Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
The European Journal of Health Economics
Published in: The European Journal of Health Economics 5/2017

01-06-2017 | Original Paper

Healthcare inequality issues among immigrant elders after neoliberal welfare reform: empirical findings from the United States

Author: Younsook Yeo

Published in: The European Journal of Health Economics | Issue 5/2017

Login to get access

Abstract

Even with the increasing importance being placed on research into immigrant elders’ healthcare use as countries change their policies to reflect their increasing immigrant and aging populations, little research has examined changes in healthcare use disparities between immigrant and native elders in relation to these policy changes. To fill this gap in the literature, this study examined healthcare disparities in relation to the welfare reform that the US implemented in 1996 and then compared significant indicators of immigrants’ healthcare use during the pre- and post-reform periods. The difference-in-difference (DD) analyses and post hoc probing of the DD analyses were used in multivariate logistic regression of the National Health Information Survey data that were pooled for the pre- and post-reform periods. The results revealed that while inequalities in healthcare existed before the reform, they significantly increased after the reform. A further test showed that the changes in the inequalities were significant among relatively long-stay immigrants, but not significant among immigrants who entered the US before the reform and thus were exempted from the reform restrictions. During the pre-reform period, insurance, employment, sex, and race/ethnicity were related to healthcare use; however, the enabling factors (i.e., insurance, income, and education) and social structural factors (i.e., marital status, family structure, length of US residency, race/ethnicity, and geographical region) explained the post-reform immigrants’ healthcare use, while controlling for healthcare needs factors. These findings suggest that welfare reform may be the driving force of inequalities in healthcare.
Literature
1.
Abramovitz, M., Zelnick, J.: Double jeopardy: the impact of neoliberalism on care workers in the United States and South Africa. Int. J. Health Serv. 40(1), 97–117 (2010)PubMedCrossRef
2.
Jenson, J.: Redesigning citizenship regimes after neoliberalism: moving towards social investment. In: Morel, N., Palier, B., Palme, J. (eds.) What future for social investment?, pp. 27–44. Institute for Future Studies, Stockholm (2009)
3.
Siddiqi, A., Kawachi, I., Keating, D.P., Hertzman, C.: A comparative study of population health in the United States and Canada during the neoliberal era, 1980–2008. Int. J. Health Serv. 43(2), 193–216 (2013)PubMedCrossRef
4.
Arentz, C., Eekhoff, J., Kochskämper, S.: Private health insurance: a role model for European health systems. Eur. J. Health Econ. 13(5), 615–621 (2012)PubMedCrossRef
5.
Boas, T.C., Gans-Morse, J.: Neoliberalism: from new liberal philosophy to anti-liberal slogan. Stud. Comp. Int. Dev. 44(2), 137–161 (2009)CrossRef
6.
Gelormino, E., Bambra, C., Spadea, T., Bellini, S., Costa, G.: The effects of health care reforms on health inequalities: a review and analysis of the European evidence base. Int. J. Health Serv. 41(2), 209–230 (2011)PubMedCrossRef
7.
Pavolini, E., Ranci, C.: Restructuring the welfare state: reforms in long-term care in Western European countries. J. Eur. Soc. Policy 18(3), 246–259 (2008)CrossRef
8.
Maarse, H.: The privatization of health care in Europe: an eight-country analysis. J. Health Polit. Polic. 31(5), 981–1014 (2006)CrossRef
9.
Saltman, R., Figueras, J.: European health care reform. World Health Organization, Copenhagen (1997)
10.
Saltman, R.B., Figueras, J.: Analyzing the evidence on European health care reforms. Health Affair. 17(2), 85–108 (1998)CrossRef
11.
Joppke, C.: Beyond national models: civic integration policies for immigrants in Western Europe. West Eur. Polit. 30(1), 1–22 (2007)CrossRef
12.
Kraler, A.: Civic stratification, gender and family migration policies in Europe (final report). ICMPD/BMWF, Vienna (2010)
13.
Sainsbury, D.: Immigrants’ social rights in comparative perspective: welfare regimes, forms of immigration and immigration policy regimes. J. Eur. Soc. Policy 16(3), 229–244 (2006)CrossRef
14.
Staver, A.: Hard work for love: the economic drift in Norwegian family immigration and integration policies. J. Fam. Issues 36(1), 1453–1471 (2015)CrossRef
15.
Østergaard-Nielsen, E.: Counting the costs: Denmark’s changing migration policies. Int. J. Urban Regional 27(2), 448–454 (2003)CrossRef
16.
Sales, R.: The deserving and the undeserving? Refugees, asylum seekers and welfare in Britain. Crit. Soc. Policy 22(3), 456–478 (2002)CrossRef
17.
Minderhoud, P.E.: Het Immigratiebeleid (The immigration policy). In: Entzinger, H., Van der Meer, J. (eds.) Grenzeloze Solidariteit. Naareen Migratiebestendige Verzorgingsstaat (Solidarity without borders. Towards a migration-proof welfare state), De Balie, Amsterdam (2004)
18.
Durán, A., Lara, J.L., van Waveren, M.: Spain: health system review. Health Syst Transit 8(4), 1–208 (2006)
19.
De Cock, K.M.: Trends in global health and CDC’s international role, 1961–2011. Morb. Mortal. Wkly Rep. 60(04), 104–111 (2011)
20.
21.
Marmot, M., Atkinson, T., Bell, J., Black, C., Broadfoot, P., Cumberlege, J., Diamond, I., Gilmore, I., Ham, C., Meacher, M., Mulgan, G.: Fair society healthy lives: the Marmot review. Strategic review of health inequalities in England post-2010. University College London, London (2010)
22.
Buron, A., Cots, F., Garcia, O., Vall, O., Castells, X.: Hospital emergency department utilization rates among the immigrant population in Barcelona, Spain. BMC Health Serv. Res. 8(51), 1–10 (2008)
23.
Jiménez-Rubio, D., Hernández-Quevedo, C.: Inequalities in the use of health services between immigrants and the native population in Spain: what is driving the differences? Eur. J. Health Econ. 12(1), 17–28 (2011)PubMedCrossRef
24.
Koning, E.A., Banting, K.G.: Inequality below the surface: reviewing immigrants’ access to and utilization of five Canadian welfare programs. Can. Public. Pol. 39(4), 581–601 (2013)CrossRef
25.
26.
Stronks, K., Ravelli, A., Reijneveld, S.: Immigrants in the Netherlands: equal access for equal needs? J. Epidemiol. Commun. H. 55(10), 701–707 (2001)CrossRef
27.
Solé-Auró, A., Guillén, M., Crimmins, E.M.: Health care usage among immigrants and native-born elderly populations in eleven European countries: results from SHARE. Eur. J. Health Econ. 13(6), 741–754 (2012)PubMedCrossRef
28.
Wendt, C., Frisina, L., Rothgang, H.: Healthcare system types: a conceptual framework for comparison. Soc. Policy Admin. 43(1), 70–90 (2009)CrossRef
29.
Burau, V.: Transforming health policy and services: challenges for comparative research. Curr. Sociol. 60(4), 569–578 (2012)CrossRef
30.
Gupta, K.: Comparative public policy: using the comparative method to advance our understanding of the policy process. Policy Stud. J. 40(S1), 11–26 (2012)CrossRef
31.
Heidenheimer, A.J., Heclo, H., Adams, C.T.: Comparative public policy: the politics of social choice in Europe and America. St. Martin’s Press, New York (1983)
32.
Jasper, J.M.: Two or twenty countries: contrasting styles of comparative research. Comp. Soc. Re. 10, 205–229 (1987)
33.
Lipset, S.M.: Historical traditions and national characteristics: a comparative analysis of Canada and the United States. Can. J. Sociol. 11(2), 113155 (1986)CrossRef
34.
Rinnert, D.: The politics of civil service and administrative reforms in development: explaining within-country variation of reform outcomes in Georgia after the rose evolution. Public Admin. Dev. 35, 19–33 (2015)CrossRef
35.
Ashenfelter, O., Card, D.: Using the longitudinal structure of earnings to estimate the effect of training programs. Rev. Econ. Stat. 67, 648–660 (1985)CrossRef
36.
Krieger, N.: Epidemiology and social sciences: towards a critical reengagement in the 21st century. Epidemiol. Rev. 22(1), 155–163 (2000)PubMedCrossRef
37.
Krieger, N.: Theories for social epidemiology in the 21st century: an ecosocial perspective. Int. J. Epidemiol. 30(4), 668–677 (2001)PubMedCrossRef
38.
Galea, S.: An argument for a consequentialist epidemiology. Am. J. Epidemiol. 178(8), 1185–1191 (2013)PubMedCrossRef
39.
40.
Brunner, L., Colarelli, M.S.: Immigration in the twenty-first century: a personal selection approach. Indep. Rev. 14(3), 389–413 (2010)
41.
Jasso, G., Rosenzweig, M.R.: Family reunification and the immigration multiplier: U.S. immigration law, origin-country conditions, and the reproduction of immigrants. Demography 23(3), 291–311 (1986)PubMedCrossRef
42.
Carr, S., Tienda, M.: Family sponsorship and late-age immigration in aging America: revised and expanded estimates of chained migration. Popul. Res. Policy Rev. 32, 825–849 (2013)CrossRef
43.
Kandel, W.A.: U.S. family-based immigration policy. Congressional Research Service, Washington, D.C. (2014)
44.
Zong, J., Batalova, J.: Frequently requested statistics on immigrants and immigration in the United States. Migration Policy Institute, Washington, D.C. (2015)
45.
Batalova, J., Lee, A.: Frequently requested statistics on immigrants and immigration in the United States. Migration Policy Institute, Washington D.C (2012)
46.
He, W.: The older foreign-born population in the United States: 2000. US Census Bureau, Washington, D.C. (2002)
47.
Leach, M.A.: America’s older immigrants: a profile. Generations 32(4), 34–39 (2009)
48.
O’Neil, K., Tienda, M.: Age at immigration and the incomes of older immigrants, 1994–2010. J. Gerontol. B Psychol. 70(2), 291–302 (2015)CrossRef
49.
Kritz, M.M., Gurak, D.T., Chen, L.: Elderly immigrants: their composition and living arrangements. J. Sociol. Soc. Welfare 27(1), 85 (2000)
50.
Beckfield, J., Krieger, N.: Epi+ demos+ cracy: linking political systems and priorities to the magnitude of health inequities—evidence, gaps and a research agenda. Epidemiol. Rev. 31, 152–177 (2009)PubMedCrossRef
51.
Esping-Andersen, G.: The three worlds of welfare capitalism. Princeton University Press, New Jersey (1990)
52.
Sainsbury, D.: Welfare states and immigrant rights: the politics of inclusion and exclusion. Oxford University Press, Oxford (2012)CrossRef
53.
Xu, Q.: Globalization, immigration and the welfare state: a cross-national comparison. J. Sociol. Soc. Welfare 34(2), 87–106 (2007)
54.
Angel, J.L.: Devolution and the social welfare of elderly immigrants: who will bear the burden? Public Admin. rev. 63(1), 79–89 (2003)CrossRef
55.
Fremstad, S., Cox, L.: Covering New Americans: a review of federal and state policies related to immigrants eligibility and access to publicly funded health insurance. Kaiser Commission on Medicaid and the Uninsured, Washington, D.C. (2004)
56.
Friedland, R.B., Pankaj, V.: Welfare reform and elderly legal immigrants. The Henry J. Kaiser Family Foundation, Washington, D.C. (1997)
57.
Ku, L., Kessler, B.: The number and cost of immigrants on Medicaid, the national and state estimates. Urban Institute, Washington, D.C. (1997)
58.
Buff, R.I.: Immigrant rights in the shadows of citizenship. New York University Press, New York (2008)
59.
Kandula, N.R., Kersey, M., Lurie, N.: Assuring the health of immigrants: what the leading health indicators tell us. Annu. Rev. Publ. Health 25(1), 357–376 (2004)CrossRef
60.
Quadagno, J.: One nation, uninsured: why the US has no national health insurance. Oxford University Press, New York (2005)
61.
Yelowitz, A.: Public policy and health insurance choices of the elderly: evidence from the Medicare buy-in program. J. Public Econ. 78(3), 301–324 (2000)CrossRef
62.
Choi, S.: Insurance status and health service utilization among newly-arrived older immigrants. J. Immigr. Minor. Health 8(2), 149–161 (2006)PubMedCrossRef
63.
Choi, S.: Longitudinal changes in access to health care by immigrant status among older adults: the importance of health insurance as a mediator. Gerontologist 51(2), 156–169 (2010)PubMedCrossRef
64.
Carrasquillo, O., Carrasquillo, A.I., Shea, S.: Health insurance coverage of immigrants living in the United States: differences by citizenship status and country of origin. Am. J. Public Health 90(6), 917–923 (2000)PubMedPubMedCentralCrossRef
65.
66.
Andersen, R.M.: Revisiting the behavioral model and access to medical care: does it matter? J. Health Soc. Behav. 36(1), 1–10 (1995)PubMedCrossRef
67.
Aday, L.A., Andersen, R.M.: Models of health care utilization and behavior. In: Armitage, P., Colton, T. (eds.) Encyclopedia of biostatistics, pp. 1841–1845. Wiley, New York (1998)
68.
Choi, S.: A critical review of theoretical frameworks for health service use among older immigrants in the United States. Soc Theory Health 9(2), 183–202 (2011)CrossRef
69.
National Center for Health Statistics: National Health Interview Survey (NHIS): Public-use data release: NHIS survey description document. National Center for Health Statistics, Washington, D.C (2014)
70.
71.
National Center for Health Statistics: 1998 National Health Interview Survey (NHIS): Public-use data release: NHIS survey description document. National Center for Health Statistics, Washington, D.C (2000)
72.
National Center for Health Statistics: Variance estimation and other analytic issues in the 1997–2005 NHIS: adapted from appendices III and VII of the 2005 NHIS survey description document, and appendix III of the 2006 NHIS survey description document. http://​www.​cdc.​gov/​nchs/​data/​nhis/​9705var.​pdf (2009). Accessed 17 June 2015
73.
Burg, M.M., Seeman, T.E.: Families and health: the negative side of social ties. Ann. Behav. Med. 16, 109–115 (1994)
74.
Samek, D.A., Laporte, A., Nauenberg, E., Shen, L., Coyte, P.C.: The effect of social capital on the use of general practitioners: a comparison of immigrants and non-immigrants in Ontario. Health Policy 8(1), 49–66 (2012)
75.
Harteloh, P.P.M.: The meaning of quality in health care: a conceptual analysis. Health Care Anal. 11, 259–267 (2003)PubMedCrossRef
76.
Lee, K.J., Simpson, J.A.: Introduction to multiple imputation for dealing with missing data. Respirology 19, 162–167 (2014)PubMedCrossRef
77.
Holmbeck, G.N.: Post-hoc probing of significant moderational and mediational effects in studies of pediatric populations. J. Pediatr. Psychol. 27(1), 87–96 (2002)PubMedCrossRef
78.
Hjelm, K., Albin, B.: Limited focus on the use of health care by elderly migrants: a literature review. Open J Nurs 4, 465–473 (2014)CrossRef
79.
Albin, B., Albertsson, M., Ekberg, J., Hjelm, K.: Health and consumption of health care and social service among old migrants in Sweden. Prim Health Care Res Dev 6(1), 37–45 (2005)CrossRef
80.
Denktaş, S., Koopmans, G., Birnie, E., Foets, M., Bonsel, G.: Ethnic background and differences in health care use: a national cross-sectional study of native Dutch and immigrant elderly in the Netherlands. Int J Equity Health 8(35) (2009)
81.
Yeo, Y.S., Johnson, M.M.: Healthy immigrant effect on older adult immigrants in relation to welfare reform. J Soc Soc Work Res 4(3), 182–197 (2013)CrossRef
82.
Adler, N.E., Stewart, J.: Health disparities across the lifespan: meaning, methods, and mechanisms. Ann. NY Acad. Sci. 1186(1), 5–23 (2010)PubMedCrossRef
83.
84.
Teghtsoonian, K.: Depression and mental health in neoliberal times: a critical analysis of policy and discourse. Soc. Sci. Med. 69(1), 28–35 (2009)PubMedCrossRef
85.
Woodall, J.R., Warwick-Booth, L., Cross, R.: Has empowerment lost its power? Health Educ. Res. 27(4), 742–745 (2012)PubMedCrossRef
86.
87.
Holmström, I., Roïng, M.: The relation between patient-centeredness and patient empowerment: a discussion on concepts. Patient Educ. Couns. 79(2), 167–172 (2010)PubMedCrossRef
88.
Menon, S.T.: Toward a model of psychological health empowerment: implications for health care in multicultural communities. Nurs. Educ. Today 22(1), 28–39 (2002)CrossRef
89.
Derose, K.P., Escarce, J.J., Lurie, N.: Immigrants and health care: sources of vulnerability. Health Affair. 26(5), 1258–1268 (2007)CrossRef
90.
Feld, P., Power, B.: Immigrants’ access to health care after welfare reform: findings from focus groups in four cities. Kaiser Commission on Medicaid and the Uninsured, Washington, D.C. (2000)
91.
92.
Borjas, G.J.: Welfare reform, labor supply, and health insurance in the immigrant population. J. Health Econ. 22(6), 933–958 (2003)PubMedCrossRef
93.
Gerdtham, U-G., Jönsson, B.: Chapter 1 international comparisons of health expenditure: theory, data and econometric analysis. Handbook of Health Economics, 1(Part A), 11–53 (2000)
94.
Kröger, T., Silipa, J.: Overstretched: European families up against the demands of work and care. Blackwell, Oxford (2005)
95.
Boucher, A.: Familialism and migrant welfare policy: restrictions on social security provision for newly arrived immigrants. Policy Polit. 42(3), 367–384 (2014)CrossRef
96.
Albert, I., Ferring, D., Michels, T.: Intergenerational support and the emotional well-being of older Jews and Arabs in Israel. Eur. Psychol. 18(1), 59–69 (2013)CrossRef
97.
Chappell, N.L., Funk, L.M.: Social support, caregiving, and aging. Can. J. Aging 30(3), 355–370 (2011)PubMedCrossRef
98.
Chen, R., Simon, M.A., Chang, E.S., Zhen, Y., Dong, X.: The perception of social support among U.S. Chinese older adults: findings from the PINE Study. J. Aging Health 26(7), 1137–1154 (2014)PubMedCrossRef
99.
Dietz, T.L.: Patterns of intergenerational assistance within the Mexican American family: is the family taking care of the older generation’s needs? J. Fam. Issues 16(3), 344–356 (1995)CrossRef
100.
Hoff, A.: Patterns of intergenerational support in grandparent-grandchild and parent-child relationships in Germany. Aging Soc 27(05), 643–665 (2007)CrossRef
101.
Weeks, J.R., Cuellar, J.B.: The role of family members in the helping networks of older people. Gerontologist 21(4), 388–394 (1981)PubMedCrossRef
102.
Bass, S.A., Caro, F.G.: The economic value of grandparent assistance. Generations 20(1), 29–33 (1996)
103.
Fabian, T.: Großeltern als helfer in familialen krisen [Grandparents as helpers in family crises]. Neue Praxis 24(6), 384–396 (1994)
104.
Fthenakis, W.E.: Intergenerative familiale Beziehungen nach Scheidung und Wiederheirat aus der Sicht der Großeltern [Intergenerative family relations after divorce and remarriage from the perspective of the grandparents]. Zeitschr Soziol Erziehung Sozial 18(2), 152–167 (1998)
105.
Glick, J.E., Bean, F.D., Van Hook, J.V.W.: Immigration and changing patterns of extended family household structure in the United States: 1970–1990. J. Marriage Fam. 59(1), 177–191 (1997)CrossRef
106.
Leach, M.A.: A burden of support? Household structure and economic resources among Mexican immigrant families. J. Fam. Issues 35(1), 28–53 (2014)CrossRef
107.
Treas, J., Mazumdar, S.: Older people in America’s immigrant families: dilemmas of dependence, integration, and isolation. J. Aging Stud. 16(3), 243–258 (2002)CrossRef
108.
Treas, J., Mazumdar, S.: Kinkeeping and caregiving: contributions of older people in immigrant families. J. Comp. Fam. Stud. 35(1), 105–122 (2004)
109.
Fix, M., Laglagaron, L.: Social rights and citizenship: an international comparison: a report of the working group on social rights and citizenship of the Carnegie Endowment for International Peace Comparative Citizenship Project. The Urban Institute, Washington, D.C. (2002)
110.
McCabe, K., Meissner, D.: Immigration and the United States: recession affects flows, prospects for reform. Migration Policy Institute, Washington, D.C. (2010)
111.
Casado, B., Sacco, P.: Correlates of caregiver burden among family caregivers of older Korean Americans. J. Gerontol. B Psychol. 67(3), 331–336 (2012)CrossRef
112.
Covinsky, K.E., Goldman, L., Cook, E.F., Oye, R., Desbiens, N., Reding, D., Fulkerson, W., Connors, A.F., Lynn, J., Phillips, R.S.: The impact of serious illness on patients’ families. J. Am. Med. Assoc. 272(23), 1839–1844 (1994)CrossRef
113.
Lai, D.W.L.: Effect of financial costs on caregiving burden of family caregivers of older adults. SAGE Open 2(4), 1–14 (2012)CrossRef
114.
Stewart, M.J., Neufeld, A., Harrison, M.J., Spitzer, D., Hughes, K., Makwarimba, E.: Immigrant women family caregivers in Canada: implications for policies and programmes in health and social sectors. Health Soc. Care Commun 14(4), 329–340 (2006)CrossRef
115.
Strasser, E., Kraler, A., Bonjour, S., Bilger, V.: Doing family: responses to state constructions of “the migrant family” across Europe. Hist Family 14(2), 165–176 (2009)CrossRef
116.
117.
Charsley, K.: Transnational marriage. In: Charsley, K. (ed.) Transnational marriage: new perspectives from Europe and beyond, pp. 3–22. Routledge, London (2012)
118.
119.
Wasem, R.E.: U.S. immigration policy: chart book of key trends. Congressional Research Service, Washington, D.C. (2013)
120.
Islam, N.S., Khan, S., Kwon, S., Jang, D., Ro, M., Trinh-Shevrin, C.: Methodological issues in the collection, analysis, and reporting of granular data in Asian American populations: historical challenges and potential solutions. J. Health Care Poor Underserved 21(4), 1354–1381 (2010)PubMedPubMedCentral
121.
Metadata
Title
Healthcare inequality issues among immigrant elders after neoliberal welfare reform: empirical findings from the United States
Author
Younsook Yeo
Publication date
01-06-2017
Publisher
Springer Berlin Heidelberg
Published in
The European Journal of Health Economics / Issue 5/2017
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-016-0809-y

Other articles of this Issue 5/2017

The European Journal of Health Economics 5/2017 Go to the issue

Original Paper

Impact assessment of a pay-for-performance program on breast cancer screening in France using micro data

Original Paper

Measuring the efficiency of large pharmaceutical companies: an industry analysis

Original Paper

The impact of race, income, drug abuse and dependence on health insurance coverage among US adults

Original Paper

Societal costs of fetal alcohol syndrome in Sweden

Original Paper

The dynamic relationship between health expenditure and economic growth: is the health-led growth hypothesis valid for Turkey?

Original Paper

Measuring the productivity of residential long-term care in England: methods for quality adjustment and regional comparison