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Maldonado A, Martinez DE, Villavicencio EA, Crocker R, Garcia DO. Salud sin Fronteras: Identifying Determinants of Frequency of Healthcare Use among Mexican immigrants in Southern Arizona. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02024-x. [PMID: 38833092 DOI: 10.1007/s40615-024-02024-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/16/2024] [Accepted: 05/08/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Guided by Andersen's Behavioral Model of Health Services Use (BMHSU), this study aimed to identify determinants of post-migration healthcare use among a sample of Mexican immigrants in a US-Mexico border region in Southern Arizona, while considering pre-migration health and healthcare experiences. METHODS A non-probabilistic convenience sample of 300 adult Mexican immigrants completed a telephone survey to assess healthcare practices. Multivariable logistic regressions were fitted to determine adjusted relationships between frequency of care and predisposing, enabling, need, and contextual factors as well as personal health practices. RESULTS Overall, participants had a 79% probability of receiving healthcare "at least once a year" after migrating to Southern Arizona. Receiving post-migration healthcare was associated with predisposing, enabling, need, contextual factors, and personal health practices (p < 0.05). DISCUSSION Consistent with BMHSU, our findings suggest that frequency of healthcare is not only a function of having post-migration health insurance but is also shaped by a complex array of other factors. The results of this study shed light onto potential areas to be leveraged by multifactorial sociocultural interventions to increase Mexican immigrants' frequency of healthcare services use.
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Affiliation(s)
- Adriana Maldonado
- Mel and Enid Zuckerman College of Public Health, Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, 85724, USA.
| | - Daniel E Martinez
- College of Social and Behavioral Sciences, School of Sociology, University of Arizona, Tucson, AZ, 85724, USA
| | - Edgar A Villavicencio
- Mel and Enid Zuckerman College of Public Health, Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, 85724, USA
| | | | - David O Garcia
- Mel and Enid Zuckerman College of Public Health, Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, 85724, USA
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Ferre Z, Triunfo P, Antón JI. Immigrant assimilation in health care utilisation in Spain. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:701-715. [PMID: 37525076 PMCID: PMC11136863 DOI: 10.1007/s10198-023-01622-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023]
Abstract
Abundant evidence has tracked the labour market and health assimilation of immigrants, including static analyses of differences in how foreign-born and native-born residents consume health care services. However, we know much less about how migrants' patterns of healthcare usage evolve with time of residence, especially in countries providing universal or quasi-universal coverage. We investigate this process in Spain by combining all the available waves of the local health survey, which allows us to separately identify period, cohort, and assimilation effects. We find robust evidence of migrant assimilation in health care use, specifically in visits to general practitioners and emergency care and among foreign-born women. The differential effects of ageing on health care use between foreign-born and native-born populations contributes to the convergence of utilisation patterns in most health services after 15 years in Spain. Substantial heterogeneity by the time of arrival and by region of origin both suggest that studies modelling future welfare state finances would benefit from a more thorough assessment of migration.
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Affiliation(s)
- Zuleika Ferre
- Department of Economics, Faculty of Social Sciences, University of the Republic (Uruguay), Montevideo, Uruguay
| | - Patricia Triunfo
- Department of Economics, Faculty of Social Sciences, University of the Republic (Uruguay), Montevideo, Uruguay
| | - José-Ignacio Antón
- Department of Applied Economics, Faculty of Economics and Business, University of Salamanca, Salamanca, Spain.
- Instituto Universitario Gutiérrez Mellado, Universidad Nacional de Educación a Distancia, Madrid, Spain.
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Bazikian S, Urbina D, Hsu CH, Gonzalez KA, Rosario ER, Chu DI, Tsui J, Tan TW. Examining health care access disparities in Hispanic populations with peripheral artery disease and diabetes. Vasc Med 2023; 28:547-553. [PMID: 37642640 PMCID: PMC10712238 DOI: 10.1177/1358863x231191546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
INTRODUCTION This study investigated disparities in health care access for Hispanic adults with diabetes and peripheral artery disease (PAD) who are at risk of lower-extremity amputation and other cardiovascular morbidities and mortalities. METHODS We utilized the health care access survey data from the All of Us research program to examine adults (⩾ 18 years) with either diabetes and/or PAD. The primary associations evaluated were: could not afford medical care and delayed getting medical care in the past 12 months. Multivariable logistic regression models were used to assess the association of Hispanic ethnicity and survey responses, adjusting for age, sex, income, health insurance, and employment status. RESULTS Among 24,104 participants, the mean age was 54.9 years and 67% were women. Of these, 8.2% were Hispanic adults. In multivariable analysis, Hispanic adults were more likely to be unable to afford seeing a health care provider, and receiving emergency care, follow-up care, and prescription medications (p < 0.05) than non-Hispanic adults. Furthermore, Hispanic adults were more likely to report being unable to afford medical care due to cost (odds ratios [OR] 1.72, 95% CI 1.50-1.99), more likely to purchase prescription drugs from another country (OR 2.20, 95% CI 1.69-2.86), and more likely to delay getting medical care due to work (OR 1.46, 95% CI 1.22-1.74) and child care (OR 1.80, 95% CI 1.35-2.39) issues than non-Hispanic White adults. CONCLUSION The Hispanic population with diabetes and PAD faces substantial barriers in health care access, including a higher likelihood of delaying medical care and being unable to afford it.
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Affiliation(s)
- Sebouh Bazikian
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
| | | | | | | | - Emily R. Rosario
- Research Institute at Case Colina Hospital and Centers for Healthcare, Pamona, CA, USA
| | - Dan I. Chu
- Heershink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer Tsui
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
| | - Tze-Woei Tan
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
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Gaitán-Rossi P, Vilar-Compte M, Ferré-Eguiluz I, Ortiz L, Garcia E. Association between Feelings of Trust and Security with Subjective Health among Mexican Migrants in the New York City Area. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2981. [PMID: 36833676 PMCID: PMC9966475 DOI: 10.3390/ijerph20042981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
The size of the foreign-born population living in the United States makes migrants' health a substantive policy issue. The health status of Mexican immigrants might be affected by the level of social capital and the social context, including the rhetoric around immigration. We hypothesize that a diminished perception of trust and safety in the community has a negative impact on self-reported health. In a cross-sectional study, we conducted a survey among 266 Mexican Immigrants in the New York City Area who used the Mexican Consulate between May and June 2019 for regular services provided to documented and undocumented immigrants. A univariate and bivariate descriptive analysis by trust and security items first shows the diversity of the Mexican population living in the US and the conditions of vulnerability. Then, logistic regression models estimate the association between trust and security items with self-reported health status. Results show that safety is consistently associated with good self-rated health, especially when rating the neighborhood, and trust showed mixed results, more reliant to the way it is operationalized. The study illustrates a pathway by which perceptions of the social context are associated with migrants' health.
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Affiliation(s)
- Pablo Gaitán-Rossi
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, Mexico City 01219, Mexico
| | - Mireya Vilar-Compte
- Department of Public Health, Montclair State University, Montclair, NJ 07043, USA
| | - Isabel Ferré-Eguiluz
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, Mexico City 01219, Mexico
| | - Luis Ortiz
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, Mexico City 01219, Mexico
| | - Erika Garcia
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, Mexico City 01219, Mexico
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Schober T, Zocher K. Health-Care Utilization of Refugees: Evidence from Austria. INTERNATIONAL MIGRATION REVIEW 2022. [DOI: 10.1177/01979183211061091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
European countries have experienced significant inflows of migrants in the past decade, including many refugees from regions engaged in armed conflicts. Although previous research on migrant health has largely focused on economic migration, empirical evidence on refugee health is sparse. This article uses administrative data from Austria to differentiate between economic migrants and refugees and to analyze both groups’ health-care expenditures in comparison to natives. We contribute to the literature on migrant health in several dimensions. First, we follow economic migrants and refugees over the first five years after arrival and show different health-care expenditure patterns among migration groups. In contrast to patterns for economic migrants, we find substantially higher health-care expenditures for refugees compared to natives, especially in the first year after arrival. This difference is not explained by specific diseases or individual refugee groups, indicating refugees’ generally inferior health status in the first years of settlement. Second, we focus on the health effects of granting asylum and find that the expenditure differences decrease after a positive asylum decision. In the last part, by using refugees’ quasi-random placement as a natural experiment, we show that the local health-care sector's characteristics do not have a significant effect on expenditure levels. The findings highlight the importance of distinguishing between migrant groups in the analysis of health-care utilization and show that the time spent in the host country, as well as legal status, have a substantial impact on migrants’ health-care utilization.
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Affiliation(s)
- Thomas Schober
- Department of Economics, Christian Doppler Laboratory for Aging, Health, and the Labor Market, Johannes Kepler University Linz, Linz, Austria
| | - Katrin Zocher
- Department of Economics, Christian Doppler Laboratory for Aging, Health, and the Labor Market, Johannes Kepler University Linz, Linz, Austria
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Bustamante AV, Chen J, Félix Beltrán L, Ortega AN. Health Policy Challenges Posed By Shifting Demographics And Health Trends Among Immigrants To The United States. Health Aff (Millwood) 2021; 40:1028-1037. [PMID: 34228519 DOI: 10.1377/hlthaff.2021.00037] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Since the 1960s the immigrant population in the United States has increased fourfold, reaching 44.7 million, or 13.7 percent of the US population, in 2018. The shifting immigrant demography presents several challenges for US health policy makers. We examine recent trends in immigrant health and health care after the Great Recession and the nationwide implementation of the Affordable Care Act. Recent immigrants are more likely to have lower incidence of chronic health conditions than other groups in the US, although these differences vary along the citizenship and documentation status continuum. Health care inequities among immigrants and US-born residents increased after the Great Recession and later diminished after the Affordable Care Act took effect. Unremitting inequities remain, however, particularly among noncitizen immigrants. The number of aging immigrants is growing, which will present a challenge to the expansion of coverage to this population. Health care and immigration policy changes are needed to integrate immigrants successfully into the US health care system.
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Affiliation(s)
- Arturo Vargas Bustamante
- Arturo Vargas Bustamante is a professor in the Department of Health Policy and Management at the UCLA Fielding School of Public Health, and faculty director of research at the UCLA Latino Policy and Politics Initiative, University of California Los Angeles, in Los Angeles, California
| | - Jie Chen
- Jie Chen is a professor in the Department of Health Policy and Management, School of Public Health, University of Maryland, in College Park, Maryland
| | - Lucía Félix Beltrán
- Lucía Félix Beltrán is a research assistant in the Department of Health Policy and Management, UCLA Fielding School of Public Health
| | - Alexander N Ortega
- Alexander N. Ortega is a professor in the Department of Health Management and Policy, Drexel University Dornsife School of Public Health, in Philadelphia, Pennsylvania
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Himmelstein J, Himmelstein DU, Woolhandler S, Bor DH, Gaffney A, Zallman L, Dickman S, McCormick D. Health Care Spending And Use Among Hispanic Adults With And Without Limited English Proficiency, 1999-2018. Health Aff (Millwood) 2021; 40:1126-1134. [PMID: 34228521 DOI: 10.1377/hlthaff.2020.02510] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
One in seven people in the US speak Spanish at home, and twenty-five million people in the US have limited English proficiency. Using nationally representative data from the Medical Expenditure Panel Survey, we compare health care spending for and health care use by Hispanics adults with limited English proficiency with spending for and use by English-proficient Hispanic and non-Hispanic adults. During 2014-18 mean annual per capita expenditures were $1,463 (35 percent) lower for Hispanic adults with limited English proficiency than for Hispanic adults who were English proficient, after adjustment for respondents' characteristics. Hispanic adults with limited English proficiency also made fewer outpatient and emergency department visits, had fewer inpatient days, and received fewer prescription medications than Hispanic adults who were English proficient. Health care spending gaps between Hispanic adults with limited English proficiency and non-Hispanic adults with English proficiency widened between 1999 and 2018. These language-based gaps in spending and use raise concern that language barriers may be obstructing access to care, resulting in underuse of medical services by adults with limited English proficiency.
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Affiliation(s)
- Jessica Himmelstein
- Jessica Himmelstein is a fellow in internal medicine, Cambridge Health Alliance, in Cambridge, Massachusetts
| | - David U Himmelstein
- David U. Himmelstein is a distinguished professor of public health at Hunter College, City University of New York, in New York, New York, and a lecturer in medicine at Cambridge Health Alliance/Harvard Medical School
| | - Steffie Woolhandler
- Steffie Woolhandler is a distinguished professor of public health at Hunter College, City University of New York, and a lecturer in medicine at Cambridge Health Alliance/Harvard Medical School
| | - David H Bor
- David H. Bor is a professor of medicine at Harvard Medical School, in Boston, Massachusetts, and chief academic officer at Cambridge Health Alliance
| | - Adam Gaffney
- Adam Gaffney is an assistant professor of medicine at Harvard Medical School and is in the Division of Pulmonary and Critical Care Medicine at Cambridge Health Alliance
| | - Leah Zallman
- Leah Zallman, who died in November 2020, was director of research at the Institute for Community Health, an assistant professor of medicine at Harvard Medical School, and a primary care physician at Cambridge Health Alliance, when this research was conducted
| | - Samuel Dickman
- Samuel Dickman is the medical director for primary care at Planned Parenthood South Texas, in San Antonio, Texas
| | - Danny McCormick
- Danny McCormick is an associate professor of medicine at Harvard Medical School and director of the Division of Social and Community Medicine in the Department of Medicine, Cambridge Health Alliance
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8
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Disability, food insecurity by nativity, citizenship, and duration. SSM Popul Health 2020; 10:100550. [PMID: 32090167 PMCID: PMC7026296 DOI: 10.1016/j.ssmph.2020.100550] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 01/08/2023] Open
Abstract
Prior research examines the prevalence of either disability or food insecurity among immigrants. We examine whether the presence of a disability operates as a stronger predictor of food insecurity among prime-aged immigrants relative to the US-born. Probit models estimate the relationship of disability with food insecurity among immigrants and distinguish by duration of US residence and citizenship status using nationally representative data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2014. Descriptively, food insecurity was highest among non-citizen immigrants with longer durations of US residence, compared to non-citizen immigrants with shorter durations and naturalized immigrants. Multivariate results suggest that among Hispanics, the association between disability and food insecurity was stronger among immigrants compared to US-born adults; the disability-food insecurity association varied by an immigrant's duration of US residence and citizenship status. The results emphasize the importance of disaggregating by citizenship status and duration of US residence.
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9
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Health Care Access and Utilization Among U.S. Immigrants Before and After the Affordable Care Act. J Immigr Minor Health 2019; 21:211-218. [PMID: 29633069 DOI: 10.1007/s10903-018-0741-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We examine changes in health insurance coverage and access to and utilization of health care before and after the national implementation of the Patient Protection and Affordable Care Act (ACA) among the U.S. adult immigrant population. Data from the 2011-2016 National Health Interview Survey are used to compare adult respondents in 2011-2013 (before the ACA implementation) and 2014-2016 (after the ACA implementation). Multivariable logistic regression analyses are used to compare changes over time. This study shows that the ACA has closed the coverage gap that previously existed between U.S. citizens and non-citizen immigrants. We find that naturalized citizens, non-citizens with more than 5 years of U.S. residency, and non-citizens with 5 years or less of U.S. residency reduced their probability of being uninsured by 5.81, 9.13, and 8.23%, respectively, in the first 3 years of the ACA. Improvements in other measures of access and utilization were also observed.
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10
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Bustamante AV, McKenna RM, Viana J, Ortega AN, Chen J. Access-To-Care Differences Between Mexican-Heritage And Other Latinos In California After The Affordable Care Act. Health Aff (Millwood) 2019; 37:1400-1408. [PMID: 30179559 DOI: 10.1377/hlthaff.2018.0416] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We examined changes in health insurance coverage and access to and use of health care among adult (ages 18-64) Latinos in the US before (2007-13) and after (2014-16) implementation of the main provisions of the Affordable Care Act. Data from the California Health Interview Survey were used to compare respondents in the two periods. We used multivariable and decomposition regression analyses to investigate the role of documentation status in access disparities between Mexicans and other Latinos in California. Our findings show that after the implementation of these provisions in California, insurance coverage increased for US- and foreign-born Latinos, including undocumented Latinos. Our decomposition analyses show that after implementation, disparities between Mexicans and other Latinos declined with respect to having coverage and a usual source of care. Without the implementation of these provisions in 2014, these disparities would have been 5.76 percent and 0.31 percent larger, respectively. In contrast, legal documentation status was positively associated with disparities between Mexicans and other Latinos in having coverage and physician visits. If Mexican Latinos had had the same share of undocumented immigrants as other Latinos, disparities in health insurance coverage would have declined by 24.17 percent.
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Affiliation(s)
- Arturo Vargas Bustamante
- Arturo Vargas Bustamante ( ) is an associate professor of health policy and management at the Jonathan and Karin Fielding School of Public Health, University of California Los Angeles (UCLA)
| | - Ryan M McKenna
- Ryan M. McKenna is an assistant professor of health management and policy at the Drexel University Dornsife School of Public Health, in Philadelphia, Pennsylvania
| | - Joseph Viana
- Joseph Viana is a graduate student researcher at the Jonathan and Karin Fielding School of Public Health at UCLA
| | - Alexander N Ortega
- Alexander N. Ortega is a professor in and chair of the Department of Health Management and Policy, Drexel University Dornsife School of Public Health
| | - Jie Chen
- Jie Chen is an associate professor of health services administration at the University of Maryland, in College Park
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11
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Gutierrez CM. The Institutional Determinants of Health Insurance: Moving Away from Labor Market, Marriage, and Family Attachments under the ACA. AMERICAN SOCIOLOGICAL REVIEW 2018; 83:1144-1170. [PMID: 35572763 PMCID: PMC9098124 DOI: 10.1177/0003122418811112] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
For more than a century, the American welfare state required working-age adults to obtain social welfare benefits through their linkages to employers, spouses, or children. Recent changes to U.S. healthcare policy prompted by the Patient Protection and Affordable Care Act (ACA), however, provide adults with new pathways for accessing a key form of social welfare-health insurance-decoupled from employers, spouses, and children. Taking advantage of this fundamental shift in the country's system of social welfare provision, I use data from the National Survey on Drug Use and Health (NSDUH) to explore patterns of health insurance coverage from before and after the ACA became active in 2014. The results show that the salience of labor market, marriage, and family attachments as pathways to coverage significantly declined in the first three years following passage of the ACA. By providing adults with a new route to coverage decoupled from their institutional attachments, the ACA helped narrow health insurance inequalities across gender, race and ethnicity, and education. Given the strong association between health insurance and health outcomes, the results from this study raise important questions about the centrality of institutional attachments for our knowledge of health inequalities.
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12
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Zallman L, Woolhandler S, Touw S, Himmelstein DU, Finnegan KE. Immigrants Pay More In Private Insurance Premiums Than They Receive In Benefits. Health Aff (Millwood) 2018; 37:1663-1668. [PMID: 30273017 DOI: 10.1377/hlthaff.2018.0309] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
As US policy makers tackle immigration reform, knowing whether immigrants are a burden on the nation's health care system can inform the debate. Previous studies have indicated that immigrants contribute more to Medicare than they receive in benefits but have not examined whether the roughly 50 percent of immigrants with private coverage provide a similar subsidy or even drain health care resources. Using nationally representative data, we found that immigrants accounted for 12.6 percent of premiums paid to private insurers in 2014, but only 9.1 percent of insurer expenditures. Immigrants' annual premiums exceeded their care expenditures by $1,123 per enrollee (for a total of $24.7 billion), which offsets a deficit of $163 per US-born enrollee. Their net subsidy persisted even after ten years of US residence. In 2008-14, the surplus premiums of immigrants totaled $174.4 billion. These findings suggest that policies curtailing immigration could reduce the numbers of "actuarially desirable" people with private insurance, thereby weakening the risk pool.
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Affiliation(s)
- Leah Zallman
- Leah Zallman ( ) is the director of research at the Institute for Community Health, in Malden, Massachusetts, and an assistant professor of medicine at Harvard Medical School, in Boston, Massachusetts
| | - Steffie Woolhandler
- Steffie Woolhandler is a professor of health policy at Hunter College, City University of New York, in New York City, and a lecturer in medicine at Harvard Medical School
| | - Sharon Touw
- Sharon Touw is an epidemiologist at the Institute for Community Health
| | - David U Himmelstein
- David U. Himmelstein is a professor of health policy at Hunter College, City University of New York, and a lecturer in medicine at Harvard Medical School
| | - Karen E Finnegan
- Karen E. Finnegan is an epidemiologist at the Institute for Community Health
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13
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Flavin L, Zallman L, McCormick D, Wesley Boyd J. Medical Expenditures on and by Immigrant Populations in the United States: A Systematic Review. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2018; 48:601-621. [PMID: 30088434 DOI: 10.1177/0020731418791963] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In health care policy debates, discussion centers around the often-misperceived costs of providing medical care to immigrants. This review seeks to compare health care expenditures of U.S. immigrants to those of U.S.-born individuals and evaluate the role which immigrants play in the rising cost of health care. We systematically examined all post-2000, peer-reviewed studies in PubMed related to health care expenditures by immigrants written in English in the United States. The reviewers extracted data independently using a standardized approach. Immigrants' overall expenditures were one-half to two-thirds those of U.S.-born individuals, across all assessed age groups, regardless of immigration status. Per capita expenditures from private and public insurance sources were lower for immigrants, particularly expenditures for undocumented immigrants. Immigrant individuals made larger out-of-pocket health care payments compared to U.S.-born individuals. Overall, immigrants almost certainly paid more toward medical expenses than they withdrew, providing a low-risk pool that subsidized the public and private health insurance markets. We conclude that insurance and medical care should be made more available to immigrants rather than less so.
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Affiliation(s)
- Lila Flavin
- 1 Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Leah Zallman
- 2 Institute for Community Health and Department of Psychiatry, CHA, Malden, Massachusetts, USA.,3 Harvard Medical School, Boston, Massachusetts, USA
| | - Danny McCormick
- 3 Harvard Medical School, Boston, Massachusetts, USA.,4 Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - J Wesley Boyd
- 5 Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA.,6 Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA
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14
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Sommers BD, McMURTRY CL, Blendon RJ, Benson JM, Sayde JM. Beyond Health Insurance: Remaining Disparities in US Health Care in the Post-ACA Era. Milbank Q 2018; 95:43-69. [PMID: 28266070 DOI: 10.1111/1468-0009.12245] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Benjamin D Sommers
- Harvard T.H. Chan School of Public Health.,Harvard Medical School.,Brigham & Women's Hospital
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15
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Nghiem SH, Connelly LB. Convergence and determinants of health expenditures in OECD countries. HEALTH ECONOMICS REVIEW 2017; 7:29. [PMID: 28819772 PMCID: PMC5560333 DOI: 10.1186/s13561-017-0164-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/31/2017] [Indexed: 05/30/2023]
Abstract
This study examines the trend and determinants of health expenditures in OECD countries over the 1975-2004 period. Based on recent developments in the economic growth literature we propose and test the hypothesis that health care expenditures in countries of similar economic development level may converge. We hypothesise that the main drivers for growth in health care costs include: aging population, technological progress and health insurance. The results reveal no evidence that health expenditures among OECD countries converge. Nevertheless, there is evidence of convergence among three sub-groups of countries. We found that the main driver of health expenditure is technological progress. Our results also suggest that health care is a (national) necessity, not a luxury good as some other studies in this field have found.
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Affiliation(s)
- Son Hong Nghiem
- The Australian Research Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4059 Kelvin Grove Australia
| | - Luke Brian Connelly
- Centre for the Business and Economics of Health, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD 4072 Australia
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Corrigan PW, Torres A, Lara JL, Sheehan L, Larson JE. Prioritizing the healthcare needs of Latinos with mental illness. INTERNATIONAL JOURNAL OF CULTURE AND MENTAL HEALTH 2017; 10:19-32. [PMID: 30505348 PMCID: PMC6261424 DOI: 10.1080/17542863.2016.1246581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Latinos with serious mental illness have higher morbidity and mortality rates than same age peers. In this paper, we review findings of a community based participatory research project meant to identify important health needs of this group, barriers to these needs, solutions to the barriers and the promise of peer navigators as a solution. Findings from a prior qualitative study yielded 84 themes related to needs, barriers and solutions. These findings were transposed into individual items, to which 122 Latino participants with mental illness responded using a 7-point importance scale. Results showed item importance means ranging from 4.34 to 5.47, with counseling/therapy services and mental health treatment topping the list for healthcare needs. Analyses also examined differences between those born in the USA versus those born elsewhere. Latinos who were native to the USA differed significantly from those born abroad in over one quarter of importance ratings. Implications of these findings for integrated care of Latinos with serious mental illness are discussed.
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Affiliation(s)
- Patrick W Corrigan
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois
| | - Alessandra Torres
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois
| | - Juana L Lara
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois
| | - Lindsay Sheehan
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois
| | - Jonathon E Larson
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois
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Choi S. Experiencing Unmet Medical Needs or Delayed Care Because of Cost: Foreign-Born Adults in the U.S. by Region of Birth. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2016; 46:693-711. [PMID: 27496545 DOI: 10.1177/0020731416662610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED Healthy People 2020 in the United States highlights timely access to necessary health care as a major factor that can reduce health-related disparities. This study examined the prevalence of delaying/missing necessary health care because of cost among foreign-born adults (26+ years old) in the United States by their region of origin, after controlling for geographic clustering at the county and state levels. METHODS Using the pooled 2007-2011 National Health Interview Survey and linked state/county-level data, this study analyzed data on 61,732 foreign-born adults from nine regions of birth. Three-level multilevel modeling (state > county > individual) was conducted. The age-adjusted percentages of foreign-born adults who delayed/missed necessary health care because of cost varied by region of birth, ranging from 7.0% (Southeast Asia) and 11.9% (Europe) to 15.5% (Mexico/Central America/Caribbean) and 16.7% (the Middle East). However, after controlling for geographic clustering and other individual-level covariates (e.g., insurance), adults from Mexico/Central America/Caribbean were less likely to delay or not receive necessary care compared to their counterparts from all other parts of the world except for those from Asian regions. This study implies that disparities can be reduced if some known risk factors (e.g., insurance) are improved among foreign-born adults.
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Affiliation(s)
- Sunha Choi
- College of Social Work, The University of Tennessee, Knoxville, Tennessee, USA
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18
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Sommers BD, Chua K, Kenney GM, Long SK, McMorrow S. California's Early Coverage Expansion under the Affordable Care Act: A County-Level Analysis. Health Serv Res 2016; 51:825-45. [PMID: 26443883 PMCID: PMC4874826 DOI: 10.1111/1475-6773.12397] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To assess the coverage effects of California's 2011 Low-Income Health Program (LIHP), enacted as an "early expansion" under the Affordable Care Act (ACA), and to demonstrate the feasibility of using Census data to measure county-level coverage changes. DATA SOURCES/STUDY SETTING 2008-2012 American Community Survey (ACS). The sample contained California adults ages 19-64 years (n = 237,876) and children 0-18 years (n = 113,159) with incomes below 200 percent of the federal poverty level. STUDY DESIGN Differences-in-differences analysis comparing public coverage, private insurance, and the uninsured rate in counties that expanded the LIHP in 2011 versus California counties not expanding during this time. Additional analyses tested for heterogeneous impacts of the LIHP and spillover effects on children. PRINCIPAL FINDINGS Compared to nonexpansion counties, public coverage for adults increased by 1.8 percentage points (p = .02) in expanding counties, while the uninsured rate declined by 2.1 percentage points (p = .01). There was no significant change in private coverage. Public coverage gains were largest for Latinos and those with limited English proficiency. The expansion produced a positive spillover effect on children's Medicaid enrollment. CONCLUSIONS California's 2011 expansion produced significant increases in public coverage for low-income individuals, particularly Latinos. Substate coverage analyses with the ACS can add valuable detail to future assessments of the ACA.
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Affiliation(s)
| | - Kao‐Ping Chua
- Department of PediatricsSection of Academic PediatricsUniversity of ChicagoChicagoIL
- Department of Public Health SciencesUniversity of ChicagoChicagoIL
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Gee GC, Morey BN, Walsemann KM, Ro A, Takeuchi DT. Citizenship as Privilege and Social Identity: Implications for Psychological Distress. THE AMERICAN BEHAVIORAL SCIENTIST 2016; 60:680-704. [PMID: 37850037 PMCID: PMC10580256 DOI: 10.1177/0002764216632834] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Citizenship is both a system of privilege and a source of social identity. This study examines whether there are disparities in psychological distress between citizens and noncitizens, and whether these disparities may be explained by markers of social disadvantage (e.g., poverty, discrimination) or perceptions of success in the United States (i.e., subjective social status). We analyze data from the Asian subsample (n = 2,095) of the National Latino and Asian American Study. The data show that noncitizens report greater psychological distress compared with naturalized citizens and native-born citizens after accounting for sociodemographics (e.g., age, gender, Asian subgroup), socioeconomic characteristics (education, employment, income-to-poverty ratio), immigration (e.g., interview language, years in the United States, acculturative stress), health care visits, and everyday discrimination. Preliminary evidence suggests that subjective social status may explain some of the disparities between naturalized citizen and noncitizen Asian Americans.
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Affiliation(s)
- Gilbert C. Gee
- University of California Los Angeles, Los Angeles, CA, USA
| | | | | | - Annie Ro
- University of California Irvine, Irvine, CA, USA
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20
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Chen J, Mullins CD, Novak P, Thomas SB. Personalized Strategies to Activate and Empower Patients in Health Care and Reduce Health Disparities. HEALTH EDUCATION & BEHAVIOR 2016; 43:25-34. [PMID: 25845376 PMCID: PMC4681678 DOI: 10.1177/1090198115579415] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Designing culturally sensitive personalized interventions is essential to sustain patients' involvement in their treatment and encourage patients to take an active role in their own health and health care. We consider patient activation and empowerment as a cyclical process defined through patient accumulation of knowledge, confidence, and self-determination for their own health and health care. We propose a patient-centered, multilevel activation and empowerment framework (individual-, health care professional-, community-, and health care delivery system-level) to inform the development of culturally informed personalized patient activation and empowerment (P-PAE) interventions to improve population health and reduce racial and ethnic disparities. We discuss relevant Affordable Care Act payment and delivery policy reforms and how they affect patient activation and empowerment. Such policies include Accountable Care Organizations and value-based purchasing, patient-centered medical homes, and the community health benefit. Challenges and possible solutions to implementing the P-PAE are discussed. Comprehensive and longitudinal data sets with consistent P-PAE measures are needed to conduct comparative effectiveness analyses to evaluate the optimal P-PAE model. We believe the P-PAE model is timely and sustainable and will be critical to engaging patients in their treatment, developing patients' abilities to manage their health, helping patients express concerns and preferences regarding treatment, empowering patients to ask questions about treatment options, and building up strategic patient-provider partnerships through shared decision making.
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Affiliation(s)
- Jie Chen
- University of Maryland, Baltimore, MD, USA
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21
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Chen J, Bustamante AV, Tom SE. Health care spending and utilization by race/ethnicity under the Affordable Care Act's dependent coverage expansion. Am J Public Health 2015; 105 Suppl 3:S499-507. [PMID: 25905850 DOI: 10.2105/ajph.2014.302542] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We estimated the effect of the ACA expansion of dependents' coverage on health care expenditures and utilization for young adults by race/ethnicity. METHODS We used difference-in-difference models to estimate the impact of the ACA expansion on health care expenditures, out-of-pocket payments (OOP) as a share of total health care expenditure, and utilization among young adults aged 19 to 26 years by race/ethnicity (White, African American, Latino, and other racial/ethnic groups), with adults aged 27 to 30 years as the control group. RESULTS In 2011 and 2012, White and African American young adults aged 19 to 26 years had significantly lower total health care spending compared with the 27 to 30 years cohort. OOP, as a share of health care expenditure, remained the same after the ACA expansion for all race/ethnicity groups. Changes in utilization following the ACA expansion among all racial/ethnic groups for those aged 19 to 26 years were not significant. CONCLUSIONS Our study showed that the impact of the ACA expansion on health care expenditures differed by race/ethnicity.
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Affiliation(s)
- Jie Chen
- Jie Chen is with the Department of Health Services Administration, School of Public Health, University of Maryland, College Park. Arturo Vargas Bustamante is with the Department of Health Policy and Management, Fielding School of Public Health, University of California-Los Angeles. Sarah E. Tom is with the Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland
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Affiliation(s)
- Benjamin D Sommers
- From the Department of Health Policy and Management, Harvard School of Public Health (B.D.S.), and Northeastern University School of Law (W.E.P.) - both in Boston
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Ortega AN, Rodriguez HP, Vargas Bustamante A. Policy dilemmas in Latino health care and implementation of the Affordable Care Act. Annu Rev Public Health 2015; 36:525-44. [PMID: 25581154 DOI: 10.1146/annurev-publhealth-031914-122421] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The changing Latino demographic in the United States presents a number of challenges to health care policy makers, clinicians, organizations, and other stakeholders. Studies have demonstrated that Latinos tend to have worse patterns of access to, and utilization of, health care than other ethnic and racial groups. The implementation of the Affordable Care Act (ACA) of 2010 may ameliorate some of these disparities. However, even with the ACA, it is expected that Latinos will continue to have problems accessing and using high-quality health care, especially in states that are not expanding Medicaid eligibility as provided by the ACA. We identify four current policy dilemmas relevant to Latinos' health and ACA implementation: (a) the need to extend coverage to the undocumented; (b) the growth of Latino populations in states with limited insurance expansion;
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Affiliation(s)
- Alexander N Ortega
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California 90095-1772; ,
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Vargas Bustamante A, Chen J. The great recession and health spending among uninsured U.S. immigrants: implications for the Affordable Care Act implementation. Health Serv Res 2014; 49:1900-24. [PMID: 24962550 DOI: 10.1111/1475-6773.12193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We study the association between the timing of the Great Recession (GR) and health spending among uninsured adults distinguishing by citizenship/nativity status and time of U.S. residence. DATA SOURCE Uninsured U.S. citizens and noncitizens from the 2005-2006 and 2008-2009 Medical Expenditure Panel Survey. STUDY DESIGN The probability of reporting any health spending and the natural logarithm of health spending are our main dependent variables. We compare health spending across population categories before/during the GR. Subsequently, we implement two-part regression analyses of total and specific health-spending measures. We predict average health spending before/during the GR with a smearing estimation. PRINCIPAL FINDINGS The probability of reporting any spending diminished for recent immigrants compared to citizens during the GR. For those with any spending, recent immigrants reported higher spending during the GR (27 percent). Average reductions in total spending were driven by the decline in the share of the population reporting any spending among citizens and noncitizens. CONCLUSIONS Our study findings suggest that recent immigrants could be forgoing essential care, which later translates into higher spending. It portrays the vulnerability of a population that would remain exposed to income shocks, even after the Affordable Care Act (ACA) implementation.
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Affiliation(s)
- Arturo Vargas Bustamante
- Department of Health Services, UCLA School of Public Health, 650 Charles E. Young Drive South Room 31-299C, Box 951772, Los Angeles, CA, 90095
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Martinez-Donate AP, Zhang X, Rangel MG, Hovell M, Simon NJ, Amuedo-Dorantes C, Sipan C, Guendelman S. Healthcare access among circular and undocumented Mexican migrants: results from a pilot survey on the Mexico-US border. ACTA ACUST UNITED AC 2014; 1:57-108. [PMID: 25364381 DOI: 10.1504/ijmbs.2014.065069] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Temporary and unauthorized migrants may face unique obstacles to access health care services in the U.S. OBJECTIVE This study estimated levels of health care access among Mexican migrants returning to Mexico from the U.S. and factors associated with access to health care, with emphasis on the role of modifiable, enabling factors. METHODS We conducted a pilot probability health care survey of migrants in the border city of Tijuana, Mexico (N=186). RESULTS Approximately 42% of migrants reported having used health care services in the U.S. during the past year. Only 38% had a usual source of care and approximately 11% went without needed medical care in the U.S. About 71% of migrants did not have health insurance in the U.S. Lack of health insurance and transportation limitations were significantly related to various access indicators. CONCLUSION These results have implications for future policies and programs aimed to address modifiable health care access barriers faced by these vulnerable and underserved segments of the Mexican migrant population.
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Affiliation(s)
| | - Xiao Zhang
- Department of Population Health Sciences, University of Wisconsin, Madison, WI
| | - M Gudelia Rangel
- Departamento de Estudios de Población, El Colegio de la Frontera Norte, Tijuana, Mexico
| | | | - Norma-Jean Simon
- Department of Population Health Sciences, University of Wisconsin, Madison, WI
| | | | - Carol Sipan
- Department of Health Sciences, University of California, Merced, CA
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Abstract
BACKGROUND Millions of adults will gain Medicaid or private insurance in 2014 under the Affordable Care Act, and prior research shows that underinsurance is common among middle-income adults. Less is known about underinsurance among low-income adults, particularly those with public insurance. OBJECTIVE To compare rates of underinsurance among low-income adults with private versus public insurance, and to identify predictors of being underinsured. DESIGN Descriptive and multivariate analysis of data from the 2005-2008 Medical Expenditure Panel Survey. PARTICIPANTS Adults 19-64 years of age with family income less than 125 % of the Federal Poverty Level (FPL) and full-year continuous coverage in one of four mutually exclusive insurance categories (N = 5,739): private insurance, Medicaid, Medicare, and combined Medicaid/Medicare coverage. MAIN MEASURES Prevalence of underinsurance among low-income adults, defined as out-of-pocket expenditures greater than 5 % of household income, delays/failure to obtain necessary medical care due to cost, or delays/failure to obtain necessary prescription medications due to cost. KEY RESULTS Criteria for underinsurance were met by 34.5 % of low-income adults. Unadjusted rates of underinsurance were 37.7 % in private coverage, 26.0 % in Medicaid, 65.1 % in Medicare, and 45.1 % among Medicaid/Medicare dual enrollees. Among underinsured adults, household income averaged $6,181 and out-of-pocket spending averaged $1,115. Due to cost, 8.1 % and 12.8 % deferred or delayed obtaining medical care or prescription medications, respectively. Predictors of underinsurance included being White, unemployed, and in poor health. After multivariate adjustment, Medicaid recipients were significantly less likely to be underinsured than privately insured adults (OR 0.22, 95 % CI 0.17-0.28). CONCLUSIONS Greater than one-third of low-income adults nationally were underinsured. Medicaid recipients were less likely to be underinsured than privately insured adults, indicating potential benefits of expanded Medicaid under health care reform. Nonetheless, more than one-quarter of Medicaid recipients were underinsured, highlighting the importance of addressing cost-related barriers to care even among those with public coverage.
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Affiliation(s)
- Hema Magge
- Division of General Pediatrics,, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
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Vargas Bustamante A, Chen J, Fang H, Rizzo JA, Ortega AN. Identifying health insurance predictors and the main reported reasons for being uninsured among US immigrants by legal authorization status. Int J Health Plann Manage 2013; 29:e83-e96. [PMID: 24038524 DOI: 10.1002/hpm.2214] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 04/04/2013] [Accepted: 07/15/2013] [Indexed: 11/07/2022] Open
Abstract
This study identifies differences in health insurance predictors and investigates the main reported reasons for lacking health insurance coverage between short-stayed (≤ 10 years) and long-stayed (>10 years) US immigrant adults to parse the possible consequences of the Affordable Care Act among immigrants by length of stay and documentation status. Foreign-born adults (18-64 years of age) from the 2009 California Health Interview Survey are the study population. Health insurance coverage predictors and the main reasons for being uninsured are compared across cohorts and by documentation status. A logistic-regression two-part multivariate model is used to adjust for confounding factors. The analyses determine that legal status is a strong health insurance predictor, particularly among long-stayed undocumented immigrants. Immigration status is the main reported reason for lacking health insurance. Although long-stayed documented immigrants are likely to benefit from the Affordable Care Act implementation, undocumented immigrants and short-stayed documented immigrants may encounter difficulties getting health insurance coverage.
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Affiliation(s)
- Arturo Vargas Bustamante
- Department of Health Policy and Management, University of California Los Angeles Fielding School of Public Health, Los Angeles, California, USA
| | - Jie Chen
- Department of Health Services Administration, University of Maryland, College Park, Maryland, USA
| | - Hai Fang
- Center for Health Development Studies, Peking University, Beijing, China
| | - John A Rizzo
- Department of Economics, Stony Brook University, Stony Brook, New York, USA
| | - Alexander N Ortega
- Department of Health Policy and Management, University of California Los Angeles Fielding School of Public Health, Los Angeles, California, USA
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Abstract
Using two nationally representative data sets, this study examined health care expenditure disparities between Caucasians and different Asian American subgroups. Multivariate analyses demonstrate that Asian Americans, as a group, have significantly lower total expenditures compared with Caucasians. Results also point to considerable heterogeneities in health care spending within Asian American subgroups. Findings suggest that language assistance programs would be effective in reducing disparities among Caucasians and Asian American subgroups with the exception of Indians and Filipinos, who tend to be more proficient in English. Results also indicate that citizenship and nativity were major factors associated with expenditure disparities. Socioeconomic status, however, could not explain expenditure disparities. Results also show that Asian Americans have lower physician and pharmaceutical costs but not emergency department or hospital expenditures. These findings suggest the need for culturally competent policies specific to Asian American subgroups and the necessity to encourage cost-effective treatments among Asian Americans.
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Affiliation(s)
- Jie Chen
- University of Maryland, College Park, MD 20742, USA.
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