Impact of Health Insurance Status on Having a Personal Health Care Professional for Older Asian Americans with Disabilities

Background
Older Asian Americans are among the fastest growing minority groups in the U.S. Improving access to quality health care has been recognized as one of the national goals in the Healthy People 2020 initiatives by the U.S. Department of Health and Human Services. Yet, older Asian Americans with disabilities continue to experience health disparities, and little is known regarding the impact of health insurance on accessing health care for this population. The purpose of this study is to examine the impact of having health insurance, which would lead to greater health care access for older Asian Americans with disabilities. It is hypothesized that having health insurance will increase the likelihood of having a doctor or health care provider for all older Asians, but effect will be greater for those with a disability.

Methods
This study used data from the 2012 Behavioral Risk Factor Surveillance System (BRFSS), a national survey conducted annually by the Centers for Diseases Control and Prevention. The sample used in this study included Asian elders 50 and over (N=4067). The outcome measure is health care access based on the question, “Do you have one person you think of as your personal doctor or health care provider?” Disability status was defined as being limited in any activities because of physical, mental, or emotional problems. Weighted multivariate logistic regression was performed to examine the impact of having health insurance on having a doctor for older Asians who have a disability, compared to those without a disability. Covariates included gender, age group (50 to 64, 65 and above), educational level, income, marital status, obesity and having chronic health conditions.

Results
Although the prevalence of having health insurance was not significantly different between Asian elders with or without a disability (p=0.395), the association between having health insurance and having a doctor was observed for both groups. For Asian elders with a disability, having insurance had a much stronger relationship with having a doctor (OR=17.50, p<0.05), compared to those without a disability (OR=6.33, p<0.05). For Asian elders without a disability, those aged 65 and over were more than 3 times as likely to have a doctor (OR=3.17, p<0.05), compared to those between 50 to 64.

Conclusion
The findings revealed that the impact of health insurance on having a doctor operates differently for older Asians with and without a disability. This suggests that health insurance status is more important for older Asians with a disability in accessing health care. Age is the strongest predictor for developing chronic health conditions and disabilities. While most older adults have health insurance at 65, it is imperative to increase health insurance coverage for everyone, especially ethnic minorities such as Asian Americans who tend to use less services. Social work educators and practitioners should understand how insurance status, disabilities, and health care access intersect for this population. Future research should explore the cultural beliefs or systemic barriers that may hinder older Asian Americans from obtaining health insurance and using services.