Health expenditure dynamics and years of U.S. residence: analyzing spending disparities among Latinos by citizenship/nativity status

Health Serv Res. 2012 Apr;47(2):794-818. doi: 10.1111/j.1475-6773.2011.01278.x. Epub 2011 Jun 3.


Objective: We investigate health expenditure disparities between Latinos and non-Latino whites by years of United States residence and citizenship/nativity status.

Data sources: We link the Medical Expenditure Panel Survey and the National Health Interview Survey from 2000 to 2007. The sample consists of 31,514 Latinos and 76,021 white adults (18-64 years).

Study design: The likelihood of any health spending, total health expenditure, and the out-of-pocket (OOP) share of health expenditure are our main dependent variables. We use two-part multivariate models to adjust for confounding factors. A stratified analysis by insurance status checks for the results' robustness. The decomposition technique is implemented to estimate the share of disparities that can be explained by observed and unobserved variables.

Principal findings: Latinos are much less likely to have any health spending (68 percent), total health expenditure (57 percent), and more likely to pay OOP (6 percent) compared with the white population. Overall, disparities narrow or disappear for naturalized Latinos the longer they stay in the country. Among noncitizen Latinos, disparities remain constant or decline slightly, but they remain large over time.

Conclusions: Low-health spending by foreign-born Latinos contributes to health expenditure disparities between Latinos and whites. Our findings provide preliminary evidence on health-spending convergence over time between foreign-born Latinos and that of whites.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Emigrants and Immigrants / statistics & numerical data*
  • Female
  • Health Care Surveys
  • Health Expenditures / statistics & numerical data*
  • Healthcare Disparities / economics*
  • Healthcare Disparities / statistics & numerical data
  • Hispanic or Latino / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Models, Economic
  • Socioeconomic Factors
  • Time Factors
  • United States
  • Young Adult