Language Barriers and Healthcare Uptake. Causal Evidence From Immigrants in France

Immigrants often arrive with better health than natives of their host country, a phenomenon known as the ‘healthy immigrant effect.’ This advantage diminishes over time, one reason being unequal healthcare access. Our study examines whether communication barriers contribute to these inequalities in a healthcare system that rarely accommodates an increasingly diverse and multilingual population. We expect that limited French proficiency restricts equitable access to care. Using the Trajectoires et Origines 2 survey conducted in 2019 in France among over 27,000 individuals---oversampling immigrant-origin populations---we investigate how language shapes healthcare use. France provides a relevant case, as immigrants come from diverse origins, including former colonies where French is an official language, generating substantial variation in proficiency. Findings show significant language-related disparities in medical visits, except for generalist practitioners. To address possible endogeneity bias in the relationship between language and healthcare uptake, we construct an instrument combining age at arrival in France and linguistic distance between French and the mother tongue. This method reveals a significant language effect only for visits to psychologists or psychiatrists. Theoretically, we propose a quantitative strategy to assess language barriers’ effects on immigrants’ healthcare access. Practically, we highlight the need for linguistically inclusive health services.