Variations in Healthcare Access and Utilization Among Mexican Immigrants: The Role of Documentation Status

The objective of this study is to identify differences in healthcare access and utilization among Mexican immigrants by documentation status. Cross-sectional survey data are analyzed to identify differences in healthcare access and utilization across Mexican immigrant categories. Multivariable logistic regression and the Blinder-Oaxaca decomposition are used to parse out differences into observed and unobserved components. Mexican immigrants ages 18 and above who are immigrants of California households and responded to the 2007 California Health Interview Survey (2,600 documented and 1,038 undocumented immigrants). Undocumented immigrants from Mexico are 27% less likely to have a doctor visit in the previous year and 35% less likely to have a usual source of care compared to documented Mexican immigrants after controlling for confounding variables. Approximately 88% of these disparities can be attributed to predisposing, enabling and need determinants in our model. The remaining disparities are attributed to unobserved heterogeneity. This study shows that undocumented immigrants from Mexico are much less likely to have a physician visit in the previous year and a usual source of care compared to documented immigrants from Mexico. The recently approved Patient Protection and Affordable Care Act will not reduce these disparities unless undocumented immigrants are granted some form of legal status

Identifying Sources of Health Care Underutilization Among California’s Immigrants

Many studies show that immigrants face significant barriers in accessing health care. These barriers may be particularly pronounced for newer immigrants, who may face additional obstacles in navigating the health care system. Understanding the sources of health care disparities between recent and non-recent immigrants may allow for better design of policies and interventions to address the vulnerabilities unique to different subgroups of immigrants defined by their length of residency. This study employs descriptive analyses and multivariate logistic regression to estimate the likelihood of accessing and utilizing health care services based on immigration-related factors after controlling for predisposing, enabling, and health care need factors. We also employ a regression-based decomposition method to determine whether health care differences between recent and non-recent immigrants are statistically significant and to identify the primary drivers of healthcare differences between recent and non-recent immigrants. The findings support the hypothesis that significant disparities in health care access and utilization exist between recent and non-recent immigrants. We found that health care access and utilization differences between recent and non-recent immigrants were driven primarily by enabling resources, including limited English proficiency (LEP), insurance status, public assistance usage, and poverty level. These results indicate that not only are newer immigrants more likely to underutilize health care, but also that their underutilization is driven primarily by their lack of insurance, lack of adequate financial resources, and inability to navigate the health care system due to LEP. The results further indicate that immigrants with prolonged LEP may be less likely to have a usual source of care and more likely to report delays in obtaining medical treatments, than even recent immigrants with LEP