Disparities in having a usual source of care among non-citizen individuals in the U.S

Purposes. Little is known about health care disparities between citizen and non-citizen individuals in the U.S. Using a usual source of care as a proxy for access to health care, this study examined 1) the extent to which U.S. citizenship status affects the probability of having a usual source of care, and 2) the factors associated with having a usual source of care among non-citizen individuals to identify more vulnerable subpopulations within non-citizens. Design. This study used the data from the 2005 California Health Interview Survey (CHIS). The sample consisted of 33,187 adults (ages 18-64) including U.S.-born citizens (n=24,727), naturalized U.S. citizens (n=4,165), and non-U.S. citizens (n=4,295). To account for the CHIS's complex survey design, STATA 10.0 survey procedures were used with replicate weights. Guided by the modified Andersen model, a series of logistic regression analyses were conducted to answer the research questions. Results. The logistic regression models indicated that compared to U.S.-born citizens, non-U.S. citizens were about 1.6 times less likely to have a usual source of care in terms of odds after controlling for predisposition, enabling, and need factors (OR = .61, CI = .52-.72, p<.0001). There was no difference between naturalized and U.S.-born citizens in the probability of having a usual source of care. Among non-U.S. citizens, insurance status has a highest effect on the possibility of having a usual source of care (OR = 4.34, CI = 3.49-5.41, p<.0001). Furthermore, shorter duration of residence in the U.S. (OR = .55, CI = .40-.76, p<.0001) and lower English speaking level (OR = .87, CI = .77-.98, p<.05) were related to lower probabilities of having a usual source of care among non-citizen individuals in the U.S. In terms of demographic characteristics, younger, poorer, never-married, and males were more vulnerable to have a usual source of care. Conclusion. Considering the importance and cost-effectiveness of having a usual source of care, findings from this study suggest that policymakers should target their efforts to develop affordable health care and health insurance options for the identified sub-populations within the non-citizen individuals.