Out-of-pocket health care expenditures and the financial burden of health care among older immigrants

Purpose: Recently-arrived older immigrants are likely to be greatly affected by dramatically increasing out-of-pocket (OOP) expenditures for medical care due to their limited insurance options. This study examined disparities in OOP health care expenditures and financial burden of healthcare by immigrant status. The need for research on health care utilization among older immigrants has been growing, especially since the welfare reform of 1996, which, for the first time, declared immigrant status as an eligibility criterion for public benefits.

Methods: The 2005 Medical Expenditure Panel Survey (MEPS) linked to the 2004 National Health Interview Survey (NHIS) was analyzed guided by the Andersen model. OLS models were tested for four dependent variables: total and OOP medical expenditures, and the percentage of total expenditure and income spent for OOP medical payments. Immigrant status (IV) had three categories (N=3,454; ages 65+): 1) late-life immigrants with less than 15 years of residence in US (recent immigrants; n=77); 2) longer-term immigrants (n=392); and 3) the U.S.-born (n=2,985). The SAS survey procedures were used to account for the complex sampling design.

Results: The findings indicate no differences in the total and OOP medical expenditures, and the proportion of expenditures paid out-of-pocket across the three groups, after controlling for predisposing (e.g., age, gender, ethnicity), enabling (e.g., insurance status), and need factors (e.g., 12 medical conditions). However, recent immigrants spent a higher proportion of their income for OOP medical payments compared to the U.S.-born (p=.020) and longer-term immigrants (p=.009). In 2005, OOP medical payments accounted for 18% of recent immigrants' income (median), while it was only 4.6% and 3.9% among the U.S.-born and longer-term immigrants, respectively.

Implications: Many studies on older immigrants' health care utilization focused on access to health care in relation to their insurance status, whereas few studies have examined the OOP financial burdens of health care among this population. Considering the higher OOP financial burden of healthcare among recent immigrants, further studies are necessary to understand the consequences and appropriate policies should be considered (e.g., providing affordable health insurance options).