Disparities in Access to Health Care among Non-Citizens in the United States
Lee, Sungkyu, Choi, Sunha, Health Sociology Review
As one of the major immigrant-accepting countries, the United States has observed a rapid increase in its foreign-born population. In 2005, about 12% of the US population (36 million) consisted of foreign-born individuals, a figure that had doubled since 1970 (Derose et al 2007). Despite the dramatic increase in the numbers of foreign-born individuals they are still significantly less likely to use formal health care in contrast with US-born counterparts, even after controlling for health status (Derose et al 2007). For example, foreignborn individuals are less likely to use preventive services (De Alba et al 2005; Wallace et al 2003) and inpatient care (Damron-Rodriguez et al 1994). This indicates the presence of barriers to access to formal health care and disparities in the use of health services among foreign-born individuals in the United States.
Access to formal health services in the United States has been measured with a number of different indicators. Among them, having a 'usual source of care' has been widely used as a proxy for access to health care due to its positive relationship with the use of various types of health care services (Bindman et al 1996; DeVoe et al 2003; Ettner 1999; Guendelman et al 2002; Halfon et al 1997; Sox et al 1998; Xu 2002; Zuvekas and Weinick 1999). A usual source of care is defined as a place where people usually go to access health care services (United States Department of Health and Human Services 2006). It is believed that having a usual source of care is a facilitator for the utilisation of formal health services when required, similar to having adequate health insurance (Xu 2002). Some studies conclude that having a usual source of care is a stronger and more consistent predictor of the utilisation of health care services than having health insurance (Sox et al 1998). Empirical studies have determined that having a usual source of care is closely related to better access to the health care system and increased use of preventive care services, such as cholesterol testing and cancer screening (Juon et al 2003; Shih et al 2006).
Having a usual source of care is also associated with positive health outcomes, such as compliance with medication regimens, lower levels of disability, decreases in health care costs, improved control of chronic conditions, and increases in patient satisfaction with care (Carrasquillo and Pati 2004; Corbie-Smith et al 2002; Echeverria and Carrasquillo 2006; Shih et al 2006; Viera et al 2006; Weiss and Blustein 1996; Xu 2002). In addition, the significant role of the primary care doctor as a gatekeeper for access to specialty mental health, and health services in the United States has been well established (Roberts 1998).
This study focused on the legal status of immigrants as a major factor associated with their access to health care, as the rights of immigrants after admission is based on the national immigration policy and the legal status of the immigrants (Legomsky 2005; Scheppers et al 2006). In this sense, considering the legal status of a foreign-born individual is critical in understanding access to health services because it determines both the eligibility for accessing government-provided health benefits and the right to work in the host country. Particularly in the United States, private health insurance through employment is a major source of insurance among non-elderly individuals, as the government does not provide universal health insurance (Angel et al 2002). Furthermore, the welfare reform of 1996 restricted the use of federal funds for immigrant medical care (Weil and Holahan 2002).
Although some studies have examined the differences in the use of a usual source of care across ethnicities, little is known about the impact of United States citizenship status due to a lack of citizenship status variables in many national and administrative health datasets (Choi 2007). In addition, little is known about which subgroups among non-citizens are most impacted. …