Ethnic variation in access to health care of Asian noncitizens in the United States

Background and Purpose: Despite the rapidly growing number of foreign-born population, significant disparities in health care access exist between native- and foreign-born individuals. Within the foreign-born population, noncitizens are more vulnerable in terms of health care access. Prior research found that noncitizens were approximately 1.6 times less likely to have access to health care when compared to their U.S. citizen counterparts. However, little is known about disparities in health care access by ethnicity among Asian noncitizens. Using a usual source of care as a proxy for access to health care, this study examined the extent to which the access to health care differed by ethnicity among Asian noncitizens in the United States, and its associated factors among different Asian ethnic subgroups.

Methods: Data were derived from the 2009 California Health Interview Survey (CHIS), which is a statewide population-based random-digit-dial telephone survey. The sample for this study consisted of 561 Asian noncitizens (ages 18-64), including Chinese (n=177), Korean (n=233), and Vietnamese individuals (n=155). Guided by the modified Andersen's behavioral model of health care utilization, a series of logistic regression models were conducted after controlling for predisposing, enabling, need, and immigration-related factors. To account for the CHIS's complex sampling designs (e.g., stratification and unequal weighting), all statistical analyses were conducted using the survey procedures of SAS version 9.3.

Results: Chinese noncitizens reported the highest probability of having a usual source of health care (78.0%), followed by Vietnamese (59.8%) and Korean noncitizens (45.2%). The results of the bivariate analysis also suggest ethnic variation as having a usual source of health care (χ2 = 54.11, p <.01). However, after controlling for other covariates, this significant effect of ethnicity on having a usual source of care disappeared (p >.05). Among Chinese noncitizens, marital status, poverty, insurance status, and English proficiency were found to be associated with having a usual source of care, while age, education, and insurance status were found among Vietnamese noncitizens. Among Korean noncitizens, only poverty status was found to be associated with having a usual source of care.

Conclusions: The study identified vulnerable ethnic subgroups in health care access (e.g., Chinese noncitizens with lower English proficiency, uninsured Vietnamese noncitizens, and poor Korean noncitizens, etc.). To enhance health care access for these vulnerable subgroups of Asian noncitizens, health care professionals should account for the heterogeneity of health care in diverse cultural contexts.