Staying Away from the Doctor

A new study finds that immigrants pay in much more for health care than they use
the hands of a doctor who is explaining something to a patient
“Immigrants pay in more than they withdraw, generating an annual surplus of $11 to $17 billion to the Medicare Health Insurance Fund,” said Lila Flavin. Photo: Ingimage
August 22, 2018

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Some pundits and politicians grumble that immigrants are a drain on the American health-care system, but a new study found immigrants pay more toward medical expenses than they withdraw, thus helping to subsidize the public and private U.S. health-insurance markets. First author Lila Flavin, M19, collaborated with colleagues at Harvard Medical School and Cambridge Health Alliance on the paper, recently published in the International Journal of Health Services. They reviewed all post-2000, peer-reviewed studies related to health-care expenditures by immigrants in the United States available through the PubMed database.

Flavin, who worked as a Spanish translator at an outpatient clinic when she was an undergraduate at Princeton University, said she “started hearing rhetoric that immigrants, particularly undocumented immigrants, are a burden to our health-care system. I wanted to look at the data and see if there was any truth to it.”

Tufts Now spoke to Flavin about the study—and its implications.

Tufts Now: What did you discover?

Lila Flavin: “Immigrants are often younger and healthier than the general U.S. population when they first arrive, and therefore need less medical services,” said Lila Flavin. Photo: Sharona JacobsWe found that immigrants have medical expenditures that are half that of United States-born individuals. Undocumented immigrants spend a disproportionately small amount of total health-care dollars in this country—they account for 5 percent of the population but only 1.4 percent of total health-care spending. And perhaps most surprisingly, immigrants pay in more than they withdraw, generating an annual surplus of $11 to $17 billion to the Medicare Health Insurance Fund.

Were you surprised by any of the findings?

I didn’t realize that even if undocumented immigrants aren’t eligible for services, a portion of their salaries goes toward paying for it. I was also surprised to see that elderly recent immigrants spend a third of their income on out-of-pocket medical bills, whereas the elderly U.S.-born spend only 12 percent.

Why do you think immigrants use less health care than others?

Immigrants are often younger and healthier than the general U.S. population when they first arrive, and therefore need less medical services. Furthermore, it can be difficult for recent immigrants to access medical care if it isn’t offered in their language, they don’t have insurance, or they fear deportation.   

What are some of the limitations in studies related to health-care expenditures by immigrants?

This was a review paper based on 188 peer-reviewed papers that used data collected from the Medical Expenditure Panel Survey (MEPS), which surveys individuals, their providers, and employers across the U.S. None of the MEPS data included the years after the Affordable Care Act (ACA) was put in place, so the numbers may be different now.

What’s the next step for this research?

In the future it will be important to study how the ACA has influenced expenditures among immigrants and U.S.-born individuals.

Courtney Hollands can be reached at courtney.hollands@tufts.edu.