Immigrants in the United States use fewer health resources and pay more out-of-pocket costs than U.S.-born residents, according to a systematic review recently published in the International Journal of Health Services. This finding contrasts sharply with public opinion-52% of Americans in one study-that immigrants account for the disproportionately higher health care costs in the United States.

Community health worker Lorena Ojeda offers medical resources to new U.S. immigrants at the Consulate General of Mexico in Los Angeles. Photo by Patrick T. Fallon.

According to the authors, their systematic review "overwhelmingly showed that immigrants spend less on health care, including publicly funded health care, compared to their U.S.-born counterparts." They analyzed data from 16 studies published from 2003 through 2016 that compared the health care expenditures among different categories of immigrants with those of people born in the United States. The researchers found that expenditures incurred by immigrants were one-half to two-thirds of those born in the United States (per capita health care expenditures were $1,139 compared with $2,546 in one study). As a group, immigrants account for 12% of the U.S. population but only 8.6% of health care expenditures.

Expenditures increased over time for both immigrants and U.S.-born residents, but increases were greater among the latter. Even if immigrants were citizens, they had lower health care costs than U.S.-born citizens, and even when insured, their health care expenditures were lower. Both public and private health care expenditures were lower overall for immigrants, and immigrants paid more for health care out of pocket.

The differences in expenditures between immigrants and U.S.-born residents lessened with age and disappeared altogether after age 64. The authors offered several explanations for the age-associated leveling of expenditures, including immigrants' equal access to Medicare and the effect of a possible lack of preventive care earlier in life, leading to more expensive health care needs later.

In analyzing the overall lower health care costs among immigrants, the authors cited a possible "healthy immigrant effect," based on demographics showing recent immigrants to be "young and robust." They called for more research on the topic, including how expenditures relate to health care access, and how the Affordable Care Act-and possible changes in the law's mandates-affect access to health insurance among immigrants.-Elizabeth Mechcatie, MA, BSN

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