Access to Health Insurance & Care among Mexican Binationals: Reality & Potential

Access to Health Insurance & Care among Mexican Binationals: Reality &

PotentialSteven P. Wallace, Ph.D.Steven P. Wallace, Ph.D.

UCLA Center for Health Policy Research & UCLA School of Public HealthUCLA Center for Health Policy Research & UCLA School of Public Health

2007 Academy Health Research Meeting2007 Academy Health Research MeetingOrlando, FLOrlando, FL

http://swallace.bol.ucla.eduhttp://swallace.bol.ucla.edu

http://swallace.bol.ucla.edu/

SummarySummary

The economic profile of Mexican The economic profile of Mexican immigrants is quite lowimmigrants is quite lowTheir health status, in contrast, is Their health status, in contrast, is generally goodgenerally goodHealth insurance and access to care is Health insurance and access to care is very poorvery poorAre use rates appropriate or not?Are use rates appropriate or not?

Mexican Immigrants have lowest levels of educationMexican Immigrants have lowest levels of education

53.1 52.2

14.04.4 7.8 14.4

33.7 32.4

44.0

38.545.9 31.4

27.1

27.2

18.6

5.4 5.212.8

30.019.1

35.6

29.2

10.17.8

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Recent Mexicanimmigrants (<10

years)

Longer-stayMexican immigs

(10+ yrs)

MexicanAmerican

U.S.-Born Whites U.S.-Born Non-Whites

Immigrants from acountry otherthan Mexico

Less than 10 grade 10 - 12 grade Technical Professional

Source: Current Population Survey, 2005. See http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=196

http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=196

28.4

19.614.8

8.1

19.6

12.1

0.0

10.0

20.0

30.0

Recent MexicanImmigrants

Longer-stayMexican

immigrants

Mexican-Americans

U.S.-BornWhites

U.S.-born Non-whites

Immigrants froma country other

than Mexico

Por

cent

age

Mexican immigrants have high levels of povertyMexican immigrants have high levels of poverty

24.9

18.5

11.57.7

13.89.6

0.0

10.0

20.0

30.0


Longer-stayMexican

immigrants

Mexican-Americans

U.S.-BornWhites

U.S.-born Non-whites

Immigrants froma country other

than Mexico

Por

cent

age

United States

California



Partial coverage(2)

12.6%

Total coverage(1)

80.9%

No coverage(3)6.5%

Mexican immigrant households have the lowest levels of medical coverage for all members

Total coverage(1)

38.2%

Partial coverage(2)

36.2%

No coverage(3)25.5%

Households headed by Mexican immigrants

Households headed by immigrants from country other than Mexico

Households headed by U.S.-born

No coverage(3)

12.7%

Total coverage(1)

70.0%

Partial coverage(2)

17.3%



12.4 15.728.9

13.125.7

15.0

23.3

41.4

48.1 75.7 56.260.9

11.2 18.1 24.0

64.4

42.8

23.0

0%

20%

40%

60%

80%

100%

RecentMexican

immigrants

Longer-stayMexican

immigrants

MexicanAmerican

U.S.-BornWhites

U.S.-BornNon-Whites

Immigrantsfrom other

than Mexico

Public Private (incl. mixed public/private) No health insurance


Mexican immigrant individuals also have the lowest Mexican immigrant individuals also have the lowest levels of health insurancelevels of health insurance


13.428.5

37.0 34.145.0

32.79.3

14.2

17.635.0

21.2

24.3

30.9 33.843.0

77.3

57.345.3

0%

20%

40%

60%

80%

100%

RecentMexican

immigrants

Longer-stayMexican

immigrants

MexicanAmerican

U.S.-BornWhites

U.S.-BornNon-Whites

Immigrantsfrom other

than Mexico

Public Private (incl. mixed public/private) No health insurance

Among adults living in poverty, Mexican immigrants are Among adults living in poverty, Mexican immigrants are least likely to rely on public health insuranceleast likely to rely on public health insurance



Among adults employed in manual occupations* Among adults employed in manual occupations* Mexican immigrants have least health insuranceMexican immigrants have least health insurance

28.5%

56.3%65.6%

72.8%65.5%

81.9%

0%

20%

40%

60%

80%


Longer-stayMexican

immigrants

Mexican-Americans

U.S.-BornWhites

U.S.-Born Non-Whites

Immigrantsfrom a country

other thanMexico

* Includes cleaning and maintenance of buildings, food preparation, construction, repair and production, farming, fishing and forestry.



Epidemiological paradox: Hispanics have Epidemiological paradox: Hispanics have lowest death rates/100,000, U.S.lowest death rates/100,000, U.S.

African American

Non-Hispanic white Hispanic

Hispanic/Non-Hispanic White ratio

MenUnder 1 1,567.60 658.7 637.1 0.971–4 54.5 32.4 31.5 0.975–14 28.2 20 17.9 0.915–24 181.4 103.5 107.7 1.0425–34 261 123 120.2 0.9835–44 453 233.9 211 0.945–54 1,017.70 497.7 439 0.8855–64 2,080.10 1,170.90 965.7 0.8265–74 4,253.50 2,930.50 2,287.90 0.7875–84 8,486.00 6,977.80 5,395.30 0.7785 and older 16,791.00 17,853.20 13,086.20 0.73Age-adjusted rate 1,403.50 1,035.40 818.1 0.79

Source: Markides & Eschbach (2005) JGSS. Vol. 60B (Special Issue II): 68–75Source: Markides & Eschbach (2005) JGSS. Vol. 60B (Special Issue II): 68–75

Mexican immigrants have better health indicators Mexican immigrants have better health indicators except for diabetes, ages 18-64except for diabetes, ages 18-64

5.8%3.2%

13.6%

0.9%

16.8%20.2%

6.9% 5.9%

1.7% 0.6%

6.6%

2.1%

6.3%2.1%3.5%

5.4%

High bloodpressure

Heart disease Cancer Diabetes

Recent Mexican Immigrants Long-stay Mexican immigrantsMexican-Americans U.S.-Born Whites

Source: U.S. National Health Interview Survey, 2005, age adjusted to 2005 total adult population

Immigrant advantage shrinks when age adjusted Immigrant advantage shrinks when age adjusted (2000 Census population standard), ages 18-64(2000 Census population standard), ages 18-64

8.6%

1.0%

21.0%

6.0% 5.3%

14.6%

2.9%1.0%

14.5%

7.1%

2.4%

8.3%

2.4%4.0%

18.1%

4.8%

High bloodpressure

Heart disease Cancer Diabetes


Source: U.S. National Health Interview Survey, 2005, age adjusted to 2005 total adult population

Mexican immigrants have lowest work disability rates Mexican immigrants have lowest work disability rates Ages 18-44Ages 18-44

0.9 0.31.7 2.40.8 1.7

3.63.3

0

1

2

3

4

5

6

RecentMexican

Immigrants

Longer-stayMexican

immigrants

Mexican-Americans

U.S.-BornWhites

perc

ent

Limited in amount/kind Unable to workSource: U.S. National Health Interview Survey, 2005

Mexican immigrants most likely to have no usual source Mexican immigrants most likely to have no usual source of careof care

14.6%39.9% 55.9% 72.8%22.6%

16.8%57.5%33.1% 22.9% 11.8%

12.9%

21.3%


Longer-stayMexican

immigrants

Mexican American U.S.-Born Whites

Doctor's office or health center Clinic None

Source: U.S. National Health Interview Survey, 2005. Adults 18 or older, U.S.

No usual source of care – Odds Ratio controlling for age, No usual source of care – Odds Ratio controlling for age, sex, chronic conditions, poverty, education, Ages 18-64sex, chronic conditions, poverty, education, Ages 18-64

3.47

1.921.36

1.00


Longer-stayMexican

immigrants

Mexican American U.S.-Born Whites

Source: U.S. National Health Interview Survey, 2005. Adults 18 or older, U.S.

Mexican immigrants have the lowest levels of Mexican immigrants have the lowest levels of emergency room visits emergency room visits

11.2% 12.4%

23.2%20.2%


Longer-stayMexican

immigrants

Mexican-Americans

U.S.-Born Whites

Source: U.S. National Health Interview Survey 2005.

Mexican immigrants have the highest levels of Mexican immigrants have the highest levels of no medical visits in the past two years, ages 18-64no medical visits in the past two years, ages 18-64

23.7%

13.2%7.9%

41.9%

Recent Mexicanimmigrants

Longer-stayMexican

Immigrants

MexicanAmericans

U.S.-Born Whites

Source: U.S. National Health Interview Survey, 2005.

Insurance & no usual source of care related, Insurance & no usual source of care related, Mexican immigrants lowest, ages 18-64Mexican immigrants lowest, ages 18-64

54.0%45.4%

68.6%57.3%

8.6%11.8%14.9%22.4%

Recent Mexicanimmigrants

Longer-stayMexican

Immigrants

MexicanAmericans

U.S.-Born Whites

Uninsured, no USC Insured, no USCSource: U.S. National Health Interview Survey, 2005.

Logistic regression of no MD visit past 2 years, Logistic regression of no MD visit past 2 years, ages 18-64ages 18-64

0

1

2

3

4

5

age male* near poor education sr health nochronic*

no USC* uninsured


* All groups significant at p<0.05; § individual group significant at p<.05; ~ significant at p<0.1 Source: U.S. National Health Interview Survey, 2005.

§§§

§§~~

§ §

Any care (medical, dental, prescription) Any care (medical, dental, prescription) in Mexico past year , California 2001in Mexico past year , California 2001

2.1%

5.3%

15.0%

11.4%

3.5%

US BornNonLatino

White

US BornMexicanAm

Immg MexAm,in US 15+ yrs

Imm MexAm,in US <15 yrs

Other LatAmimmigrants

Source: U.S. California Health Interview Survey 2001.

ConclusionsConclusions

Mexican immigrants have limited economic Mexican immigrants have limited economic resources, high uninsurance ratesresources, high uninsurance ratesBut have high levels of health capitalBut have high levels of health capitalThey use health services less compared to They use health services less compared to native born with similar health statusnative born with similar health statusAccess to care is impacted most strongly by Access to care is impacted most strongly by usual source of care for Mexican immigrantsusual source of care for Mexican immigrants

Next StepsNext Steps

Develop an understanding of help seeking Develop an understanding of help seeking processesprocesses of recent immigrants. We know they of recent immigrants. We know they use less medical care, are they simply going use less medical care, are they simply going without?without?Better identify Better identify wherewhere immigrants obtain immigrants obtain services (private store-fronts, Mexico, etc.)services (private store-fronts, Mexico, etc.)Analyze recent immigrants over time. Analyze recent immigrants over time. Longitudinal data shows health advantage Longitudinal data shows health advantage persists but weakens persists but weakens over timeover time. Similar . Similar analyses are needed for health service use.analyses are needed for health service use.

Documents

Access to Health Insurance & Care among Mexican Binationals: Reality & Potential