Health spending among working-age immigrants with disabilities compared to those born in the US

Abstract

Background: Immigrants have disparate access to health care. Disabilities can amplify their health care burdens.

Objective/hypothesis: Examine how US- and foreign-born working-age adults with disabilities differ in their health care spending patterns.

Methods: Medical Expenditures Panel Survey yearly-consolidated files (2000-2010) on working-age adults (18-64 years) with disabilities. We used three operational definitions of disability: physical, cognitive, and sensory. We examined annual total, outpatient/office-based, prescription medication, inpatient, and emergency department (ED) health expenditures. We tested bivariate logistic and linear regression models to, respectively, assess unadjusted group differences in the propensity to spend and average expenditures. Second, we used multivariable two-part models to estimate and test per-capita expenditures adjusted for predisposing, enabling, health need and behavior indicators.

Results: Adjusted for age and sex differences, US-born respondents with physical, cognitive, sensory spent on average $2977, $3312, and $2355 more in total compared to their foreign-born counterparts (P < 0.01). US-born spending was also higher across the four types of health care expenditures considered. Adjusting for the behavioral model factors, especially predisposing and enabling indicators, substantially reduced nativity differences in overall, outpatient/office-based and medication spending but not in inpatient and ED expenditures.

Conclusions: Working-age immigrants with disabilities have lower levels of health care use and expenditures compared to their US-born counterparts. Affordable Care Act provisions aimed at increasing access to insurance and primary care can potentially align the consumption patterns of US- and foreign-born disabled working-age adults. More work is needed to understand the pathways leading to differences in hospital and prescription medication care.

Keywords: Disparities; Health care expenditures; Immigrants.

Figure 1

Unadjusted (%) differences in 1) the propensity to use healthcare and 2) average health expenditures among spenders by nativity status and disability type. Results based on data from working-age adults (18-64) from the Medical Expenditures Panel Survey (2000-2010).

Figure 2

Estimated marginal differences in per-capita healthcare expenditures by nativity status and disability type. Estimates are based on two-part models using data on working-age adults (18-64) from the Medical Expenditures Panel Survey (2000-2010). Note 1: Fully Adjusted for age, sex, geographic region, Metropolitan Statistical Area (MSA), survey year, race/ethnicity, poverty status, employment, education, insurance, a usual source of care, self-reported health status, two indices of physical and mental health based on the SF-12, count of 9 health conditions, obesity, physical activity, and smoking status. The models for physical disability also adjust for cognitive and sensory disabilities. The models for cognitive disability also adjust for physical and sensory disabilities. Finally the models for sensory disability also adjust for physical and cognitive disabilities.