English Proficiency and Health Insurance Coverage: Focusing on Ethnic Differences in Asian Americans

Background: Low rates of health insurance coverage for Asian Americans, particularly Koreans and Vietnamese, has been regarded as a significant health disparity issue. Among the various influential factors for the low rates, limited English proficiency (LEP) has been regarded as a barrier to health insurance access. There is a dearth of research, however, focusing on discrepancies in the associations of English proficiency among the sub-ethnic groups of Asian Americans with their health insurance status. This study aims to examine how the associations between English proficiency of Asian Americans and their health insurance status vary by ethnic groups.

Methods: Data was retrieved from the California Health Interview Survey (CHIS) 2011-2012. A total of 2,814 Asian Americans including Chinese (n=1,200), Korean (n=737), and Vietnamese (n=877) adults over age 18 were analyzed in this study. Current health insurance status and English proficiency were coded as a dummy variable. In terms of ethnicity, Chinese was used as a reference group. Demographic (age, gender, marital status), socioeconomic (income, working status), and immigration-related factors (citizenship status) were included in the model as control variables. Multivariate logistic regression was conducted to examine the interaction effect of ethnicity, with independent effects of English proficiency on health insurance status for each ethnic group then examined.

Results: There were significant interaction effects between English proficiency and ethnicity (Korean vs. Chinese: OR=1.36, p<.001; Vietnamese vs. Chinese: OR=.63, p<.001). For each ethnic group, Koreans (OR=5.70, 95% CI=5.56-5.84) and Chinese (OR=2.33, 95% CI=2.30-2.37) with high English proficiency were more likely than LEP Koreans and Chinese to have health insurance coverage. However, Vietnamese who speak English well were less likely than LEP Vietnamese (OR=.66, 95% CI=.65-.68) to have health insurance coverage. Interestingly, middle-class Koreans whose income is identified as two to three times their federal poverty level (FPL) were less likely than those with income below FPL (OR=.35, 95% CI=.34-.36) to have health insurance coverage; this was the opposite case with comparison to Chinese (OR=1.86, 95% CI=1.82-1.90) and Vietnamese (OR=5.19, 95% CI=4.97-5.42).

Conclusion and Implications: Even after controlling for confounders, the associations between English proficiency and health insurance status significantly varied by ethnicity. The association between income level and health insurance status also varied by ethnicity. These results indicate that, even in the same race group, predictors of having health insurance coverage may vary by ethnic groups. Several explanations can be applicable such as ethnic differences in access to information about affordable health insurance or in types of employment such as self-employment or small businesses. In-depth understanding to the different determinants of health insurance status by ethnic groups would contribute to develop culturally sensitive approaches to help underserved populations access to adequate healthcare. Further study is needed to consider how health insurance coverage varies by ethnicity depending on types of health insurance as well as employment.