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The role of health insurance in explaining immigrant versus non-immigrant disparities in access to health care: Comparing the United States to Canada

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  • Siddiqi, Arjumand
  • Zuberi, Daniyal
  • Nguyen, Quynh C.

Abstract

Using a cross-national comparative approach, we examined the influence of health insurance on U.S. immigrant versus non-immigrant disparities in access to primary health care. With data from the 2002/2003 Joint Canada/United States Survey of Health, we gathered evidence using three approaches: 1) we compared health care access among insured and uninsured immigrants and non-immigrants within the U.S.; 2) we contrasted these results with health care access disparities between immigrants and non-immigrants in Canada, a country with universal health care; and 3) we conducted a novel direct comparison of health care access among insured and uninsured U.S. immigrants with Canadian immigrants (all of whom are insured). Outcomes investigated were self-reported unmet medical needs and lack of a regular doctor. Logistic regression models controlled for age, sex, nonwhite status, marital status, education, employment, and self-rated health. In the U.S., odds of unmet medical needs of insured immigrants were similar to those of insured non-immigrants but far greater for uninsured immigrants. The effect of health insurance was even more striking for lack of regular doctor. Within Canada, disparities between immigrants and non-immigrants were similar in magnitude to disparities seen among insured Americans. For both outcomes, direct comparisons of U.S. and Canada revealed significant differences between uninsured American immigrants and Canadian immigrants, but not between insured Americans and Canadians, stratified by nativity. Findings suggest health care insurance is a critical cause of differences between immigrants and non-immigrants in access to primary care, lending robust support for the expansion of health insurance coverage in the U.S. This study also highlights the usefulness of cross-national comparisons for establishing alternative counterfactuals in studies of disparities in health and health care.

Suggested Citation

  • Siddiqi, Arjumand & Zuberi, Daniyal & Nguyen, Quynh C., 2009. "The role of health insurance in explaining immigrant versus non-immigrant disparities in access to health care: Comparing the United States to Canada," Social Science & Medicine, Elsevier, vol. 69(10), pages 1452-1459, November.
    • Handle: RePEc:eee:socmed:v:69:y:2009:i:10:p:1452-1459
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    References listed on IDEAS

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    1. Rohitha Goonatilake & Susantha Herath, 2016. "The Economy of Healthcare: Disparity of Insured/Uninsured Profiles among European Immigrants in the United States," Eurasian Journal of Social Sciences, Eurasian Publications, vol. 4(1), pages 1-9.
    2. Bill McCarthy & Mikael Jansson & Cecilia Benoit, 2021. "Job Attributes and Mental Health: A Comparative Study of Sex Work and Hairstyling," Social Sciences, MDPI, vol. 10(2), pages 1-21, January.
    3. G. Trohel & V. Bertaud-Gounot & M. Soler & P. Chauvin & Olivier Grimaud, 2016. "Socio-Economic determinants of the need for dental care in adults," Post-Print hal-01372359, HAL.
    4. Nguyen, Quynh C. & Hussey, Jon M. & Halpern, Carolyn T. & Villaveces, Andres & Marshall, Stephen W. & Siddiqi, Arjumand & Poole, Charles, 2012. "Adolescent expectations of early death predict young adult socioeconomic status," Social Science & Medicine, Elsevier, vol. 74(9), pages 1452-1460.
    5. Gilda Trohel & Valérie Bertaud-Gounot & Marion Soler & Pierre Chauvin & Olivier Grimaud, 2016. "Socio-Economic Determinants of the Need for Dental Care in Adults," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-11, July.
    6. Astri Syse & Bjorn H. Strand & Oyvind Naess & Ólöf Anna Steingrímsdóttir & Bernadette N. Kumar, 2016. "Differences in all-cause mortality," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 34(22), pages 615-656.
    7. David E. Bloom & Elizabeth Cafiero & Eva Jané-Llopis & Shafika Abrahams-Gessel & Lakshmi Reddy Bloom & Sana Fathima & Andrea B. Feigl & Tom Gaziano & Ali Hamandi & Mona Mowafi & Danny O’Farrell & Emre, 2012. "The Global Economic Burden of Noncommunicable Diseases," PGDA Working Papers 8712, Program on the Global Demography of Aging.
    8. Noreen Goldman & Anne Pebley & Mathew Creighton & Graciela Teruel & Luis Rubalcava & Chang Chung, 2014. "The Consequences of Migration to the United States for Short-Term Changes in the Health of Mexican Immigrants," Demography, Springer;Population Association of America (PAA), vol. 51(4), pages 1159-1173, August.
    9. Rod Missaghian, 2021. "Social Capital and Post-Secondary Decision-Making Alignment for Low-Income Students," Social Sciences, MDPI, vol. 10(3), pages 1-18, March.
    10. Viladrich, Anahí, 2012. "Beyond welfare reform: Reframing undocumented immigrants’ entitlement to health care in the United States, a critical review," Social Science & Medicine, Elsevier, vol. 74(6), pages 822-829.
    11. Jimenez, Anthony M., 2021. "The legal violence of care: Navigating the US health care system while undocumented and illegible," Social Science & Medicine, Elsevier, vol. 270(C).
    12. Kannikar Hannah Wechkunanukul & Shahid Ullah & Justin Beilby, 2022. "Variation in Seeking Care for Cardiovascular Disease and Ambulance Utilization among Migrants in Australia: Time, Ethnicity, and Delay (TED) Study III," IJERPH, MDPI, vol. 19(3), pages 1-14, January.
    13. Guixin Han & Pengcheng Liu & Yihang Zhao & Yinyin Liang & Xiaojie Wang, 2023. "The Influence of Foreign Direct Investment on Physical Health of Rural-Urban Migrants—Empirical Evidence from China Migrants Dynamic Survey," IJERPH, MDPI, vol. 20(5), pages 1-13, February.
    14. Prus, Steven G., 2011. "Comparing social determinants of self-rated health across the United States and Canada," Social Science & Medicine, Elsevier, vol. 73(1), pages 50-59, July.
    15. Ramraj, Chantel & Shahidi, Faraz Vahid & Darity, William & Kawachi, Ichiro & Zuberi, Daniyal & Siddiqi, Arjumand, 2016. "Equally inequitable? A cross-national comparative study of racial health inequalities in the United States and Canada," Social Science & Medicine, Elsevier, vol. 161(C), pages 19-26.

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