Determinants of Healthcare Utilization By Older Refugees in the United States: A Modified Andersen Model Approach

Background and Objectives: Rapid aging of global populations is accompanied by rising numbers of forcibly displaced persons and increased prevalence of chronic health conditions. These trends underscore the immediate need to effectively integrate resettled older adults into the national healthcare systems of hosting countries. Health service use is a key means of decreasing health disparities and improving health equity, particularly among individuals with chronic illness. Yet, there is limited research on barriers and facilitators to healthcare service use by older refugees in the U.S. The current study uses national data to examine the use of primary care visits by older refugees’ who were resettled in the U.S. from 2015 through 2019.

Research Design and Methods: Drawing on data from the 2020 Annual Survey of Refugees, we used Andersen’s Modified Behavioral Model of Health Service Use to examine the association of migration-related predisposing, enabling, and need factors with having a routine physical exam during the past year. Our model includes migration-associated variables, such as post-migration stressors, neighborhood ethnic density, and cohort year of arrival. We used hierarchical logistic analysis to understand the comparative effects of the various factors, entering in predisposing variables in the first model, enabling in the second, and needs factors in the final model.

Results and Discussion: Race, religion, insurance coverage, education level, and English proficiency were significantly associated with accessing primary care for a physical exam. Muslim identity was a strong correlate of accessing care, and Asian and Black refugees were more likely than White refugees to access this service. Both higher education levels and lower English proficiency were associated with more frequent primary care visits.

Implications: Findings highlight key determinants of healthcare access and suggest a need for targeted interventions to improve older refugees’ use of health services. Departing from previous research, the study found no significant associations between need-based health variables and exam completion. Findings suggest that expanding insurance, education, culturally responsive care, and community-based interventions—such as ethnic health navigators—could enhance access. Future research should use administrative health data and qualitative methods to address the sample limitations of the survey design, as well as to explore within-group differences in healthcare utilization.