medical degree from Johns Hopkins University and her law degree from the University of Chicago. Contact: Facebook | Twitter | More Posts