Factors that Explain Healthcare Access and Utilization Variations Among Mexican Immigrants by Lawful Permanent Residency Status

Background: Mexicans are the largest immigrant group in the United States and comprise the majority of Non-lawful permanent residents (Non-LPR).

Objective: To identify differences in healthcare access and utilization among Mexican immigrants by lawful permanent residency status, and determine the relative contribution of predisposing, enabling, need, and unobserved factors.

Research Design: Cross-sectional survey data are analyzed to identify differences in healthcare access and utilization across Mexican immigrant categories. Multivariable logistic regression and the Blinder-Oaxaca decomposition are used to parse out differences into observed and unobserved components.

Subjects: Mexican immigrants ages 18 and above who are non-institutionalized residents of California households and responded to the 2007 California Health Interview Survey (2,600 LPR and 1,038 Non-LPR).

Measures: Self-reported doctor visits, emergency department visits, usual source of care, delays in prescription drugs, and delays in seeking other health services.

Results: Non-LPR immigrants from Mexico are 27% less likely to have a doctor visit in the previous year and 35% less likely to have a usual source of care compared to LPR Mexican immigrants after controlling for confounding variables. Approximately 88% of these disparities can be attributed to predisposing, enabling and need determinants in our model. The remaining disparities are attributed to unobserved heterogeneity.

Limitations: The cross-sectional design limits the analyses of differences over time. Self reported data might underestimate levels of need for those with impaired access to care. Conclusions: This study shows that Non-LPR immigrants from Mexico are much less likely to have a physician visit in the previous year and a usual source of care compared to Mexican LPR immigrants.