摘要：Objectives. I examined insurance coverage and medical expenditures of both immigrant and US-born adults to determine the extent to which immigrants contribute to US medical expenditures. Methods. I used data from the 2003 Medical Expenditure Panel Survey to perform 2-part multivariate analyses of medical expenditures, controlling for health status, insurance coverage, race/ethnicity, and other sociodemographic factors. Results. Approximately 44% of recent immigrants and 63% of established immigrants were fully insured over the 12-month period analyzed. Immigrants' per-person unadjusted medical expenditures were approximately one half to two thirds as high as expenditures for the US born, even when immigrants were fully insured. Recent immigrants were responsible for only about 1% of public medical expenditures even though they constituted 5% of the population. After controlling for other factors, I found that immigrants' medical costs averaged about 14% to 20% less than those who were US born. Conclusions. Insured immigrants had much lower medical expenses than insured US-born citizens, even after the effects of insurance coverage were controlled. This suggests that immigrants' insurance premiums may be cross-subsidizing care for the US-born. If so, health care resources could be redirected back to immigrants to improve their care. There is substantial public policy disagreement in the United States about whether the nation should restrict or expand health care for immigrants. Polls show that roughly half of Americans believe that immigrants are a burden on the nation because they take jobs, housing, and health care from US-born citizens. 1 Some further believe that “high rates of immigration are straining the health care system to the breaking point” 2 or that “illegal aliens in this country are taking a large part of our health care dollars.” 3 But others believe that steps should be taken to bolster immigrants' health care, such as restoring their eligibility for Medicaid or having insurers pay for interpreter services for patients who are not proficient in English. 4 – 6 Researchers have found that immigrants' unadjusted per capita medical utilization and expenditures are actually much lower than those of US-born citizens. Mohanty et al. analyzed the 1998 Medical Expenditure Panel Survey (MEPS) and found that immigrants' average per capita medical costs were approximately half those of US-born citizens. 7 Goldman et al. examined data from a 2000 Los Angeles survey and concluded that immigrants incurred a disproportionately small share of medical expenses, both government-paid expenses and overall expenses. 8 These findings are consonant with studies showing that immigrants have less access to health insurance and use less health care than the native born. 9 – 14 However, previous research has not clearly examined the relationships among immigrants' health care expenditures, immigration status, and insurance coverage. To learn more about these relationships, I analyzed data from a recent nationally representative survey of adult US residents.
