The myth of undocumented immigrants using American health care

I hear it all the time: “All these illegals are coming over here and they don’t pay taxes, but they get all these government handouts and they’re clogging up our health care system …”

I often point out that many undocumented immigrants actually do obtain a taxpayer identification number for the express purpose of paying taxes in hopes that if a path to citizenship ever becomes a reality for the undocumented in this country, they will have a record of their contributions into the system. I don’t think people believe me when I tell them this. But perhaps they’ll pay attention to the information from a recently published study by Dejun Su and colleagues.

The study, “Cross-Border Utilization of Health Care: Evidence from a Population-Based Study in South Texas” appears in the latest issue of Health Services Research. While many of the people whose social circles overlap my own are of the opinion that all the immigrants are crossing over into the U.S. to take advantage of all our “widely available free care”–you know, the ER variety–this study showed the opposite: people are headed from the U.S. to Mexico for care.

Of course, that’s not the case generally. The study looked only at border towns, and specifically, found that those who were uninsured and/or in poor health were the most likely to head to Mexico for care. But the point is that about 50% of the residents of border towns do actually go to Mexico for care. Some of these are undocumented immigrants heading back to their homeland for care, but others are U.S. citizens who are finding it more cost-effective to head to a Mexican physician or pharmacy.

This study actually speaks volumes. Opponents of health reform claim that the U.S. has the best health care system in the world, and that the uninsured can get health care whenever they want it, by going to an emergency room. If this were truly the case, the flow of cross-border health care seeking behavior would be unidirectional, with everyone pouring into the U.S., but it isn’t. Instead, many people find it better to go to Mexico, where care is far more affordable, and I expect, absent improvements in our health care system, more and more people will choose to do so and will make the journey from farther away.

After all, medical tourism is already a booming business far beyond Mexico. I just wonder if the people of Juarez are as disgusted with those of us crossing into Mexico to see their doctors as we are about them coming here. Something tells me they’re not.

Brad Wright is a health policy doctoral student who blogs at Wright on Health.

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  • rdowney

    Brad,
    Comparing medical tourism (Americans going to Mexico for medical care) and undocumented immigrants who enter this country illegally who use emergency medical services amounts to comparing apples and oranges.
    Americans don’t go to emergency rooms at Mexican hospitals unless it is a true emergency and they need emergent medical care. They do cross the border for appointments with Mexican physicians, but they pay for those visits.
    The same cannot be said for those who are in this country illegally. Most have no family physicians here, and so they end up in the emergency rooms when they get very ill. EDs must treat anyone who presents, whether they can pay or not. You might suggest that they are going to Urgent Care centers. Yes, if they can afford to pay – because an urgent care center is not obligated to treat any patient who cannot pay.

  • http://www.healthjusticect.org Heangtan

    Brad brings up some good points. There are many myths involving undocumented immigrants — accessing healthcare services for free is one of the biggest. Many people think we have a healthcare system that cares for everyone, in fact that’s the real myth. We don’t have a healthcare system that ‘cares’. In reality what drives our healthcare costs is the lack of care for others. We have to focus on education and work towards closing the health gap in at risk communities. Many of us are locked out of the system for one of more reasons, even if we have access to insurance. We need to focus on the social issues of health – this includes immigration reform and a shift in paradigm.

    Atul Gawande’s article in the New Yorker is good case in point for reducing healthcare cost by caring for the most vulnerable http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande.

    • http://Www.twitter.com/alicearobertson Alice

      I think Atul Gawande’s award winning piece was about much more than that. I define vulnerable a bit different. He discussed hard cases of a type of fear that lead them to abuse the system, he discusses hospice care. Actually…for some he suggests a type of tough love that made the patient responsible for their own health. I don’t see the vast majority of immigrants as being anywhere near this status…they are refugees not so much seeking to get their health back, but freedom.

      Remember the house everyone liked to hang out at? But the parents could not afford to feed you? They graciously let you hang out, but you had to go home to eat, or everyone pitched in for pizza….even pitching in they could not have afforded a hospital visit if you were injured on their property. So it is with illegals…….we cannot absorb the cost…and that’s no myth.

  • Karen

    I would be happier to have read that “all”, or even “most” had entered the system as taxpayers. But since it is only “many”, these many are just as much victims of an unfairly applied system as the rest of us.

  • Jack G

    “Opponents of health reform claim that the U.S. has the best health care system in the world”

    What? Who has claimed this? There are just more sustainable & fair options that what were rolled in the recent attempt at healthcare accessibility reform.

    • pj

      “Who has claimed this?”

      Only a few thousand or more, GOP supporters….

  • Big Thinker

    I call bullcrap. This study was not powered to generalize the utilization of healthcare services in areas outside of “border cities.” Your extrapolation of conclusions are opinion at best.

    The idea that people are traveling to Mexico for healthcare because it is superior to that in the U.S. is an asinine idea espoused by liberal ideologs. If, in fact, people were heading to Mexico, it would most likely be toward Monterrey and Guadalajara where there are teaching institutions.

    I would challenge you to visit federally subsidized healthcare clincs in rural Texas, New Mexico, Arizona, and especially California. “Business is often swapped between ERs and these facilities, generally at taxpayer expense.

  • ninguem

    American citizens are heading south for certain specific healthcare services and pharmaceuticals, PAYING for the goods and services. The price is low compared to the USA economy but very profitable in the Mexican economy.

    You can say the same for shoppers going back and forth across the Canadian border, depending on how the Canadian dollar is doing against the USA dollar.

    I’m undocumented when I forget my driver license.

    The ILLEGAL Mexican immigrants come north and get free services from USA hospitals.

    “This study actually speaks volumes.”

    Actually, this study is trite.

  • Steven Wynn

    I wonder if the author actually read the whole article or is he trying to mislead people? Or maybe he only read the part that affirms his beliefs?

    —————————-
    From the article:
    “The overall response rate was 28.6 percent…the significant concentration of undocumented immigrants in the region implies that these immigrants might be unwilling to participate in any kind of surveys for fear of being identified and eventually deported”

    Hmmmm so maybe the study was skewed from the start?

    “An additional 200 interviews were conducted in two nonborder counties (Harris and Bexar) to compare health care utilization patterns between border and non-border residents, but these cases are not included here.”

    Why are they not included here? Did they not find information that was useful? Or maybe they found information that was not useful to their agenda?

    So how many of the survey respondents were hispanics you ask? 83%!!! And how many of those surveyed were hispanics born in Mexico? 54%!!!

    Yeah this study isn’t skewed at all.

    “Hispanics who were born in Mexico were far more likely to visit a Mexican dentist (p<.001)…For medication purchases and doctor visits, the likelihood of utilization increased with higher levels of Spanish fluency"

    So you're saying hispanics from Mexico and people who spoke Spanish well were more likely to go to Mexico for care? In fact, the odds ratio for non-Spanish speakers to visit a doctor was 0.01. Hmmmmm so only Spanish speakers went to Mexican doctors?

    "Dissatisfaction with the quality of health care received in the United States was associated with increased odds of obtaining health care services in Mexico."

    Well the author is right about one thing. These people aren't happy about their health care. Now one thing I'd like to know is why didn't the authors of the article do an analysis correlating self rated health status and cultural affinity to Mexico? Would it undermine their wider point?

    Is it possible that people who have a high affinity to Mexico (i.e. they speak Spanish and/or they are from Mexico) go to Mexico because……they have a high affinity for Mexico? Is it possible that these same people have a poor self related health status are not getting their proper care because of language or cultural barriers? Just some questions to ask that the author of the study and the article on KevinMD.com fail to address.

    All this article tells me is that 83% of the respondents (who actually responded) are Hispanic (which is a lot). Let me know when you get some serious analysis on the issue.

  • http://Www.twitter.com/alicearobertson Alice

    I wish I had the stats handy for those who come here with the desire to deliver their baby on US soil. Unless the law has changed that loophole was no myth and Texas and CA had huge bills from that highway to delivering a US citizen.

  • http://thepinkteeshirt.blogspot.com emmy

    The first objection is that the study was done in South Texas. I was in McAllen Texas during my first pregnancy. Obstetric care was just as good in Reynosa as it was nine miles away in McAllen, but was 1/5 the cost. My ex-husband’s prescription for phenobarbital cost $55 in the US, but only $3 in Mexico. Yes, I crossed the border. That was the year that President Carter signed the bill that declared that pregnancy had to be treated as any other illness, so I had my son in the US with a staff physician. Twelve years later in Georgia, when my ex-husband was in the middle of a jobless cycle and I found myself pregnant, I sought care at a public clinic. I was denied care because the system was being used by undocumented immigrants. The difference was that when I went to Mexico, I was paying for my care out of pocket. I have been a tax paying citizen of this country since I was 12 years old and I was denied care in favor of someone who may never pay for the care they receive and who isn’t a citizen. I didn’t receive care for that pregnancy until I was 5 months along and could pay for it with the money that I received from my mother’s estate. Are you going to tell me that illegals aren’t the problem with the health care system?