摘要：Objectives. We compared the health care expenditures of immigrants residing in the United States with health care expenditures of US-born persons. Methods. We used the 1998 Medical Expenditure Panel Survey linked to the 1996–1997 National Health Interview Survey to analyze data on 18398 US-born persons and 2843 immigrants. Using a 2-part regression model, we estimated total health care expenditures, as well as expenditures for emergency department (ED) visits, office-based visits, hospital-based outpatient visits, inpatient visits, and prescription drugs. Results. Immigrants accounted for $39.5 billion (SE=$4 billion) in health care expenditures. After multivariate adjustment, per capita total health care expenditures of immigrants were 55% lower than those of US-born persons ($1139 vs $2546). Similarly, expenditures for uninsured and publicly insured immigrants were approximately half those of their US-born counterparts. Immigrant children had 74% lower per capita health care expenditures than US-born children. However, ED expenditures were more than 3 times higher for immigrant children than for US-born children. Conclusions. Health care expenditures are substantially lower for immigrants than for US-born persons. Our study refutes the assumption that immigrants represent a disproportionate financial burden on the US health care system. The United States is a nation of immigrants. In 2000, the immigrant population of the United States was 28.4 million, 10.4% of the total population. 1 In one of the most comprehensive analyses to date on the costs and benefits of immigrants to the US economy, the National Research Council concluded that immigrants add as much as $10 billion to the economy each year and that immigrants will pay on average $80000 per capita more in taxes than they use in government services over their lifetimes. 2 The Social Security Administration estimates that workers without valid social security numbers contribute 8.5 billion dollars annually to Social Security and Medicare. Such workers, most of them immigrants, usually receive no eligibility credits for their contributions. 3 Taxpayers and politicians in states such as New York, California, Texas, Arizona, and Florida have expressed concern about the potential extra burden immigrants place on their states’ health care systems, 5 – 8 particularly state welfare and Medicaid programs. 9 Researchers from the Center for Immigration Studies have concluded that because immigrant labor has “limited value . . . in an economy that increasingly demands educated workers,” providing insurance to immigrants is “at the taxpayer expense.” 10 These views have resulted in legislative initiatives such as California’s Proposition 181, which attempted (before it was ultimately overturned in court) to bar undocumented immigrants from receiving nonemergency health services. 11 Similarly, the 1996 Personal Work and Responsibility Reconciliation Act made most legal immigrants who entered the United States after 1996 ineligible for Medicaid for 5 years after entry. 12 Although more recent surveys suggest that public attitudes toward immigrants’ contributions, particularly with regard to economic impact, are becoming more positive, 13 public fears after September 2001 may reverse this trend. In this study, we used nationally representative data to compare the health care expenditures of immigrants and US-born individuals.
