Roles of length of stay and language proficiency on immigrants' access to care: A cross-country comparison of Canada and the United States

Background: Canada and the US are among the world's top migrant destinations, and previous research in both countries has consistently documented the link between immigrants' acculturation and access to health care services. However, there are no comparative studies examining differences across the two countries. The aim of this study was to conduct cross-country comparisons, using similar datasets from Canada and the US, in order to assess the influence of length of stay and language proficiency on access to care among foreign-born populations in each country.

Methods: Data came from the 2007-2008 Canadian Community Health Survey and the National Health Interview Survey. Comparable variables from each dataset were extracted, and multiple logistic regressions were built for each country. Access to care measures included: usual source of care, health consultation in the past year, dentist visit in the past year, and Pap test in the past 3 years. Length of stay was dichotomized (± 10 years). Language proficiency was measured using reports of language spoken at home in Canada and language of interview in the US. Sociodemographic factors were included in models to account for potential confounding, including age, sex, marital status, health status, race/ethnicity, education, household income, and insurance coverage.

Results: In adjusted analyses, recent immigrants to Canada had lower odds of having a usual source of care, health consultation, and Pap test compared with the native-born population. Immigrants who spoke only French or some Other language had lower odds of access to care compared with those who spoke only English.

In the US, recent immigrants had lower odds of access to care for all indicators compared with the native-born population. Immigrants who spoke only Spanish, a combination of Spanish and English, or some Other language had lower odds of access to care compared with immigrants who spoke only English. However, adjusting for health insurance coverage eliminated most of the language-based disparities in access among the foreign-born.

Conclusions: Barriers to care based on immigrants' length of resettlement and language proficiency were found in both countries but were more pervasive in the US. Differences in insurance coverage accounted for many of the language-based disparities in access to care in the US. However, some barriers remained in Canada for more recent immigrants and non-English speaking immigrants, suggesting that universal health coverage is not sufficient for ensuring access to care among foreign-born populations.