Emergency department services use among immigrant and non-immigrant groups in the United States

Abstract

Immigrants have disproportionate lack of access to healthcare and insurance. Emergency departments could serve as a healthcare substitute and increased demand can negatively affect the US emergency services system. Medical Expenditures Panel Survey (2000-2008) data was modeled to compare emergency departments (ED) use between non-citizens, foreign-born (naturalized), and US-born citizens. Group differences were assessed using non-linear decomposition techniques. Non-citizens were less likely to use ED services (8.7 %) compared to naturalized immigrants (10.6 %) and US-born Americans (14.7 %). Differences in ED use persisted after adjusting for the Behavioral Model covariates. Healthcare need and insurance partially explained the differences in ED use between the groups. Between 2000 and 2008 non-citizen immigrants used markedly less ED services compared to US citizens, regardless of their nation of origin. We also found that demographic and healthcare need profiles contributed to the divergence in use patterns between groups. A less restrictive healthcare policy environment can potentially contribute to lower population disease burden and greater efficiencies in the US health care system.

Figure 1

Emergency department use by citizenship status among U.S. adults 18-years and older. Data from the medical Expenditure Panel Survey (2000–2008). Note 1: “FB-Citizens” indicates foreign-born citizens (i.e., naturalized), and USB stands for US-born citizens Note 2: Panel (a) Presents unadjusted trends in emergency department use by citizenship status among U.S. adults 18-years and older. Note 3: Panel (b) presents the predicted probabilities of emergency department use among U.S. adults 18-years and older by citizenship and insurance status. Predicted values are based on logistic regression model using data from the Medical Expenditure Panel Survey (2000–2008). E(pr) indicates the expected 12-month probability of emergency department use. The straight lines present the average unadjusted probability of use for the overall sample, as well as by citizenship grouping. The point estimates represent fully adjusted expected probabilities and their 95% confidence interval by citizenship and insurance status.

Figure 2

Non-linear (Fairlie) decompositon of differences in expected probability of emergency department use between adult (18-years and older) citizenship groups in the United States. Results are from the Medical Expenditures Panel Survey (2000–2008). Δ(pr) is the difference in the expectedprobability of use between the reference and comparison groups † Comparison group * Reference group Note 1: “Non” indicates non-citizens, “FB” indicates foreign-born citizens and “USB” indicates US-born citizens. Note 2: Only statistically significant factors are emphasized. Note 3: Bars included in the negative quadrant of the graph represent factors that contribute to higher probability of use in the reference groups. Bars included in the positive quadrant of the graph represent factors that increase the probability of use among the comparison groups. The width of each included bar represents the percentage of between group difference in the probability (i.e. Δ(pr)) of reporting ED use explained by the factor or, more specifically, the expected change in difference if both groups had similar factor characteristics. The sum of the positive (including unexplained) and negative contributors add up to 100% of the difference between the compared groups.