The Unauthorized Residency Status Myth: Health Insurance Coverage and Medical Care Use among Mexican Immigrants in California

Enrico A. Marcelli

Idioma original:



Informed by recent developments in the behavioral model of medical care use and social epidemiology, this article employs survey data to estimate whether unauthorized residency status among non-elderly Mexican and other-Latino immigrant adults in California influenced the probability of having had health insurance and having received medical care. Unauthorized residency status is estimated to have decreased the probability of having been insured, and augmented the probability of having relied on public health insurance. However, after controlling for other individual characteristics, neighborhood context, and social capital, neither insurance nor residency status appears to have influenced whether a person obtained needed medical care. Rather, neighborhood context, difficulty locating a medical care facility, and civic engagement appear to be more important for understanding use of medical services.


Tomando en cuenta los avances recientes en el modelo conductual del uso de asistencia médica y la epidemiología social, este artículo utiliza datos de encuestas para estimar si el estatus de residencia no autorizada entre los mexicanos que todavía no llegan a la vejez y otros inmigrantes latinos en California influyó en la probabilidad de que tuvieran seguro de salud y recibieran asistencia médica. Se estima que el estatus de residencia no autorizada ha disminuido la probabilidad de que estuvieran asegurados y, a su vez, ha aumentado la de que recurrieran al seguro de salud pública. Sin embargo, después de controlar otras características individuales, el contexto de vecindad y el capital social, ni el seguro ni el estatus de residencia parecen haber influido en que una persona obtuviera la asistencia médica necesaria. Finalmente, el contexto de vecindad, la dificultad para encontrar un lugar de asistencia médica y el compromiso cívico parecieran ser más importantes para comprender el uso de los servicios médicos.

Keywords: international migration; medical care; undocumented migrants; Mexico; United States

Texto completo:

Idioma original


Aday, Lu Ann, At Risk in America: The Health and Health Care Needs of Vulnerable Populations in the United States, San Francisco (CA), Jossey- Bass Publishers, 1993.

———, and Ronald A. Andersen, “A Framework for the Study of Accessto Medical Care”, Health Services Research, 9, 1974, pp. 208-220.

———, Development of Indices of Access to Medical Care, Ann Arbor (MI), Health Administration Press, 1975.

Aday, Lu A., Gretchen V. Flemming, and Ronald A. Andersen, Access to Medical Care in the U.S.: Who Has It, Who Doesn’t?, Chicago, Pluribus, 1984.

Andersen, Ronald A., Behavioral Model of Families’ Use of Health Services, Chicago, Center for Health Administration Studies, University of Chicago (Research Series No. 25), 1968.

Andersen, Ronald A., “Revisiting the Behavioral Model and Access to Medical Care: Does It Matter?”, Journal of Health and Social Behavior, 36, March, 1995, pp. 1-10.

———, and Odin W. Anderson, A Decade of Health Services, Chicago, University of Chicago Press, 1967.

Andersen, Ronald A., and Pamela Davidson, “Improving Access to Care in America: Individual and Contextual Indicators”, in Ronald A.

Andersen, T. H. Rice, and G. F. Kominski (eds.), Changing the U.S. Health Care System: Key Issues in Health Services, Policy, and Management, San Francisco, Jossey-Bass Publishers, 2001, pp. 3-30.

———, and Patricia Ganz, “Symbiotic Relationships of Quality of Life, Health Services Research, and Other Health Research”, Quality of Life Research, 3, 1994, pp. 365-371.

Asch, S., S. Frayne, and H. Waitzkin, “To Discharge or Not to Discharge: Ethics of Care for an Undocumented Immigrant”, Journal of Health Care for the Poor and Underserved, 6(1), 1995, pp. 3-8.

Bean, Frank D., Rodolfo Corona, Rodolfo Tuirán, Karen A. Woodrow-Lafield, and Jennifer Van Hook, “Circular, Invisible, and Ambiguous Migrants: Components of Difference in Estimates of the Number of Unauthorized Mexican Migrants in the United States”, Demography, 38(3), 2001, pp. 411-422.

Berk, Marc L., and Claudia L. Schur, “The Effect of Fear on Access to Care among Undocumented Latino Immigrants”, Journal of Immigrant Health, 3(3), 2001, pp. 151-156.

Berk, Marc L., Claudia L. Schur, Leo R. Chávez, and Martin Frankel, “Health Care Access among Undocumented Latino Immigrants: Is Free Health Care the Main Reason Why Latinos Come to the United States? A Unique Look at the Facts”, Health Affairs, 19(4), 2000, pp. 51-64.

Berkman, Lisa F., and Ichiro Kawachi (eds.), Social Epidemiology, New York, Oxford University Press, 2000.

Bollini, Paola, and Harald Siem, “No Real Progress Towards Equity: Health of Migrants and Ethnic Minorities on the Eve of the Year 2000”, Social Science and Medicine, 41(6), 1995, pp. 819-828.

Brown, E. Richard, Victoria D. Ojeda, Lisa M. Lara, and Abel Valenzuela, Undocumented Immigrants: Changes in Health Insurance Coverage with Legalized Immigration Status, Los Angeles, UCLA Center for Health Policy Research, 1999.

Brown, E. Richard, Victoria D. Ojeda, Roberta Wyn, and Rebecka Levan, Racial and Ethnic Disparities in Access to Health Insurance and Health Care, Los Angeles, UCLA Center for Health Policy Research and the Henry J. Kaiser Family Foundation, 2000.

Brown, E. Richard, Ninez Ponce, Thomas Rice, and Shana A. Lavarreda, The State of Health Insurance in California: Findings from the 2001California Health Interview Survey, Los Angeles, UCLA Health Policy Research Center, 2002.

Brown, E. Richard, and Hongjian Yu, “Latinos’ Access to Employment-Based Health Insurance”, in M. M. Suárez-Orozco and M. Páez (eds.), Latinos: Remaking America, Berkeley, University of California Press, 2002, pp. 236-253.

Bruhn, John G., and Jeffrey E. Brandon (eds.), Border Health: Challenges for the United States and Mexico, New York, Garland Publishing, Inc., 1997.

Capps, Randy, Leighton Ku, Michael Fix, Chris Furgiuele, Jeffrey S. Passel, Rajev Ramchand, Scott McNiven, Dan Pérez-López, Eve Fielder, Michael Greenwell, and T. Hays, How Are Immigrants Faring After Welfare Reform? Preliminary Evidence from Los Angeles and New York City, Washington (D.C.), The Urban Institute, 2002.

Carrillo, J. Emilio, Fernando M. Treviño, Joseph R. Betancourt, and Alberto Coutasse, “Latino Access to Health Care: The Role of Insurance, Managed Care, and Institutional Barriers”, in M. Aguirre-Molina, C. W. Molina, and R. E. Zambrana (eds.), Health Issues in the Latino Community, San Francisco, Jossey-Bass, 2001, pp. 55-73.

Chan, Theodore C., Scott J. Krishel, Kenneth J. Bramwell, and Richard F. Clark, “Survey of Illegal Immigrants Seen in an Emergency Department”, The Western Journal of Medicine, 164(3), 1996, pp. 212-216.

Chávez, Leo R., “Mexican Immigration and Health Care: A Political Economy Perspective”, Human Organization, 45(4), 1986, pp. 344-352.

———, Wayne A. Cornelius, and Oliver W. Jones, “Mexican Immigrants and the Utilization of Health Services”, Social Science and Medicine, 12, 1985, pp. 93-102.

Chávez, Leo R., Estevan T. Flores, and Marta López-Garza, “Undocumented Latin American Immigrants and U.S. Health Services: An Approach to a Political Economy of Utilization”, Medical Anthropology Quarterly, 6(1), 1992, pp. 6-26.

Chávez, Leo R., F. Allan Hubbell, Shiraz I. Mishra, and R. Burciaga Valdez, “Undocumented Latina Immigrants in Orange County, California: A Comparative Analysis“, International Migration Review, 31(1), 1997, pp. 88-107.

Costanzo, Joe, Cynthia Davis, Caribert Irazi, Daniel Goodkind, and Roberto Ramírez, Evaluating Components of International Migration: The Residual Foreign-born, Suitland (MD), U.S. Bureau of the Census (Population Division Working Paper #61), 2001.

Currie, Janet, and Aaron. Yelowitz, “Health Insurance and Less Skilled Workers”, in D. Card and R. M. Blank (eds.), Finding Jobs: Work and Welfare Reform, New York, Russell Sage Foundation, 2000, pp. 233-61.

Fragomen, Jr., Austin T., “The Illegal Immigration Reform and Immigrant Responsibility Act of 1996”, International Migration Review, 31(2), 1997, pp. 438-460.

Glied, Sherry A., “Challenges and Options for Increasing the Number of Americans with Health Insurance”, Inquiry, 38, 2001, pp. 90-105.

Halfon, Neal, David L. Wood, R. Burciaga Valdez, Margaret Pereyra, and Naihua Duan, “Medicaid Enrollment and Health Services Access by Latino Children in Inner-City Los Angeles”, Journal of the American Medical Association, 277(8), 1997, pp. 636-641.

Hayes-Bautista, David E., Werner Schink, and Gregory Rodríguez, Latino Immigrants in Los Angeles: A Portrait from the 1990 Census, Los Angeles, Alta California Policy Research Center/Community Partners, 1995.

Heer, David M., V. Agadjanian, F. Hammad, Y. Qiu, and S. Ramasundaram, “A Comparative Analysis of the Position of Undocumented Mexicans in the Los Angeles County Work Force in 1980”, International Migration, 3(2), 1992, pp. 101-126.

Heer, David M., and Jeffrey S. Passel, “Comparison of Two Methods for Computing the Number of Undocumented Mexican Adults in Los Angeles County”, International Migration Review, 21(4), 1987, pp. 1446-1473.

Hernández, Donald J., and Evan Charney (eds.), From Generation to Generation: The Health and Well-Being of Children in Immigrants Families, Washington (D.C.), National Academy Press, 1998.

Hubbell, F. Allan, Howard Waitzkin, Shiraz I. Mishra, John Dombrink, and Leo R. Chávez, “Access to Medical Care for Documented and Undocumented Latinos in a Southern California County”, The Western Journal of Medicine, 54(4), 1991, pp. 414-17.

Institute of Medicine, Access to Health Care in America, Washington (D.C.), National Academy Press, 1993.

Kawachi, Ichiro, and Lisa F. Berkman (eds.), Neighborhoods and Health, New York, Oxford University Press, 2003.

Kullgren, Jeffrey T., “Restrictions on Undocumented Immigrants’ Access to Health Services: The Public Health Implications of Welfare Reform”, American Journal of Public Health, 93(10), 2003, pp. 1630-1633.

Leclere, Felicia B., Lief Jensen, and Ann E. Biddlecom, “Health Care Utilization, Family Context, and Adaptation among Immigrants in the United States”, Journal of Health and Social Behavior, 35(4), 1994, pp. 370-384.

Loue, Sana, and Jonathon Foerstel, “Assessing Immigration Status and Eligibility for Publicly Funded Medical Care: A Questionnaire for Public Health Professionals”, American Journal of Public Health, 86(11), 1996, pp. 1623-1625.

Lutzky, Amy Westpfahl, and Stephen Zuckerman, Recent Changes in Health Policy for Low-Income People in California, Washington (D.C.), The Urban Institute, 2002.

Lynch, John W., and George A. Kaplan, “Socioeconomic Position”, in L. F. Berkman and Kawachi Ichiro (eds.), Social Epidemiology, New York, Oxford University Press, 2000, pp. 12-35.

Maida, Carl A., Access to Health Care for California’s Immigrants, 2001. Accessed at (no longer available on the Internet).

Marcelli, Enrico A., “Undocumented Latino Immigrant Workers: The L.A. Experience”, in D. W. Haines and K. E. Rosenblum (eds.), Illegal Immigration in America: A Reference Handbook, Westport (CT), Greenwood Press, 1999, pp. 193-231.

———, “The Institution of Unauthorized Residency Status, Neighborhood Context, and Mexican Immigrant Earnings in Los Angeles County”, in D. Champlin and J. Knoedler (eds.), The Institutionalist Tradition in Labor Economics, Armonk (New York), M.E. Sharpe,

a, pp. 206-228.

———, “Unauthorized Mexican Immigration, Day Labour and Other Lower-wage Informal Employment in California”, Regional Studies, 38(1), 2004b, pp. 1-13.

———, and David M. Heer, “Unauthorized Mexican Workers in the 1990 Los Angeles County Labour Force”, International Migration, 35(1), 1997, pp. 59-83.

———, “The Unauthorized Mexican Immigrant Population and Welfare in Los Angeles County: A Comparative Statistical Analysis”, Sociological Perspectives, 41(2), 1998, pp. 279-302.

Marcelli, Enrico A., and B. Lindsay Lowell, “Transnational Twist: Pecuniary Remittances and Socioeconomic Integration among Authorized and Unauthorized Mexican Immigrants in Los Angeles County”, International Migration Review, 39(1) (forthcoming).

Marcelli, Enrico A., Manuel Pastor, jr., and Pascale M. Joassart, “Estimating the Effects of Informal Economic Activity: Evidence from Los Angeles County”, Journal of Economic Issues, 33(3), 1999, pp. 579-607.

National Health Foundation and UCLA Center for the Study of Latino Health, Barriers to Health Care for U.S. Citizen Children of Undocumented Parents, Los Angeles (CA), 1994.

Riedel, Ruth Lyn, “Access to Health Care“, in S. Loue (ed.), Handbook of Immigrant Health, New York, Plenum Press, 1998, pp. 101-123.

Schur, Claudia L., Marc L. Berk, Cynthia D. Good, and Eric N. Gardner, California’s Undocumented Latino Immigrants: A Report on Access to Health Care Services, Washington (D.C.), The Henry J. Kaiser Family Foundation, 1999.

Schur, Claudia L., and J. Feldman, Running in Place: How Job Characteristics, Immigrant Status, and Family Structure Keep Hispanics Uninsured, New York, The Commonwealth Fund, 2001.

Seccombe, Karen L., Leslie Clarke, and Raymond T. Coward, “Discrepancies in Employment-Sponsored Health Insurance among Hispanics, Blacks, and Whites: The Effects of Sociodemographic and Employment Factors”, Inquiry, 31, 1994, pp. 221-229.

Sekhri, Neelam K., Octavio Gómez-Dantes, and Tracy Macdonald, Cross Border Health Insurance: An Overview, Oakland, California HealthCare Foundation, 1999.

Seliger, Jerome, Health Care Options for California, 2001. Accessed at (no longer available on the Internet).

Siddharthan, Kris, and Melissa Ahern, “Inpatient Utilization by Undocumented Immigrants without Health Insurance”, Journal of Health Care for the Poor and Underserved, 7(4), 1996, pp. 355-363.

Sorenson, R., Profile of the Uninsured in California, 2001. Accessed at (no longer available on the Internet).

Stern, Andrew L., “Labor Rekindles Reform”, American Journal of Public Health, 93(1), 2003, pp. 95-98.

Stevenson, Richard W., and Robin Toner, “Bush says Kerry is Pushing Nationalized Health Care”, The New York Times, September 17, 2004, p. A13.

Swartz, Katherine, “Changes in the 1995 Current Population Survey and Estimates of Health Insurance Coverage”, Inquiry, 34, Spring, 1997, pp. 70-79.

United States Commission on Immigration Reform, U.S. Immigration Policy: Restoring Credibility, Washington (D.C.), U.S. Government Printing Office, 1994.

Valdez, R. Burciaga, Hal Morganstern, E. Richard Brown, Roberta Wyn, Chao Wang, and William Cumberland, “Insuring Latinos Against the Costs of Illness”, Journal of the American Medical Association, 269, 1993, pp. 889-894.

Wallace, Steven, Hongjian Yu, Carolyn Méndez, and E. Richard Brown, Adjusted Estimates of Uninsured Children and Program Eligibility, California 1996, Los Angeles, UCLA Center for Health Policy Research, 1998.

Warren, R., Estimates of the Unauthorized Immigrant Population Residing in the United States: 1990 to 2000, Washington (D.C.), U.S. Immigration and Naturalization Service, 2003.

Fecha de recepción: 16 de junio de 2004

Fecha de aceptación: 25 de agosto de 2004

Todos los contenidos publicados en esta revista se encuentran bajo la licencia Creative Commons Reconocimiento-NoComercial-SinDerivar 4.0 Internacional.
Licencia de Creative Commons