Immigration Directly Reduces Deaths Among The Elderly
The debate about immigration tends to generate more heat than light. Economic analyses of wages, fiscal costs, and crime statistics crowd the op-ed pages, while partisans on both sides reach for their preferred data points. A recent paper from Harvard, MIT, and the University of Rochester looks at the impact of immigration on the health of the population.
The researchers look at the impact of immigration on mortality among Medicare beneficiaries aged 65 and over. This age group happens to consume the bulk of health and long-term care spending, so they are a key demographic for policymakers. The study finds that admitting 1,000 additional immigrants results in roughly 10 fewer elderly deaths per year in the average metropolitan area. Scale that up to a 25% increase in America’s annual net inflow of immigrants, and some 5,000 elderly lives would be saved each year.
A key role
This should not be hugely surprising, as immigrants account for a disproportionate share of the health workforce in the United States. Indeed, they make up 26% of physicians and surgeons, 40% of home health aides, and 21% of nursing assistants. This is also set against a landscape of critical staffing shortages, with estimates of up to 48,000 unfilled physician vacancies by 2034.
Immigrants, therefore, can plug gaps that the domestic labor market struggles with. After all, training a doctor can take up to a decade, but admitting one is instantaneous.
The authors find that for every 1,000 new immigrants, 142 additional foreign-born healthcare workers enter the workforce, including 88 aides, nurses, and doctors. Crucially, these workers do not appear to displace natives. Indeed, rather than crowding out natives, the data suggest that the addition of immigrant support staff appears to allow domestic physicians to expand their patient loads.
Out of the nursing home
The most striking finding concerns not hospitals or clinics but nursing homes. The researchers found that an increase in immigrants resulted in a significant decline in the usage of nursing homes. Indeed, for every 1,000 new immigrants, 17 fewer elderly Americans entered a nursing home per year.
This is consistent with earlier research that suggests that the availability of immigrant care workers allows elderly people to age at home rather than in an institution, which surveys indicate most strongly prefer.
The researchers do tread carefully, of course. They worry that immigrants and elderly people may both cluster in economically vibrant cities for separate reasons, creating a spurious correlation. They tackle this possibility by using something known as a “shift-share” instrument, which predicts where new immigrants settle based on where their ethnic compatriots already live, rather than on current conditions.
This instrument is weighted towards ethnic groups that traditionally tend to work in healthcare, such as those from the Philippines, sub-Saharan Africa, and the West Indies, all of whom are far more likely to end up in a hospital or care home than immigrants from Mexico or Central America.
A clear message
While the authors try not to editorialize, the policy implications are pretty stark nonetheless. The Trump administration has made curtailing immigration a signature priority, with deportations of undocumented workers and restrictions on legal immigration alike. Such policies, if they reduce the supply of healthcare workers, may exact a toll measured not in economic statistics but in elderly deaths.
The study also suggests an even clearer corollary. The researchers argue that since the mortality benefits flow primarily through the healthcare workforce, immigration policies that specifically incentivise care workers could deliver larger health gains per visa issued.
Several such mechanisms already exist in American immigration law, from J-1 waivers for foreign physicians to the Conrad 30 program that stations doctors in rural areas. Expanding and streamlining these pathways would cost relatively little.
America’s population is aging rapidly. The 65-and-over cohort is approaching 60m people, and by mid-century it’s expected to be nearer 80m. The demand for care workers will grow accordingly, and domestic labour markets are poorly placed to meet it. The question is not really whether America can afford to admit more healthcare immigrants. This paper suggests it can ill afford not to.