Posted on July 27, 2005

Immigrants use fewer health care services, study finds


Tuesday, July 26, 2005
By Alana Semuels
Pittsburgh Post-Gazette

Although her husband is employed, 30-year-old Pamela Ramirez still pays her health bills the same way many immigrants do — out of her savings account.

Ramirez, of the South Side, moved here from Argentina more than four years ago. She’s typical in that she costs less to the health care system than do native-born residents, according to a study published yesterday in the American Journal of Public Health.

The study found that immigrants use 55 percent less health care than non-immigrants, and that both insured and non-insured immigrants use less services than the native born.

Immigrants actually subsidize care for the rest of the population, according to the study, because they pay Medicare payroll taxes and health insurance premiums, but do not reap all the benefits of these services.

“This ought to explode the myth that health care costs are due to immigrants,” said Dr. Steffie Woolhandler, an associate professor of medicine at Harvard Medical School and one of the authors of the study.

In dollar terms, per capita health expenditures were around $1,139 per immigrant, versus $2,564 for non-immigrants.

This is the first national study of immigrants’ health care expenditures. It looked at data from 21,241 people in the Agency for Healthcare Research and Quality’s 1998 Medical Expenditure Panel Survey, counting anyone born outside the country as an immigrant. The data is the most recent available, Woolhandler said, and the problems it highlights — such as immigrants’ fear of seeking treatment — have probably been exacerbated in the post-9/11 world.

Woolhandler argues that it highlights the need for a national health insurance program, which is the goal of the organization she co-founded, Physicians for a National Health Program.

But a think tank that supports tighter controls on immigration said that the study shows only that immigrants are poorer than non-immigrants, and are thus less able to afford health care.

“To the extent there’s an immigration policy conclusion, it would be that we’re taking in too many poor immigrants,” said Mark Krikorian, executive director of the Center for Immigration Studies in Washington, D.C.

One of the most striking pieces of the study found that immigrant children receive very low levels of care. They got 71 percent less care in doctors’ offices, and 72 percent fewer prescription medications than native-born children. The cost of their emergency room visits was the only expenditure that was higher — three times greater than those of native-born children — implying that parents wait until their children are very ill before seeking care.

“There’s widespread agreement that young children need to see a doctor on a regular basis,” said Woolhandler. “There’s very strong evidence that there was under-use of services in immigrant children.”

Although many of Pittsburgh’s immigrants are better-educated than those in other cities, children and elderly immigrants who don’t qualify for services are particularly vulnerable, said Dr. Vish Nimgaonkar, a professor of psychiatry at the University of Pittsburgh School of Medicine and a member of Woolhandler’s nonprofit group.

Local doctors have tried to help immigrant children obtain health care by running a bilingual clinic every week at Children’s Hospital and a monthly clinic on the South Side for uninsured children.

Lack of insurance, language barriers, and cultural differences are three of the main reasons preventing immigrants in Pittsburgh from seeking care, said Dr. Diego Chaves-Gnecco, a pediatric resident at Pitt who founded the local clinics. Many Latinos he treats would rather use traditional remedies than try to navigate a health care system that doesn’t speak their language.

Latino immigrants were found to utilize half as much health care as U.S.-born Latinos, and 70 percent less than U.S.-born whites, according to the study.

“We’re overcoming those barriers,” he said. The clinics have now had more than 1,000 visits — a significant number for a city with a small Latino population.

Ramirez takes her Pittsburgh-born daughter to Chaves-Gnecco’s clinic. But she and her husband don’t have a similar outlet to seek care for themselves.

“The ideal situation is when you don’t have to overcome all the barriers we have mentioned,” she said. “Immigration status shouldn’t affect health care.”

Alana Semuels can be reached at or 412-263-1928.