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• Posted September 21, 2023

Helping Undocumented Immigrants Find a Primary Care Doc Lowers ER Costs: Study

Helping undocumented immigrants in the United States connect with primary care doctors could be a money-saver, substantially reducing emergency department use and lowering health costs, a new study finds.

The findings are from a New York City program that helped arrange medical appointments from May 2016 to June 2017 for undocumented immigrants with limited incomes.

The data showed a 21% drop in emergency department use, as well as a 42% drop for folks with high-risk medical profiles.

Participants in the program were also far more likely to have screenings for high blood pressure and diabetes. These tests can lay the groundwork for reducing heart disease.

“This program is fairly low-touch and minimalist, yet it had a meaningful effect,” said co-author Jonathan Gruber, an economist at the Massachusetts Institute of Technology.

“It had the biggest impact on those who were the most ill," he said in an MIT news release. "Lowering the barriers to care for these in-need individuals really pays off in terms of keeping them out of the emergency room.”

After a New York City government task force recommended finding new ways to extend health care access for undocumented immigrants, researchers worked with city officials to design a pilot program. It drew on the city's estimated population of 1.1 million undocumented immigrants.

This experiment had more than 2,400 participants. More than 1,200 were in a treatment group who received help in setting up a primary care appointment. A control group of 1,100 did not receive the same help.

Each had a household income no greater than twice the federal poverty line.

The study saw a rapid impact. In its first three months, 57% of people in the treatment group saw a primary care physician. That was true of only 16% of people in the control group.

Those in the treatment group saw a savings of just over $195 in emergency-visit costs, when not admitted. This rose to more than $477 for the higher-risk patients. Federal law requires emergency departments to not turn away patients.

Diabetes screenings rose by 34 percentage points in the treatment group, which also had a 45 percentage point rise in blood pressure screenings. Past research suggests this could lead to a 12% reduction in deaths.

The program did not extend health insurance to anyone.

Most visits had a $15 co-pay. Many of New York City's public health institutions scale costs to the patient's ability to pay. The goal was to see what difference the help would make even without insurance.

“I thought there was a decent chance this program wouldn't have much of an impact,” Gruber said. “The fact we could find such a big effect … was surprising to me and I think it illustrates the nonfinancial barriers people are facing to get the care they need, and the role of management [in that].”

Researchers said this program might not be possible in places without New York City's extensive public health network.

Extending formal health insurance to undocumented immigrants “remains politically untenable,” the authors noted in the paper, but jurisdictions might examine if other approaches increase care while lowering ER visits.

“There's this tendency with health care to think that if you give people health insurance, you're done,” Gruber said. “This study is saying the right system combines insurance as financial protection with other kinds of [tools].”

Study findings were published in the September issue of the journal American Economic Review: Insights.

More information

The Commonwealth Fund has more on the importance of strengthening primary health care.

SOURCE: MIT, news release, Sept. 19, 2023