UCLA

Filling gaps in our understanding of how the effects of migration extend through familiesand impact healthcare decisions, access, and expenditures, this dissertation examined how migration is associated with health services in contexts that send a high number of migrants and a major migrant destination. The first study (Chapter 2) evaluated the impact of male spousal migration on the healthcare use and access for left-behind women and children using a quantitative cross-country comparison of four countries in South and Southeast Asia. Results showed that male spousal migration was positively associated with barriers to healthcare use across Bangladesh, Indonesia, Nepal, and the Philippines through a reduction in both economic and social (gender related) barriers to care - adding new evidence to the literature showing that migration can contribute to the health and well-being of those left-behind. The second study (Chapter 3) quantitatively measured receipt of international migrant remittances and healthcare expenditures to show how this important source of income for families and for the economy of the Philippines related to spending on healthcare. We found that remittance receiving households spent significantly more on healthcare than non-remittance receiving households in both absolute and proportional measures. Additionally, remittances did not provide financial protection against catastrophic health expenditures (CHE) and a significantly higher proportion of remittance receiving households experienced CHE compared to non-remittance households. The third study (Chapter 4), based in the United States, examined the role of family structures and immigration factors in health services decision-making. Through quantitative analyses of the interaction between migration related characteristics and family structure, this study found that immigrants had a higher probability of seeking healthcare when they needed it compared to their US born counterparts who delayed or forewent needed care at higher rates, but that family structure affected immigrant families differently and this was especially true for more newly arrived immigrants and those on temporary visas or who were undocumented. The three papers of this dissertation expand our understanding of the relationship between the migration and health systems and demonstrate that relational frameworks can help capture some of the nuance of the complicated migration and health relationship.