The Importance of Health Insurance in Addressing Asian American Disparities in Utilization of Clinical Preventive Services: 12-Year Pooled Data from California.

Sara B Mcmenamin,Nancy Breen,Nadereh Pourat,Richard Lee

doi:10.1089/heq.2020.0008

Abstract

Purpose: Previous research has shown that Asian Americans are less likely to receive recommended clinical preventive services especially for cancer compared with non-Hispanic whites. Health insurance expansion has been recommended as a way to increase use of these preventive services. This study examines the extent to which utilization of preventive services by Asians overall and by ethnicity compared with non-Hispanic whites is moderated by health insurance.Methods: Data from the California Health Interview Survey (CHIS) was used to examine preventive service utilization among non-Hispanic whites, Asians, and Asian subgroups 50–64 years of age by insurance status. Six waves of CHIS data from 2001 to 2011 were combined to allow analysis of Asian subgroups. Logistic regression models were run to predict the effect of insurance on receipt of mammography, colorectal cancer (CRC) screening, and flu shots among Asians overall and by ethnicity compared with whites.Results: Privately insured Asians reported significantly lower adjusted rates of mammography (83.1% vs. 87.6%) and CRC screening (54.7% vs. 59.4%), and higher rates of influenza vaccination (48.7% vs. 38.5%) than privately insured non-Hispanic whites. Adjusted rates of cancer screening were lower among Koreans and Chinese for mammography, and lower among Filipinos for CRC screening.Conclusion: This study highlights the limitations of providing insurance coverage as a strategy to eliminate disparities for cancer screening among Asians without addressing cultural factors.

Highlights

With the release of the 2003 Institute of Medicine report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, reducing health disparities was underscored as a national priority in the United States.[1]
Purpose: Previous research has shown that Asian Americans are less likely to receive recommended clinical preventive services especially for cancer compared with non-Hispanic whites
We examine data spanning 12 years to assess the potential role of insurance status on the utilization of three different clinical preventive services, two cancer screening modalities, and one type of vaccination (i.e., mammography, colorectal cancer (CRC) screening, and flu shots)

Summary

Introduction

With the release of the 2003 Institute of Medicine report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, reducing health disparities was underscored as a national priority in the United States.[1] Reducing racial/ethnic gaps in clinical preventive screening rates recommended by the United States Preventive Services Task Force (USPSTF) is a critical component of reducing overall health disparities.[2]. Previous research has documented disparities in the receipt of clinical preventive services by race/ethnicity.[3]. This research has found that Asian Americans are less likely to receive recommended clinical preventive services related to cancer compared with non-Hispanic whites.[3,4,5,6,7,8] In addition, Asian Americans have lower screening rates for certain cancers compared with blacks and Hispanics despite having a higher socioeconomic status compared with these groups.[9].

Methods

Results

Conclusion