• Shahzad Ali Khan
  • Khola Manzoor


Background: Health of immigrants is challenge for any host country due to multiple reasons. Immigrants of Pakistani origin constitute a significant population in the USA and their population has doubled in last 10 years. This study was conducted to determine factors affecting health service utilization in the state of Maryland, USA. Methods: This was a descriptive study, utilizing mixed method research. A sample of 100 respondents from Pakistani immigrants in Maryland was selected through convenience sampling. A structured questionnaire was used for soliciting responses. Three focus group discussions were also conducted for qualitative assessment of health service utilization. Results: Male gender, higher level of education, longer duration of stay, and higher income people had more utilization of health services. Those not having insurance had affordability issues as they had to pay out of pocket for treatment cost.  A high proportion of uninsured were resorting to traditional home remedies for treatment.  There was a concern on delays in appointment system and long waiting time for elective cases. Most respondents mentioned problem of language while interacting with doctors and need of English speaking family member in medical consultation. Many respondents reported difficulty in availing health services due to job commitments. They had to make arrangements for substitute at their workplaces, which affected their utilization of health services. Conclusion: Low-income immigrants in USA are less likely to have health insurance. Factors affecting service use are out of pocket costs, long waiting time, language problems and immigrants’ job commitments. It is recommended to get a clear idea of health systems of USA before moving to US as immigrant.Keywords: immigrant, insurance, health services utilization


North American Immigration. Immigrants groups; Pakistani Immigration. Available from:

Asian American Center for Advancing Justice. A Community of Contrasts Asian Americans in the United States: 2011. Available from URL:

US Department of Health Human Services. Summary of Immigrant Eligibility Restrictions under Current Law. Available from URL:

The World Health Report 2000: Health systems: Improving Performance. Geneva: World Health Organization; 2000

Norwegian Directorate of Health. Migration and Health; challenges and Trends. Oslo: Norwegian Directorate of Health, 2009.

Lien E, Nafstad P, Rosvold EO. Non-western immigrants’ satisfaction with the general practitioners’ services in Oslo, Norway. Int J Equity Health 2008;7:7.

Hoye S, Severinsson E. Intensive care nurses’ encounters with multicultural families in Norway: an exploratory study. Intensive Crit Care Nurs 2008;24:338–48.

Naess MH. Norwegian and immigrant patients at a health care center. Are there real differences? Tidsskr Nor Laegeforen 1992;112(3):361–4.

Varvin S, Aasland OG. Physicians’ attitude towards treating refugee patients. Tidsskr Nor Laegeforen 2009;129:1488–90.

Smaland Goth UG, Berg JE. Migrant participation in Norwegian health care. A qualitative study using key informants. Eur J Gen Pract 2011;17(1):28–33.

Leighton K. Health Insurance Coverage and Medical Expenditures of Immigrants and Native-Born Citizens in the United States. Am J Public Health. 2009; 99(7):1322–28

Goldman DP, Smith JP, Sood N. Immigrants and the cost of medical care. Health Aff (Milwood) 2006;25:1700–11

Padela AI, Gunter K, Killawi A, Heisler M. Religious Values and Healthcare Accommodations: Voices from the American Muslim Community. Journal of General Internal Medicine 2012;27(6):708–15.

Kim M, Van Wye G, Kerker B, Thorpe L, Frieden TR. The Health of Immigrants in New York City. New York: New York City Department of Health and Mental Hygiene, 2006. Available from URL: