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Health Service Utilization Among Immigrants to the United States

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Abstract

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.

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Notes

  1. Specifically, of the 9,095,417 individuals granted legal permanent residency between 1991 and 2000, 30.7% were from Asia, 24.7% were from Mexico, and only 14.9% were from Europe. In comparison, of the 3,321,677 persons granted legal permanent residency between 1961 and 1970, 33.8% were from Europe, 12.9% were from Asia, and 13.7% were from Mexico (U.S. Department of Homeland Security 2003).

  2. In this context, “traditional” medicine could also be referred to as “Oriental medicine”. We retain the use of the former term throughout the text in order to be consistent with the wording in the New Immigrant Survey survey instrument.

  3. The medical conditions considered are: high blood pressure, diabetes, cancer, chronic lung disease, heart problem, heart attack, angina, congestive heart failure, stroke, arthritis, and asthma.

  4. “Principal” refers to “the alien who applies for immigrant status and from whom another alien may derive lawful status under migration law or regulations (usually spouses or minor unmarried children)” (U.S. Citizenship and Immigration Services 2008).

  5. The questions regarding homeopathic and traditional medicine are arguably less applicable to Hispanics than to Asians. Examples in the survey instrument and therefore provided by interviewers include Chinese, Ayurvedic and American Indian types of treatment (see Appendix A). Unfortunately, for instance, the term ‘curandero’ was not listed. As it is, it is likely that many Hispanics would not respond in the affirmative to this question even if they have sought the care of alternative forms of treatment. This is an important reason to consider Hispanic immigrants separately and the results for this group should be considered lower bound estimates.

  6. Although the zero-inflated negative binomial model includes an inflation equation to predict the excess zeroes, for ease of interpretability, we follow previous work (Skeer et al. 2005) and present logistic regression results predicting any physician visits versus none.

  7. The interpretation of the percent in the state from the same region of origin may be more straightforward for Hispanics, who share a language, than for Asians, who do not. Although the NIS reflects the origin country distribution of the legal permanent resident population generally, this measure can not account, for instance, for the fact that a Japanese immigrant may be living in a state with a high percentage of Asians, but a low percentage of Japanese. Unfortunately, this is a limitation of the data in its current form and remains to be addressed in future work.

  8. The first column, no care versus Western care only, is qualitatively similar to the logistic regression results shown in Table 2.

  9. It is important here not to overemphasize the results in Table 4 as the analysis relies on few cases, particularly in the case of Hispanics, to identify the coefficients.

  10. On average, surveys were administered approximately 4 months after the individual’s date of admission. This is important as the questions about the doctor’s and dentist’s visits refer to the last 12 months, part of which time the individual may have been undocumented. Twenty-four percent of the sample who had less than 1-year elapse between the date of admission to LPR status and the NIS interview reported having no visa on their last trip to the U.S.

  11. An inherent limitation in the wording of the questions is that there is no way to discern whether respondents consider their visit to the homeopathic or traditional medicine practitioner as a visit to the doctor. Further, it is not clear how respondents distinguish between homeopathic and traditional medicine, although the correlation between reports of the two practices is low, 0.08. Although specific examples are listed in the case of the latter, there is clearly overlap in that both practices can involve herbs, natural supplements, and a natural, holistic approach to healing.

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  1. Department of Sociology, University of Illinois at Urbana-Champaign, 326 Lincoln Hall, MC-454, 702 South Wright Street, Urbana, IL, 61801, USA

    Ilana Redstone Akresh

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Appendices

Appendix A

NIS Survey Questions, from Section D

Doctor’s visits::

“Aside from any hospital stays, have you seen or talked to a medical doctor about your health, including emergency room or clinic visits in the last 12 months?”Footnote 10

“Aside from any hospital stays, how many times have you seen or talked to a medical doctor about your health, including emergency room or clinic visits in the last 12 months?”

Dental visits::

“In the last 12 months have you seen a dentist for dental care, including dentures?”

Usual Source of Care::

“What is your usual source of your health care in the United States?”

Homeopathy::

“Have you ever received homeopathic treatment?”

Traditional Medicine::

“Have you ever received traditional medicine such as Chinese, Ayurvedic, American Indian, etc.?”Footnote 11

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Akresh, I.R. Health Service Utilization Among Immigrants to the United States. Popul Res Policy Rev 28, 795–815 (2009). https://doi.org/10.1007/s11113-009-9129-6

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