By Mary Engel
Los Angeles Times Staff Writer
November 27, 2007
Illegal immigrants from Mexico and other Latin American countries are 50% less likely than U.S.-born Latinos to use hospital emergency rooms in California, according to a study published Monday in the journal Archives of Internal Medicine.
The cost of providing healthcare and other government services to illegal immigrants looms large in the national debate over immigration.
In Los Angeles County, much of the focus of that debate has been on hospital emergency rooms. Ten have closed in the last five years, citing losses from treating the uninsured, and those that remain open are notorious for backlogs.
By federal law, hospitals must treat every emergency, regardless of a person’s insurance — or immigration — status. Illegal immigrants, who often work at jobs that don’t offer health insurance, are commonly seen as driving both the closures and the crowding.
But the study found that while illegal immigrants are indeed less likely to be insured, they are also less likely to visit a doctor, clinic or emergency room.
“The current policy discourse that undocumented immigrants are a burden on the public because they overuse public resources is not borne out with data, for either primary care or emergency department care,” said Alexander N. Ortega, an associate professor at UCLA’s School of Public Health and the study’s lead author. “In fact, they seem to be underutilizing the system, given their health needs.”
Ira Mehlman, media director for the Federation for American Immigration Reform, a group that lobbies for tougher immigration controls, said that usage rates are just one measure of illegal immigrants’ effect on healthcare. The other factor, he said, is the cost to taxpayers, which Ortega’s study did not examine.
Cost estimates vary widely. A Rand Corp. study published last year in the journal Health Affairs put the cost of healthcare for illegal immigrants nationwide at $1.1 billion a year, excluding care for those younger than 18 and older than 64.
FAIR called the Rand number a “low-ball” estimate. Its own study of healthcare costs of illegal immigrants and their dependents, including U.S.-born children, estimated California’s portion alone to be about $1.5 billion a year.
Mehlman said $1.5 billion “is still a significant amount of money, unless you’re Bill Gates.”
Ortega’s study is not the first to find that illegal immigrants use fewer healthcare services than people born in the U.S. But his study used the largest sample, analyzing data from 42,044 participants of the 2003 California Health Interview Survey, a randomized telephone survey conducted by the UCLA Center for Health Policy Research and the California Department of Public Health.
And while other studies have attributed lower usage to immigrants simply being younger and healthier than the overall population, the study published Monday took into account age, health status, insurance status and poverty level. All such factors being equal, it found, immigrants still made fewer visits to physicians and were 30% less likely than U.S.-born Latinos to have a regular source of healthcare.
Dr. Felix Nuñez, a Los Angeles-based family physician and former medical director of the South Central Family Health Center, said the findings confirm what he sees in clinics.
Illegal immigrants are infrequent patients for primary care visits, he said, because being asked for ID cards, Social Security numbers and employment histories makes them nervous. They fear being reported to authorities, even though the information is used only to determine Medi-Cal eligibility or to set a sliding-scale fee.
What did surprise Nuñez was the relatively low use of emergency rooms by illegal immigrants.
“My gut would have told me that they’d be higher users of emergency services because they’re not coming in for routine, preventive care,” he said. “This kind of study is really important because it forces you to look at the data and rethink your assumptions.”