Abstract
The literature suggests that Korean Americans underutilize health services. Cultural factors and language barriers appear to influence this pattern of low utilization but studies on the relationships among length of stay in the US, English use and proficiency, and utilization of health services among Korean Americans have yielded inconsistent results. This study examines whether English language use and proficiency plays a mediating role in the relationships between length of stay in the US and health insurance coverage, access to and use of care. Structural equation modeling was used for mediation analysis with multiple dependent variables among Korean Americans (N = 555) using baseline data from a large trial designed to increase Hepatitis B testing. The results show 36% of the total effect of proportion of lifetime in the US on having health insurance was significantly mediated by English use and proficiency (indirect effect = 0.166, SE = 0.07, p<.05; direct effect = 0.296, SE = 0.13, p<.05). Proportion of lifetime in the US was not associated with usual source of care and health service utilization. Instead, health care utilization was primarily driven by having health insurance and a usual source of care, further underscoring the importance of these factors. A focus on increasing English use and proficiency and insurance coverage among older, female, less educated Korean Americans has the potential to mitigate health disparities associated with reduced access to health services in this population.
Highlights
As the fastest-growing group in the United States, the Asian American population is projected to nearly double by 2060, accounting for 11.7% of the total population (Colby & Ortman, 2015)
Kim & Chan, 2004) among Korean Americans. These studies suggest that length of stay in the United States, having health insurance and having a usual source of care are among the most important factors associated with receiving health services among Korean Americans
Compared to the overall LA County Korean population based on 2007-2009 American Community Survey 3-year estimates, our sample had a higher proportion of females (65% vs. 53% in LA County), college graduates (54.4% vs. 37.9% in LA County), and immigrants (97.3% vs.76.1% in LA County)
Summary
As the fastest-growing group in the United States, the Asian American population is projected to nearly double by 2060, accounting for 11.7% of the total population (Colby & Ortman, 2015). Lee, Choi, & Jung, 2014; Pourat, Kagawa-Singer, Breen, & Sripipatana, 2010), because of cultural and language barriers, limited knowledge of the United States (US) health care system and social services, lack of access, and lack of trust in the system (Flaskerud & Kim, 1999; Kang et al, 2010). Some of these challenges are due to the process of acculturation and life changes experienced by Asian American immigrants. Y. Lee et al, 2010; S. Lee et al, 2014; Park et al, 2013; Shin et al, 2005; Sohn & Harada, 2004)
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