Childbirth top health expense for undocumented immigrants
Childbirth top health expense for undocumented immigrants
A look at health care needs of the growing number of immigrants in the United States raises questions about the financial wisdom of excluding them from routine health care, and especially prenatal care. A study published in the March 14, 2007, Journal of the American Medical Association found that the largest share of emergency medical expenditures in North Carolina is for pregnancy and labor complications for undocumented immigrants.
"Providing a dollar's worth of prenatal care can save $3 of postnatal care," said Maria Youdelman, director of the National Language Access Advocacy Project of the National Health Law Program in Washington, DC. "It's much more costly to use Emergency Medicaid to pay for prematurity and low birth-weight babies and postnatal complications."
Undocumented immigrants are estimated to account for 29% of the total foreign-born population in the United States. Researchers say that many "new growth" states that previously did not have large immigrant populations, such as North Carolina, are now getting many of the newcomers. And they may be less prepared to meet the immigrants' health care needs.
During the 1990s, the total foreign-born population in North Carolina grew by 274% and included some 300,000 undocumented immigrants by 2004. The researchers said the immigrants face many barriers to accessing health care, including federal law.
Undocumented immigrants and legal immigrants who have been in the United States for less than five years generally are excluded from Medicaid benefits. But they can receive emergency medical care, known as Emergency Medicaid, if they are children, pregnant women, families with dependent children, elderly, or disabled. For pregnant women, Emergency Medicaid covers labor but not routine prenatal care, leading to the cost paradox.
Researchers at the University of North Carolina analyzed administrative claims data for Emergency Medicaid and found that 48,391 people received emergency care between 2001 and 2004. In that group, 99% were undocumented immigrants, 93% were Hispanic, 95% were female, and 89% were between the ages of 18 and 40. The data show some 82% of Emergency Medicaid spending in 2004 was for childbirth and pregnancy complications, which accounted for 91% of hospitalizations.
About one-third of the remaining funds were spent on things such as injuries and poisonings, and large amounts also went for the complication of chronic disease, such as kidney failure.
The study found that the largest spending increases were among undocumented immigrants who were elderly and disabled.
Spending on pregnant women increased by 22% during the study period, by 70% for families with dependent children, and by 98% for the elderly.
However, the 16,106 patients who used Emergency Medicaid in 2004 represented only 5% of the total estimated undocumented immigrant population in the state. And Emergency Medicaid was less than 1% of the total state Medicaid budget, the researchers said.
"The availability of affordable culturally and linguistically appropriate primary care will be a critical determinant of both the effectiveness and cost efficacy of health care for immigrants in new growth areas," the authors concluded.
A look at health care needs of the growing number of immigrants in the United States raises questions about the financial wisdom of excluding them from routine health care, and especially prenatal care.Subscribe Now for Access
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