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

Abstract

Background Immigrants have disparate access to healthcare. Disabilities can amplify their healthcare burdens. Objective/Hypothesis Examine how US- and foreign-born working-age adults with disabilities differ in their healthcare 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 $2,977, $3,312, and $2,355 more in total compared to their foreign-born counterparts (P<0.01). US-born spending was also higher across the four types of healthcare 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 healthcare 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.

Health differentials between citizens and immigrants in Europe: A heterogeneous convergence

“…In the United States, immigrants are less likely to have health insurance coverage and have lower health care use and spending than their native counterparts [16,17,18,19,20]. Observed differences in the access to health insurance and health care have been seen as one of the interplaying factors behind citizen-immigrant health differentials.…”

From the Guest Editors: Gender, Disability, and Intersectionality

“…The World Health Organization’s (WHO) International Classification of Functioning Disability and Health (ICF) lays out principles to help define disability types (Ustun et al 2003). While the starting point for definitions of disability is often the characterization of individuals’ impairments, the ICF currently defines disability by considering it not as an “attribute of the individual” but rather a state resulting from the interaction between person and environment (Ustun et al 2003, 40-42, as cited in Tarraf et al 2016). Following the lead of the ICF, then, scholars often categorize disabilities into three subgroups: physical limitations, mental health and/or cognitive limitations, or sensory limitations, with most of the latter being either vision or hearing impairments (Ustun et al 2003, 40-42).…”

Evidence for the Fidelity and Effectiveness of Living Independent From Tobacco for People with Disabilities and Their Caregivers

“…6,7 Moreover, recent research has documented that caregivers may impact the health behaviors of PWD they support. 8 This research aligns with Social Cognitive Theory, which posits that role modeling of peers in one’s social network reinforces day-to-day behaviors, including health-promoting and health-compromising behaviors such as smoking. 9 Moreover, Social Cognitive Theory extends that peers hold one another accountable, serving to reinforce and support meaningful behavior change for the better or for the worse.…”

“…Second, future research should attempt to empirically test the impact of including dyads of PWD and their caregivers in this and other health promotion interventions. Given that these relationships are powerful, intimate, 6,7 and influence health behaviors, 8 it is important to test the potential for these relationships to support meaningful and lasting positive health behavior changes. Third, our decision to recruit 3 caregivers who did not smoke may have limited our ability to detect change in CO levels among caregivers.…”

“…9 Previous work has documented that many paid caregivers engage in health-compromising behaviors, including smoking, and impact the health-related attitudes, knowledge, and behaviors of the PWD they support. 7,8 That is, caregivers are in a unique position to facilitate or impede the health behavior choices of PWD. With support and training, caregivers could adopt and facilitate positive health behavior changes that could lead to reduced tobacco use for both themselves and the people they care for.…”