Today's Challenges For Prudent Life Insurance Strategies

In the last six months of life, 72 percent of immigrants were admitted to the hospital, compared to 68 percent of other people. Immigrants were also more likely to be admitted to intensive care units. Roughly 6 percent of recent immigrants received dialysis or feeding tubes near the end of life, about twice the proportion of longtime residents that got these interventions. About 2 percent of immigrants got what’s known as a tracheostomy, a procedure to place a breathing tube through a hole in the neck; this was also about twice as likely for immigrants as for longtime residents. Mechanical ventilation to aid breathing was provided to 22 percent of immigrants and just 14 percent of other people, the study also found. Immigrants’ region of origin also appeared to influence their treatment, with less aggressive care provided to people from Northern and Western Europe and more intensive interventions given to people from South Asia. One limitation of the study is that researchers lacked data on disease severity and other individual patient characteristics that might influence the intensity of care, the authors note. It’s also possible that differences in care found in Canada, with universal health insurance for the entire population, might be magnified in the U.S. or other countries where costs and insurance status can influence care, Fowler said. A variety of factors may influence end-of-life care for immigrants, including whether they have family members who can advocate on their behalf, their cultural beliefs about dying, and language barriers that prevent them from understanding treatment options or communicating their preferences, said Michael Harhay, author of an accompanying editorial and fellow at the Palliative and Advanced Illness Research Center at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. “Understanding the mechanisms by which immigrants get admitted to hospitals is a missing piece to this story and may provide insight into the role of limited resources and barriers to palliative care,” Harhay said by email.

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