Factors Associated with Healthcare Access of Asian Americans with Serious Mental Illness

Background and Purpose: Given that individuals with serious mental illness are likely to have comorbid health conditions, it is critical to provide appropriate and accessible healthcare services to this population. Among them, Asian population in the U.S. is known to be vulnerable to the healthcare access due to unfamiliarity with U.S. healthcare systems and limited English proficiency. However, little is known about healthcare access among Asian Americans with serious mental illness. To fill the gap in the literature, this study aimed to examine the factors associated with healthcare access among Asian Americans with serious mental illness.

Methods: The study used the pooled data obtained from the California Health Interview Survey (CHIS; 2011-2014). The CHIS is the nation's largest population-based health survey by using a random-digit telephone survey method (UCLA Center for Health Policy Center, 2013). The sample for the current study consisted of 367 Asian adults with serious mental illness. To measure healthcare access of respondents, a usual source of care was used as a proxy (i.e., do you have a usual source of care when you are sick or need advice about your health?). The presence of serious mental illness was determined by Kessler Psychological Distress Scale (K6). Guided by the Andersen’s behavioral health service utilization model, multivariate logistic regression analysis was conducted to examine factors associated with healthcare access among Asian Americans with serious mental illness while controlling for predisposing, enabling, and need factors. To account for the CHIS’s complex sampling designs, all statistical analyses were conducted using the survey procedures of STATA version 13.

Results: Approximately 78% of the sample reported that they had a usual source of care when needed in a given year. Multivariate models indicated that married individuals were more likely to have a usual source of care than their non-married counterparts (OR=2.10, p=0.27). In addition, education level (i.e., less than high school graduate) was found as a marginally significant predictor of healthcare access (OR=.47, p=0.54), indicating that those without high school diplomat were less likely to have healthcare access when compared to their high school graduate counterparts. Last, insured individuals were more likely to have access to healthcare services when compared to their uninsured counterparts (OR=7.18, p<0.001). However, the need factor was not found to be a significant predictor of healthcare access among Asian Americans with serious mental illness.

Conclusion and Implications: Findings suggest that healthcare professionals have to be familiar with significant predictors of healthcare access among Asian Americans with serious mental illness. Recognizing the importance of marital status, education attainment, and insurance status associated with healthcare access can help this vulnerable population to have appropriate access when they are in need of healthcare. Considering that stigma and discrimination may also affect healthcare access among Asian Americans with serious mental illness, further studies should examine variation in healthcare access by the type of service provider (e.g., specialty vs. general healthcare provider) among this vulnerable population.