Have We Come Up Short? A Comparison of the Unmet Health Care Needs among U.s.-born and Foreign-born Adults

Open Access
Hasanali, Stephanie Nicole Howe
Graduate Program:
Master of Arts
Document Type:
Master Thesis
Date of Defense:
July 30, 2012
Committee Members:
  • Gordon F De Jong, Thesis Advisor
  • health care access and utilization
  • unmet medical need
  • immigrants
Providing health care to immigrants presents greater challenges than it does for their U.S.-born counterparts because of assimilation-related factors which may create health care disparities. Using data from Panels 12 (2007-2008) and 13 (2008-2009) of the Medical Expenditure Panel Survey (n=19,562 adults), this study addressed two goals. First, I determined whether immigrants had greater unmet medical need than their U.S.-born counterparts, after accounting for group differences in demographic risk factors, available resources, including income and health insurance coverage, and family context. Second, I assessed the roles of length of stay in the U.S., English language proficiency, and state-level destination type in explaining the unmet medical need of the foreign-born, controlling for covariates. Multivariate logistic regression results for two measures of unmet medical need, subjective and objective, indicated that compared to the U.S. born, immigrants reported less subjective unmet need and equal objective unmet need. Among immigrants only, length of stay in the U.S. and state-level destination type were significantly associated with objective unmet need, but not subjective unmet need. English language proficiency was not significantly related to either measure of unmet medical need. While this study reinforces the importance of stable health insurance coverage and, to a lesser extent, income for gaining entry to the formal health care system, it also highlights that perceptions of health care access may be driven by assimilation factors for immigrants, including the health care system of the origin country, which are typically left out of models of health care access or utilization based on Andersen’s behavioral model.