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

## TL;DR

The study finds that immigrants in Finland use less healthcare than natives, and this gap doesn't close over time, even for more integrated immigrants.

## Contribution

The paper introduces a novel analysis of healthcare cost convergence and integration factors among immigrants in Finland using longitudinal register data.

## Key findings

- Immigrant healthcare costs remain lower than natives' and do not converge over seven years.
- More integrated immigrants show narrower gaps, but convergence is still modest.
- Healthcare costs vary significantly between immigrant groups and other factors.

## Abstract

•Health care use and costs of recent immigrants remain lower compared to native Finnish population over time.•Accounting for other measures of integration narrows the gap between immigrants and natives, but convergence over time remains modest among more integrated immigrants too.•Significant differences in health care costs exist between immigrant groups.•In addition to better health, the results can indicate unmet health care needs among immigrants.•In the context of increasing immigration, improving access to health care among immigrants is important for ensuring health equity.

Health care use and costs of recent immigrants remain lower compared to native Finnish population over time.

Accounting for other measures of integration narrows the gap between immigrants and natives, but convergence over time remains modest among more integrated immigrants too.

Significant differences in health care costs exist between immigrant groups.

In addition to better health, the results can indicate unmet health care needs among immigrants.

In the context of increasing immigration, improving access to health care among immigrants is important for ensuring health equity.

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 in public specialized health care. We focus on immigrants who arrived in Finland between 2008–2010. 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: on average native costs are 1.6 times higher than those of immigrants. Moreover, they do not converge to the native level over a 7-years observation period. This finding of little convergence over time holds also among immigrants who have more local social, cultural, and economic capital, although the native-immigrant gap is narrower among more integrated immigrants. Notably, the costs differ remarkably between different immigrant groups and by other factors. Information on these differences is crucial for assessing equity in the distribution of health care. In addition to better health among immigrants, lower health care use among immigrants may indicate, for example, different approaches to health care use or unmet needs due to barriers to accessing health care services. 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.