We found that immigrant workers had a significantly lower incidence rate of nonfatal occupational injuries compared with U.S.-born workers. However, immigrant and U.S.-born workers had a similar likelihood of seeking medical treatment after occupational injuries. In addition, the estimated mean medical expenditures per injured worker during the 2-year MEPS reference period were comparable between the two groups, after controlling for gender, age, race/ethnicity, marital status, education, poverty level, and insurance status. Our results confirmed the third study hypothesis that proportion of medical expenditures paid by workers’ compensation for occupational injuries is smaller for immigrant workers than for U.S.-born workers (though this difference was only marginally significant).
The annual incidence rate of nonfatal occupational injuries per 100 workers in this study (3.9%; 95% CI: 3.7%-4.1%) matched the occupational injury and illness incidence rates reported by the Bureau of Labor Statistics for the 2004–2009 study period . Furthermore, our results confirmed the previous findings that immigrant workers have a lower rate of nonfatal occupational injuries than U.S.-born workers [11–13]. Unlike previous studies based on cross-sectional survey data, this study used the longitudinal data from the MEPS. Longitudinal panel surveys have many strengths over cross-sectional surveys , therefore, this study adds to what is known about occupational injury risk among immigrant workers in the U.S.
There has been increased interest in recent years in understanding immigrant experiences with the health care system and their associated medical expenditures [33, 34]. A recent systematic review of population-based studies of immigrants and their health care concluded that there is a dearth of information on medical expenditures among immigrants . Of the 67 articles reviewed, 77% examined access to care, 27% studied quality of care, but only 6% examined medical expenditures . Using the 1998 MEPS and 1996–1997 NHIS data, Mohanty et al. found that per capita total health expenditures among immigrants were 55% lower than those of U.S.-born individuals, and that immigrant children had 74% lower per capita health care expenditures than U.S.-born children . As well, expenditures for uninsured and publicly insured immigrants were one half those for their U.S.-born counterparts . Goldman et al. also found that immigrants, both documented and undocumented, had lower medical expenditures than their U.S.-born counterparts . A study of health status and hospital utilization of recent immigrants to New York City found that immigrants were much less likely to be hospitalized for most major categories of illness, and they had lower mortality rates than U.S.- born persons . Two factors have been suggested as the main reasons why immigrants have lower medical expenditures than U.S.-born individuals: immigrants are relatively healthier, and they may have less access to health insurance [19, 35]. Welfare reform legislation, such as the Illegal Immigration Reform and Immigrant Responsibility Act, has substantially restricted recent immigrants’ eligibility for governmental health services .
Even less is known about the medical expenditures for occupational injuries among immigrant workers in the U.S. Results from this study suggested that immigrant workers were not less likely than U.S.-born workers to seek medical treatment after occupational injuries and that the average mean expenditures per injured workers during the 2 year MEPS reference period were about the same between the two groups. A recent study using 2002–2006 MEPS data to investigate medical care utilization for work-related injuries in the U.S. found that individuals with work injuries spend $1843 on average per year for treating work-related injuries . The estimated mean expenditures in our study were higher due to the fact that we calculated mean expenditures per injured worker over a 2-year reference period and the expenditures were adjusted to be equivalent to 2009 U.S. dollars.
The proportion of medical expenditures paid out-of-pocket was slightly higher among immigrant workers compared to U.S.-born workers, but this difference was not statistically significant. This finding is consistent with previous studies that reported a slightly higher proportion of medical expenditures paid-out-of-pocket among immigrant adults in comparison with U.S.-born adults [19, 35]. Another study of immigrant children’s medical care also found that Spanish speakers had 1.5 times the odds of spending $500 or more out-of-pocket medical expenditures per year than English speakers. Medical costs of occupational injuries and sources of payment were compared between Hispanic and non-Hispanic construction workers in the U.S., and it was found that Hispanic workers were less likely to receive workers’ compensation payment . Results from our study also found that proportion of medical expenditures paid by workers’ compensation for occupational injuries was smaller for immigrant workers than for U.S.-born workers. Unlike a previous study that reported a significantly higher proportion of out-of-pocket payments in Hispanic construction workers than in Non-Hispanic White construction workers , our study did not find evidence of shifting medical expenditures to out-of-pocket payments. However, we did find evidence of immigrants’ greater use of other sources payment including automobile, homeowner’s, liability, and unknown sources of private insurance. More than 130 million workers in the U.S. are covered by the workers’ compensation  and, in theory, workers’ compensation could provide income benefits, medical payments and rehabilitation payments to injured workers and their families . However, the regulations and the claiming process are possibly too complicated for immigrants to exercise their rights and to obtain benefits in the same way as U.S.-born workers [17, 38]. Employers and workers’ compensation insurers can contest the workers’ compensation claims if they consider the injury is not work-related or because the worker wants more benefits than the employer and insurer are willing to pay . A recent study from Quebec, Canada found that immigrant workers often need help from others to fill out their claim form, which usually are incomplete, or their claims are often contested by their employers . A survey of unionized hotel room cleaners in Las Vegas reported that immigrant workers were less likely to file workers’ compensation, and, if they filed claims, their claims were more likely to be rejected than U.S.-born workers . Administrative changes and education programs are needed to help immigrant workers to obtain the same benefits from workers’ compensation as U.S.-born workers after occupational injuries .
Several limitations of our study should be mentioned. First, the NHIS and MEPS are government surveys in which undocumented immigrants who came to the U.S. illegally or who have overstayed their visas are likely to be underrepresented . Accurate information on illegal citizens or citizenship was not available for our study. Second, immigrants in the U.S. are not a homogeneous group. Diversity in demographics, socioeconomic status, and culture exists across immigrant groups. The simplified classification of “immigrant” vs. “U.S.-born” would likely mask some of this diversity. Third, medical expenditure data from the self-reported survey of MEPS are subject to measurement errors and recall bias. It was not possible for us to test whether measurement errors and recall bias were different in immigrant workers as compared to U.S.-born workers. It has been estimated that aggregate national expenditures in the 2002 MEPS were about 13.8% below summary national expenditures from the National Health Expenditure Accounts . Lastly, workers’ compensation programs are jointly managed by the federal and state governments, and research has suggested that the proportions of occupational injuries covered by workers’ compensation program differ significantly among the states [43–45].