Access to Health Insurance & Care among Mexican Binationals: Reality & Potential

1. Access to Health Insurance & Care among Mexican Binationals: Reality & Potential Steven P. Wallace, Ph.D. UCLA Center for Health Policy Research & UCLA School of Public Health 2007 Academy Health Research Meeting Orlando, FL http://swallace.bol.ucla.edu

2. Summary • The economic profile of Mexican immigrants is quite low • Their health status, in contrast, is generally good • Health insurance and access to care is very poor • Are use rates appropriate or not?

3. Mexican Immigrants have lowest levels of education Source: Current Population Survey, 2005. See http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=196

4. Mexican immigrants have high levels of poverty United States California Source: Current Population Survey, 2005. See http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=196

5. Mexican immigrant households have the lowest levels of medical coverage for all members Households headed by Mexican immigrants Households headed by immigrants from country other than Mexico Households headed by U.S.-born Source: Current Population Survey, 2005. See http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=196

6. Mexican immigrant individuals also have the lowest levels of health insurance Source: Current Population Survey, 2005. See http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=196

7. Among adults living in poverty, Mexican immigrants are least likely to rely on public health insurance Source: Current Population Survey, 2005. See http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=196

8. Among adults employed in manual occupations* Mexican immigrants have least health insurance * Includes cleaning and maintenance of buildings, food preparation, construction, repair and production, farming, fishing and forestry. Source: Current Population Survey, 2005. See http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=196

9. Epidemiological paradox: Hispanics have lowest death rates/100,000, U.S. Source: Markides & Eschbach (2005) JGSS. Vol. 60B (Special Issue II): 68–75

10. Mexican immigrants have better health indicators except for diabetes, ages 18-64 Source: U.S. National Health Interview Survey, 2005, age adjusted to 2005 total adult population

11. Immigrant advantage shrinks when age adjusted (2000 Census population standard), ages 18-64 Source: U.S. National Health Interview Survey, 2005, age adjusted to 2005 total adult population

12. Mexican immigrants have lowest work disability rates Ages 18-44 Source: U.S. National Health Interview Survey, 2005

13. Mexican immigrants most likely to have no usual source of care Source: U.S. National Health Interview Survey, 2005. Adults 18 or older, U.S.

14. No usual source of care – Odds Ratio controlling for age, sex, chronic conditions, poverty, education, Ages 18-64 Source: U.S. National Health Interview Survey, 2005. Adults 18 or older, U.S.

15. Mexican immigrants have the lowest levels of emergency room visits Source: U.S. National Health Interview Survey 2005.

16. Mexican immigrants have the highest levels of no medical visits in the past two years, ages 18-64 Source: U.S. National Health Interview Survey, 2005.

17. Insurance & no usual source of care related, Mexican immigrants lowest, ages 18-64 Source: U.S. National Health Interview Survey, 2005.

18. Logistic regression of no MD visit past 2 years, ages 18-64 § § § ~ ~ § § § § * All groups significant at p<0.05; § individual group significant at p<.05; ~ significant at p<0.1 Source: U.S. National Health Interview Survey, 2005.

19. Any care (medical, dental, prescription) in Mexico past year , California 2001 Source: U.S. California Health Interview Survey 2001.

20. Conclusions • Mexican immigrants have limited economic resources, high uninsurance rates • But have high levels of health capital • They use health services less compared to native born with similar health status • Access to care is impacted most strongly by usual source of care for Mexican immigrants

21. Next Steps • Develop an understanding of help seeking processes of recent immigrants. We know they use less medical care, are they simply going without? • Better identify where immigrants obtain services (private store-fronts, Mexico, etc.) • Analyze recent immigrants over time. Longitudinal data shows health advantage persists but weakens over time. Similar analyses are needed for health service use.