Community health centers as a usual source of care among immigrants

Research Objective:

This study examines the relationship of immigrant status, health insurance status, and race/ethnicity with using a Community Health Center (CHC) as a usual source of care.

Study Design:

Data is obtained from the 2005 National Health Interview Survey (NHIS). Only respondents who reported race/ethnicity as non-Hispanic White, non-Hispanic Black, or Hispanic, and were aged 18 years or older are included in the study (n=68,540). Logistic regression modeled health insurance, race/ethnicity and nativity as predictors of CHC use as a usual source of care, while adjusting for effects of poverty, age, marriage, education, gender, having a usual source of care, and health status. Post-estimation analyses using STATA 10.0 stratify race/ethnicity among CHC users by foreign vs. U.S. nativity and, separately, stratify type of health insurance (uninsured, privately insured, and publicly insured) among CHC users by foreign vs. U.S. nativity. Odds of CHC utilization within the past year are calculated comparing patients of foreign nativity to patients of U.S. nativity within race/ethnicity and within health insurance.

Principal Findings:

In the full model, foreign-born patients are significantly associated with higher CHC compared to U.S. natives [(OR=1.23 (95%CI 1.12,1.33)]. In post-estimation analyses, significant association between being foreign-born and using a CHC as a usual source of care is similar across race/ethnicity strata and also similar across health insurance strata. After stratifying results, foreign-born patients were more likely to use a CHC compared to U.S. natives among all types of health insurance [uninsured OR 1.29(95%CI 1.05,1.54);publicly insured OR=1.26 (95%CI 1.01,1.52); privately insured OR=1.26(95%CI 1.07,1.45)] and among Hispanics and Whites [OR=1.30 (95%CI 1.03,1.57); 1.30 (95%CI 1.08,1,51), respectively].

Conclusions:

Reasons that immigrants use CHCs extend beyond reasons commonly attributed to health care access. After adjusting for poverty, education, race/ethnicity, health insurance, and other factors typically associated with immigrants' health care access, immigrants were still significantly more likely than U.S. natives to use a CHC. Post-estimation stratification revealed that immigrants were more likely to use a CHC whether uninsured, publicly insured, privately insured, White or Hispanic. Reasons for CHC use may include the “enabling services”, including culturally and linguistically competent care, which CHCs are required to provide to qualify for federal funds. Further, CHCs commonly organize health care delivery similarly to that in many immigrants' countries of origin. Communities seeking to expand access for immigrants should identify and incorporate into their health systems the aspects of CHC health care delivery that make it attractive to immigrants.