Regardless of age, legal status or insurance coverage, immigrants, on average, receive about half the health care services provided to native-born Americans, according to findings released yesterday that immediately fueled the debate over tightening immigration policies.
Immigrants received an average of $1,139 worth of care, compared with $2,564 for non-immigrants, according to the analysis, published in the August issue of the American Journal of Public Health. The gap was especially pronounced among immigrant children, who received one-quarter the care given to U.S.-born youngsters.
"Our study lays to rest the myth that expensive care for immigrants is responsible for our nation's high health costs," said co-author Sarita Mohanty, an assistant professor of medicine at the University of Southern California. "The truth is, immigrants get far less care than other Americans."
The report is based on government data that tabulated health spending for 21,000 people in 1998, the most recent year for which figures were available. The analysis includes legal and illegal immigrants.
"If we think our high health care costs are due to immigrants flocking to our shores, we're wrong," said co-author David Himmelstein of Harvard Medical School. Although immigrants accounted for 10 percent of the population, they consumed 8 percent of total health services, the study found.
Some immigration experts, however, said that tracking per capita spending ignores the larger societal costs of a growing immigrant population that is far less likely to have health insurance.
"The fact that immigrants, when uninsured, might use 27 percent less medical care doesn't change the fact that they're 200 percent more likely to be uninsured in the first place," said Steven Camarota, research director at the Center for Immigration Studies, a Washington think tank that favors strict controls on immigration. "Why have a system that allows in so many people who aren't self-sufficient?"
Immigrants account for 18 percent of the costs associated with the uninsured -- expenses likely to be borne by taxpayers and charities, Camarota said.
Both sides said financial, cultural and language differences all make it hard for immigrants to afford care, understand medical advice or embrace recommendations from American doctors and nurses.
A much higher percentage of adult immigrants lack a high school education, which makes it difficult for them to navigate the health care system, said Elena Rios, president of the National Hispanic Medical Association.
"They don't understand the lingo," such as what a cholesterol reading signifies, she said. "Because of limited education levels, you can't connect the dots and think about what prevention like physical exercise means in terms of the future and things like heart disease and cancer."
Immigrants often live in low-income neighborhoods with fewer hospitals, clinics, physicians and pharmacies, she said. And many Latin Americans, coming from countries with government-run health systems, are unfamiliar with the concept of buying insurance.
In addition, many immigrants do not qualify for government health programs that are targeted at specific groups such as retirees, American Indians and veterans, Camarota said.
Over the long term, Himmelstein said, the potential ramifications for children are most alarming. The data showed immigrant children had fewer doctor visits, took less medication and made fewer trips to the emergency room. But their emergency room costs were nearly triple those for non-immigrant children, suggesting that immigrant families missed routine checkups and waited until a condition was more serious before seeking treatment, Himmelstein said.
It is far more likely, he said, that immigrant children do not receive standard vaccinations and let chronic problems such as asthma go untreated.
Even better-educated, insured immigrants -- and U.S.-born minorities -- received less care, probably because of racism and cultural differences, Mohanty said.
The paper's authors, who are active in the liberal Physicians for a National Health Program, said one solution would be to provide everyone with basic health coverage. Short of that, they advocated lifting restrictions on government health programs and easing entry into employer-provided health plans.
Camarota, who agreed that legal immigrants should have greater access to care, said lawmakers need to take a more critical look at who is allowed into the United States. He said, "The solution to the problem is make them go home or not let them in in the first place."