Health care use as an aspect of immigrant integration? An analysis of cost convergence among new immigrants and natives in Finland

Existing research has shown that immigrants’ health care use and costs are lower compared to native population. The aim of this study is to analyse 1) how average health care costs differ between newly arrived immigrants and natives in Finland, 2) whether the costs of immigrants converge to the level of natives over time, and 3) how other factors of integration are associated with convergence in health care use. We use individual-level register data on total working-age (18-64) population living in Finland between 2008 and 2017 combined with their health care use and costs in public specialised health care sector from the national Care Register for Health Care. Our analysis sample includes all working-age immigrants who arrived in Finland between 2008-2010 and divided in eight groups by region of origin. We use a 10 per cent random sample of native-born Finns as a comparison group. Information on earlier arrived immigrants is used in additional analyses. We follow the study population’s (n=296,956) health care costs from 2011 to 2017. To illustrate trajectories in health care costs, we employ growth curve models. Our results show that immigrants have lower health care costs compared to natives and they do not converge to the native level over a 7-year observation period. This finding holds also among immigrants who have more local social, cultural, and economic capital. Notably, the costs differ remarkably between sectors of health care, different immigrant groups, and by other factors. However, the determinants of health care costs appear to function relatively similarly among natives and immigrants. Information on these differences is crucial for assessing equity in the distribution of health care. Our results can also be used to improve the accuracy of regional predictions of models that forecast health expenditures at the regional level in Finland. In addition to better health among immigrants, lower health care use and costs among immigrants may indicate, for example, different approaches to health care use or unmet needs due to barriers to accessing health care services. It seems that the ‘healthy immigrant effect’ is an oversimplification of the reality. To make informed policy decisions, future research is needed to uncover the factors behind the lower health care use among immigrants and whether this affects health outcomes and health inequality.