Health Service Utilization Among Immigrants to the United States

  • Ilana Redstone Akresh


This study uses data from the New Immigrant Survey and Andersen’s behavioral model, a commonly used framework for health care utilization, to examine the utilization patterns of Asian and Hispanic immigrants to the United States. Results indicate that the behavioral framework is well suited to predicting immigrants’ physician visits and dentist visits. However, this model is less appropriate for determining the likelihood of reporting a hospital as the primary source of medical care or immigrants’ use of non Western treatments. Importantly, years in the U.S. exhibits a robust, positive relationship with physician and dental visits for both groups even after controlling for several predisposing characteristics, self-assessed and physician-diagnosed need, pointing to the importance of this as an enabling factor in health care access and use.


Immigrants Health service utilization Health 


  1. Abraido-Lanza, A., Viladrich, A., Florez, K. R., Cespedes, A., Aguirre, A. N., & De La Cruz, A. A. (2007). Commentary: Fatalismo reconsidered: A cautionary note for health-related research and practice with Latino populations. Ethnicity & Disease, 17(1), 153–158.Google Scholar
  2. Aday, L. A., & Andersen, R. (1974). A framework for the study of access to medical care. Health Services Research, 9(3), 208–220.Google Scholar
  3. Aday, L. A., & Andersen, R. (1975). Development of indices of access to medical care. Ann Arbor, Michigan: University of Michigan Health Administration Press.Google Scholar
  4. Aday, L. A., Andersen, R., & Fleming, G. (1980). Health care in the U.S.: Equitable for whom?. Beverly Hills, CA: Sage.Google Scholar
  5. Akresh, I. R. (2006a). Contexts of english language use among first generation immigrants. The International Migration Review, 41(4), 930–955. doi: 10.1111/j.1747-7379.2007.00106.x.CrossRefGoogle Scholar
  6. Akresh, I. R. (2006b). Occupational mobility among legal immigrants to the United States. The International Migration Review, 40(4), 854–885. doi: 10.1111/j.1747-7379.2006.00046.x.CrossRefGoogle Scholar
  7. Akresh, I. R. (2007). Dietary assimilation and health among hispanic immigrants to the United States. Journal of Health and Social Behavior, 48(4), 404–417.Google Scholar
  8. Akresh, I. R., & Frank, R. (2008). Health selection among new immigrants. American Journal of Public Health, 98(11), 2058–2064 doi: 10.2105/AJPH.2006.100974.CrossRefGoogle Scholar
  9. Andersen, R. (1968). A behavioral model of families’ use of health services. Chicago, IL: Center for Health Administration Studies.Google Scholar
  10. Andersen, R. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1–10. doi: 10.2307/2137284.CrossRefGoogle Scholar
  11. Andersen, R., & Aday, L. A. (1978). Access to medical care in the U.S.: Realized and potential. Medical Care, 16(7), 533–546. doi: 10.1097/00005650-197807000-00001.CrossRefGoogle Scholar
  12. Andersen, R., & Newman, J. F. (1973). Societal and individual determinants of medical care utilization in the United States. The Milbank Memorial Fund Quarterly, 51(1), 95–124. doi: 10.2307/3349613.CrossRefGoogle Scholar
  13. Balcazar, H., & Krull, J. L. (1999). Determinants of birth–weight outcomes among Mexican-American women: Examining conflicting results about acculturation. Ethnicity & Disease, 9(3), 410–422.Google Scholar
  14. Bedos, C., Brodeur, J.- M., Benigeri, M., & Olivier, M. (2004). Utilization of preventive dental services by recent immigrants in Quebec. Canadian Journal of Public Health, 95(3), 219–223.Google Scholar
  15. Berk, M. L., Schur, C. L., Chavez, L. R., & Frankel, M. (2000). Health care use among undocumented Latino immigrants. Health Affairs, 19(4), 51. doi: 10.1377/hlthaff.19.4.51.CrossRefGoogle Scholar
  16. Cadge, W., & Ecklund, E. H. (2006). Religious service attendance among immigrants: Evidence from the new immigrant survey-pilot. The American Behavioral Scientist, 49(11), 1574–1596. doi: 10.1177/0002764206288455.CrossRefGoogle Scholar
  17. Cairney, J., & Ostbye, T. (1999). Time since immigration and excess body weight. Canadian Journal of Public Health, 90(2), 120–124.Google Scholar
  18. Card, D. (2005). Is the new immigration really so bad? The Economic Journal, 115(507), F300–F323. doi: 10.1111/j.1468-0297.2005.01037.x.CrossRefGoogle Scholar
  19. Card, D., DiNardo, J., & Estes, E. (2000). The more things change: Immigrants and the children of immigrants in the 1940s, the 1970s, and the 1990s. In G. Borjas (Ed.), Issues in the economics of immigration (pp. 227–270). Chicago: University of Chicago Press.Google Scholar
  20. Chavez, L. R., Cornelius, W. A., & Jones, O. W. (1985). Mexican immigrants and the utilization of U.S. health services: The case of San Diego. Social Science & Medicine, 21(1), 93–102. doi: 10.1016/0277-9536(85)90291-6.CrossRefGoogle Scholar
  21. Chen, J., Ng, E., & Wilkins, R. (1996). The health of Canada’s immigrants in 1994–1995. Health Reports, 7(4), 33–45.Google Scholar
  22. Cho, Y., Frisbie, W. P., Hummer, R. A., & Rogers, R. G. (2004). Nativity, duration of residence, and the health of hispanic adults in the United States. The International Migration Review, 38(1), 184–211.Google Scholar
  23. Davis, E. E., Deinard, A. S., & Maiga, E. (2007). Doctor, my tooth hurts: The costs of incomplete dental care in the emergency room. Washington, D.C.: Annual Meeting: American Public Health Association.Google Scholar
  24. Ferro, M. A., Leis, A., Doll, R., Chiu, L., Chung, M., & Barroetavena, M.-C. (2007). The impact of acculturation on the use of traditional Chinese medicine in newly diagnosed Chinese cancer patients. Supportive Care in Cancer, 15(8), 985–992. doi: 10.1007/s00520-007-0285-0.CrossRefGoogle Scholar
  25. Frisbie, W. P., Cho, Y., & Hummer, R. A. (2001). Immigration and the health of Asian and Pacific islander adults in the United States. American Journal of Epidemiology, 153(4), 372–380. doi: 10.1093/aje/153.4.372.CrossRefGoogle Scholar
  26. Glied, S., & Neidell, M. (2008). The economic value of teeth. NBER Working Paper. 13879.Google Scholar
  27. Goel, M. S., McCarthy, E. P., Phillips, R. S., & Wee, C. C. (2004). Obesity among immigrant subgroups by duration of residence. Journal of the American Medical Association, 292(23), 2860–2867. doi: 10.1001/jama.292.23.2860.CrossRefGoogle Scholar
  28. Gordon-Larsen, P., Harris, K. M., Ward, D. S., & Popkin, B. M. (2003). Acculturation and overweight-related behaviors among hispanic immigrants to the US: The national longitudinal study of adolescent health. Social Science & Medicine, 57(11), 2023–2034. doi: 10.1016/S0277-9536(03)00072-8.CrossRefGoogle Scholar
  29. Himmelgreen, D. A., Pérez, E., Martinez, D., Bretnall, A., Eells, B., Peng, Y., et al. (2003). The longer you stay, the bigger you get: Length of time and language use in the U.S. are associated with obesity in Puerto Rican women. American Journal of Physical Anthropology, 125(1), 90–96. doi: 10.1002/ajpa.10367.CrossRefGoogle Scholar
  30. Jasso, G., Massey, D. S., Rosenzweig, M. R., & Smith, J. P. (2005). Immigration, health, and New York city: Early results based on the US New Immigrant Cohort of 2003. FRBNY Economic Policy Review, 11, 127–151.Google Scholar
  31. Jasso, G., Massey, D. S., Rosenzweig, M. R., & Smith, J. P. (Forthcoming). The U.S. new immigrant survey: Overview and preliminary results based on the new-immigrant cohorts of 1996 and 2003. In B. Morgan & B. Nicholson (Eds.), Longitudinal surveys and cross-cultural survey design. UK Immigration Research and Statistics Service. London: Crown Publishing.Google Scholar
  32. Jenkins, C. N. H., Le, T., McPhee, S. J., Stewart, S., & Ngoc The, Ha. (1996). Health care access and preventive care among Vietnamese immigrants: Do traditional beliefs and practices pose barriers? Social Science & Medicine, 43(7), 1049–1056. doi: 10.1016/0277-9536(95)00368-1.CrossRefGoogle Scholar
  33. Kaplan, M. S., & Marks, G. (1990). Adverse effects of acculturation: Psychological stress among Mexican American young adults. Social Science & Medicine, 31(12), 1313–1319. doi: 10.1016/0277-9536(90)90070-9.CrossRefGoogle Scholar
  34. Kim, M., Han, H.- R., Kim, K. B., & Duong, D. N. (2002). The use of traditional and Western medicine among Korean American elderly. Journal of Community Health, 27(2), 109–120. doi: 10.1023/A:1014509200352.CrossRefGoogle Scholar
  35. Ku, L., & Matani, S. (2001). Left out: Immigrants’ access to health care and insurance. Health Affairs, 20(1), 247–256. doi: 10.1377/hlthaff.20.1.247.CrossRefGoogle Scholar
  36. Kuo, T., & Torres-Gil, F. M. (2001). Factors affecting utilization of health services and home- and community-based care programs by older Taiwanese in the United States. Research on Aging, 23(1), 14–36. doi: 10.1177/0164027501231002.CrossRefGoogle Scholar
  37. Lai, D., & Chappell, N. (2007). Use of traditional Chinese medicine by older Chinese immigrants in Canada. Family Practice, 24(1), 56–64. doi: 10.1093/fampra/cml058.CrossRefGoogle Scholar
  38. Laroche, M. (2000). Health status and health services utilization of Canada’s immigrant and non-immigrant populations. Canadian Public Policy, 26(1), 51–75. doi: 10.2307/3552256.CrossRefGoogle Scholar
  39. LeClere, F. B., Jensen, L., & Biddlecom, A. E. (1994). Health care utilization, family context, and adaptation among immigrants to the United States. Journal of Health and Social Behavior, 35(4), 370–384. doi: 10.2307/2137215.CrossRefGoogle Scholar
  40. Ma, G. X. (2004). Between two worlds: The use of traditional and western health services by Chinese immigrants. Journal of Community Health, 24(6), 421–437. doi: 10.1023/A:1018742505785.CrossRefGoogle Scholar
  41. Massey, D. S. (1981). Dimensions of the new immigration to the United States and the prospects for assimilation. Annual Review of Sociology, 7, 57–85. doi: 10.1146/ Scholar
  42. Massey, D. S. (1995). The new immigration and ethnicity in the United States. Population and Development Review, 21(3), 631–652. doi: 10.2307/2137753.CrossRefGoogle Scholar
  43. Massey, D. S., & Denton, N. A. (1987). Trends in the residential segregation of Blacks, Hispanics, and Asians: 1970–1980. American Sociological Review, 52(6), 802–825. doi: 10.2307/2095836.CrossRefGoogle Scholar
  44. Massey, D. S., & Denton, N. A. (1988). Residential segregation of Blacks, Hispanics, and Asians by socioeconomic status and generation. Social Science Quarterly, 69(4), 797–817.Google Scholar
  45. Massey, D. S., Gross, A. B., & Shibuya, K. (1994). Migration, segregation, and the geographic concentration of poverty. American Sociological Review, 59(3), 425–445. doi: 10.2307/2095942.CrossRefGoogle Scholar
  46. McDonald, J. T., & Kennedy, S. (2004). Insights into the ‘Healthy Immigrant Effect’: Health status and health service use of immigrants to Canada. Social Science & Medicine, 59(8), 1613–1637. doi: 10.1016/j.socscimed.2004.02.004.CrossRefGoogle Scholar
  47. Nagi, S. Z., & Haavio-Mannila, E. (1980). Migration, health status and utilization of health services. Sociology of Health & Illness, 2(2), 174–193. doi: 10.1111/1467-9566.ep10487787.CrossRefGoogle Scholar
  48. Natale-Pereira, A., Marks, J., Vega, M., Mouzon, D., Hudson, S. V., & Salas-Lopez, D. (2008). Barriers and facilitators for colorectal cancer screening practices in the Latino community: Perspectives from community leaders. Cancer Control, 15(2), 157–165.Google Scholar
  49. Newbold, K. B. (2005). Self-related health within the Canadian immigrant population: Risk and the health immigrant effect. Social Science & Medicine, 60(6), 1359–1370. doi: 10.1016/j.socscimed.2004.06.048.CrossRefGoogle Scholar
  50. Newbold, K. B., & Patel, Amish. (2006). Use of dental services by Canadian immigrants. Journal of the Canadian Dental Association, 72(2), 143.Google Scholar
  51. O’Callaghan, C., & Quine, S. (2007). How older Vietnamese Australian women manage their medicines. Journal of Cross-Cultural Gerontology, 22(4), 405–419. doi: 10.1007/s10823-007-9045-3.CrossRefGoogle Scholar
  52. Pang, K. Y. (1989). The practice of traditional Korean medicine in Washington, D.C. Social Science & Medicine, 28(8), 875–884. doi: 10.1016/0277-9536(89)90118-4.CrossRefGoogle Scholar
  53. Patrick, D. L., Stein, J., Porta, M., Porter, C. Q., & Ricketts, T. C. (1988). Poverty, health services, and health status in rural America. The Milbank Quarterly, 66(1), 105–136. doi: 10.2307/3349987.CrossRefGoogle Scholar
  54. Redstone, I., & Massey, D. S. (2004). Coming to stay: An analysis of the U.S. census question on year of arrival. Demography, 41(4), 721–738. doi: 10.1353/dem.2004.0035.CrossRefGoogle Scholar
  55. Scribner, R., & Dwyer, J. H. (1989). Acculturation and low birthweight among Latinos in the Hispanic HANES. American Journal of Public Health, 79(9), 1263–1267. doi: 10.2105/AJPH.79.9.1263.CrossRefGoogle Scholar
  56. Skeer, M., Cheng, D. M., Rigotti, N. A., & Siegel, M. (2005). Secondhand smoke exposure in the workplace. American Journal of Preventive Medicine, 28(4), 331–337. doi: 10.1016/j.amepre.2005.01.007.CrossRefGoogle Scholar
  57. U.S. Department of Homeland Security. (2003). Yearbook of Immigration Statistics. Washington, D.C.Google Scholar
  58. Van der Stuyft, P., De Muynck, A., Schillemans, L., & Timmerman, C. (1989). Migration, acculturation, and utilization of primary health care. Social Science and Medicine, 29(1), 53–60.CrossRefGoogle Scholar
  59. Waidmann, T. A., & Rajan, S. (2000). Race and ethnic disparities in health care access and utilization: An examination of state variation. Medical Care Research and Review, 57(1), 55–84. doi: 10.1177/107755800773743600.Google Scholar
  60. Weinick, R. M., Zuvekas, S. H., & Cohen, J. W. (2000). Racial and ethnic differences in access to and use of health care services, 1977–1996. Medical Care Research and Review, 57(1), 36–54. doi: 10.1177/107755800773743592.Google Scholar
  61. Wolinsky, F. D. (1982). Racial differences in illness behavior. Journal of Community Health, 8(2), 87–101. doi: 10.1007/BF01326553.CrossRefGoogle Scholar
  62. Wolinsky, F. D., Coe, R. M., Miller, D. K., Prendergast, J. M., Creel, M. L., & Joel Chavez, M. (1983). Health services utilization among the noninstitutionalized elderly. Journal of Health and Social Behavior, 24(4), 325–337. doi: 10.2307/2136399.CrossRefGoogle Scholar
  63. Wong, R., Diaz, J. J., & Higgins, M. (2006). Health care use among elderly Mexicans in the United States and Mexico. Research on Aging, 28(3), 373–408. doi: 10.1177/0164027505285922.CrossRefGoogle Scholar
  64. Wu, A. P., Burke, A., & LeBaron, S. (2007). Use of traditional medicine by immigrant Chinese Patients. Family Medicine, 39(3), 195–200.Google Scholar
  65. Xu, Y., Sun, J., Zhang, J., & Xu, Z. (2001). Health-seeking behaviors and barriers to health care of Southeast Asian immigrants: Implications for the home health nurse. Home Health Care Management & Practice, 14(1), 22–30.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  1. 1.Department of SociologyUniversity of Illinois at Urbana-ChampaignUrbanaUSA

Personalised recommendations