OBJECTIVE: The objective of the study was to examine time trends and differences in medical expenditures between noncitizens, foreign-born, and US-born citizens. METHODS: We used multi-year Medical Expenditures Panel Survey (2000-2008) data on noninstitutionalized adults in the United States (N=190,965). Source specific and total medical expenditures were analyzed using regression models, bootstrap prediction techniques, and linear and nonlinear decomposition methods to evaluate the relationship between immigration status and expenditures, controlling for confounding effects. RESULTS: We found that the average health expenditures between 2000 and 2008 for noncitizens immigrants ($1836) were substantially lower compared with both foreign-born ($3737) and US-born citizens ($4478). Differences were maintained after controlling for confounding effects. Decomposition techniques showed that the main determinants of these differences were the availability of a usual source of health care, insurance, and ethnicity/race. CONCLUSIONS: Lower health care expenditures among immigrants result from disparate access to health care. The dissipation of demographic advantages among immigrants could prospectively produce higher pressures on the US health care system as immigrants age and levels of chronic conditions rise. Barring a shift in policy, the brunt of the effects could be borne by an already overextended public health care system. Copyright © 2012 by Lippincott Williams & Wilkins.

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