By the Numbers
Analysis from the 2016 National Health Interview Survey demonstrates that non-citizens living in the United States (US) are less likely to have a usual source of care and to use varied types of health care than US-born citizens.
In 2017, the Philadelphia Health Partnership (PHP) commissioned Dr. Leighton Ku, Director of the Center for Health Policy Research at the Milken Institute School of Public Health at George Washington University, to analyze data from the 2016 National Health Interview Survey (NHIS) by citizenship status. The NHIS is a nationally representative sample survey conducted by the Centers for Disease Control and Prevention that asks participants detailed questions about their utilization of health care.
Dr. Ku’s analysis focused on low-income children (ages 0-17) and adults (ages 18-64) who are living at 200% or below the federal poverty line. His findings indicate that non-citizens living in the United States (US) are less likely to use varied types of health care than US-born citizens. For instance, among low-income adults and children, 81% of US-born citizen adults and 92% of citizen children with citizen parents saw a medical professional in the last year compared to 63% of non-citizen adults and 72% of non-citizen children. Non-citizens are also less likely to have a usual source of care, defined in the NHIS questionnaire as a place one usually goes when sick.
Lack of insurance is one clear driver for differences in non-citizens’ utilization of care. Among low-income adults, nearly half (47%) of non-citizen adults were uninsured compared to only 17% of US-born citizen adults. Among low-income children, 38% of non-citizen children were uninsured compared to 6% of citizen children with citizen parents. However, Dr. Ku notes that while income and insurance status account for much of the disparity in health care access and utilization, “differences often exist even when we compare people with similar insurance status or who are all low-income.”
When analyzing low-income NHIS respondents who do have a usual source of care, Dr. Ku found that non-citizens were more likely to report going to a clinic than a doctor’s office or hospital: over half of non-citizens (55% of adults and 61% of children) compared to one-third or less of citizens (33% of US-born citizen adults and 29% of citizen children with citizen parents). Dr. Ku notes, “This data indicates the importance of safety net facilities for non-citizens,” many of which do not require insurance or ask patients about their citizenship status.
How does the national data compare to Philadelphia County?
The annual American Community Survey (ACS) conducted by the United States Census Bureau provides county-level information about health insurance by citizenship status. According to the 2016 ACS, 232,031 foreign-born residents live in Philadelphia County, of which just over half (52%) are not citizens. Only 66% of non-citizen adults in Philadelphia County have health insurance compared to 94% of US-born adults. Limited data exists on immigrant utilization of health care, particularly for non-citizens. Many local health surveys do not ask participants to identify their citizenship status so as to encourage full participation, particularly by unauthorized foreign-born residents (estimated to number approximately 50,000 in Philadelphia County).
At the local level, addressing data limitations will require fielding surveys that are designed to reflect linguistic and cultural differences and are delivered by trusted community members. At PHP, we are working with our immigrant- and refugee- serving grantees to determine what practice- and policy-relevant questions they are least able to effectively answer with current data to determine whether future investments in local survey research can help inform the delivery of high-quality services. In the meantime, Dr. Ku’s findings provide insight into the lack of care received by many non-citizen immigrants, particularly those who are low-income.