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To Identify factors that explain why some Mexican immigrants in California use health services in Mexico.California Health Interview Survey 2001 data were analyzed for medical care, dental care, and/or prescription drug purchases in Mexico in the previous year. Logistic regressions estimated the effect on use of need, availability, accessibility, and acceptability among immigrants from Mexico.An estimated 952,000 California adults used medical, dental, or prescription services in Mexico during the past year, of whom 488,000 were Mexican immigrants. Long-stay Mexican immigrants had the highest rate (15%), followed by short-stay Mexican immigrants (11.5%), US-born Mexican Americans (5.4%), and US-born nonLatino whites (2.1%). Predictors of use by immigrants included need, no insurance, delay seeking care, more recent immigration, limited English, and nonphysician provider use. Living closer to the border increased use, although half of immigrants seeking services lived more than 120 miles from the border. Mexican immigrants with long stays in the US have a somewhat different pattern of predictors from those with short stays.Mexican immigrants are the most likely to seek medical, dental, and prescription services in Mexico. A large number, but small percentages, of US-born nonLatino whites purchase prescription drugs there. Although proximity facilitates use, access and acceptability barriers in the US medical care system encourage immigrants to seek care in Mexico who would be helped by expanded binational health insurance.