Spending 55% less for immigrants than U.S.-born residents
08:57 PM CDT on Monday, July 25, 2005
By Sherry Jacobson
The Dallas Morning News
A new national study suggests that immigrants in the United States receive about half as much medical care as their American counterparts.
U.S.-born residents averaged $2,564 in annual health care costs compared with per capita immigrant care that averaged $1,139, about 55 percent less, according to the study published Monday in the American Journal of Public Health.
The study concluded that the spending disparity refuted the notion that immigrants were “a substantial burden” on the U.S. health-care system.
It estimated that immigrant care accounted for $39.5 billion, or almost 8 percent of U.S. health-care spending in 1998, the year that was analyzed. Immigrants made up 10 percent of the U.S. population in 2000.
“These are the most recent numbers we had to work with,” said Dr. Olveen Carrasquillo of Columbia University and one of the study’s authors. “We have no reason to think that the expenditure for immigrant care has gone up in recent years as a percentage of the entire cost.”
However, Dallas health officials said Monday that there was another way to look at the numbers. The officials wondered whether the lower cost of health care for immigrants signaled that they were having trouble accessing medical services.
“You can explain this disparity as a lack of access due to language, financial and insurance barriers,” said Dr. Ron Anderson, president and chief executive officer of Parkland Memorial Hospital, which services a large immigrant population.
“There’s nothing to celebrate in this study,” he said.
Dr. Michele Smith, who treats immigrants at the Community Health Clinic in East Dallas, said it was not uncommon to diagnose more advanced diseases in immigrants, who waited too long to see a doctor.
“We see women with cervical and breast cancer who haven’t had Pap smears and mammograms” that could have caught the disease earlier, she said. “Our patients are from Mexico, Africa and the various Asian countries. Many of the women in their 60s have never had these basic tests.”
Dr. David Buhner, medical director of the Dallas County health department, noted that the lack of insurance probably was the main reason immigrants had such trouble getting into the U.S. system.
“The ticket to access is health insurance, and if you don’t have it, you can’t get in,” he said.
Higher ER costs
In fact, the study found that immigrants were more likely to use the emergency room for basic treatment than to go to the doctor’s office. Although immigrant children had a lower rate of ER visits than American-born children, their average ER costs were three times higher because immigrant children tended to be sicker when they arrived.
The study estimated that 25 percent of U.S. immigrants lack public or private health insurance. However, immigrants were broadly defined as anyone born outside the U.S., including people who had moved to this country decades ago.
“It included people from Scandinavia who’ve been here 20 years and are citizens now,” Dr. Buhner said. “There would probably be even a greater disparity in health-care spending if it had looked at just undocumented workers. Their barriers to care are associated with being poor and uninsured.”
The study found that Asian immigrants had health-care expenses similar to U.S.-born residents, while Hispanics and blacks suffered the largest disparities in such spending.
Dr. Anderson noted that the longer immigrants resided in the United States, the more likely they were to become insured. About 25 percent of Texans are uninsured, one of the highest rates in the nation.
“Thirty-eight percent of our patients are uninsured because of our mission to serve the indigent,” he said. “We’re going to get a higher burden of uninsured patients.”
The authors of the study also theorized that immigrants receive a smaller proportion of health care than they pay for.
The study also challenged the belief that immigrants are to blame for the rising cost of U.S. health care, said Dr. Sarita A. Mohanty of the University of Southern California and the lead author of the report.
Myth debunked
“Our study lays to rest the myth that expensive care for immigrants is responsible for our nation’s high health costs,” she said. “The truth is, immigrants get far less care than other Americans. Our data indicates that many immigrants are actually helping to subsidize care for the rest of us.”
The study’s authors presented it as the first nationwide analysis of immigrant health-care expenditures, basing it on data from the Agency for Healthcare Research and Quality. It considered data collected from 21,241 people who took part in the 1998 Medical Expenditure Panel Survey.
E-mail sjacobson@dallasnews.com
