Limited English Proficiency, Access to Health Care, and Health Services Use Among Asian

Background and Purpose: High prevalence of limited English proficiency (LEP) among Asian immigrants, the fastest-growing racial and ethnic group in the United States, constitutes a significant public health issue. Individuals with LEP are at risk of experiencing language barriers to health care, including an inability to obtain sufficient health information by navigating the complex U.S. health care system. LEP patients are also less likely to have adequate communication with their physicians, resulting in poor quality of care and decreased preventive health care use. A recent study noted that Asian American subgroups have different pathways to having a usual source of care, and English proficiency contributed to the Asian American path model. However, it remains unclear how English proficiency is associated with health services use through access to care (health insurance and usual source of care) and how pathways to health services use through access to care vary across Asian ethnic subgroups. Thus, this study examined the ethnic-specific pathways whereby English proficiency affects health services use through access to care among Asian immigrants in California.

Methods: California Health Interview Survey 2011–2012 data were used and the sample was limited to Asian immigrants between 18 and 64 years old (N = 1,474; Chinese = 608, Koreans = 300, and Vietnamese = 566). Health services use was measured by the number of doctor visits. English proficiency, health insurance, and usual source of care were dichotomized in the analytic models. Covariates included predisposing (age, gender, marital status, education, employment, citizenship, length of stay in the United States); enabling (income, doctor–patient language concordance, and residential area); and need (self-reported health and presence of conditions) factors. Pathways from English proficiency to health services use via access to health care (English proficiency → health insurance → usual source of care → health services use) were examined and a multiple-group path analysis was used to determine whether potential ethnic differences exist in the models.

Results: A significant indirect effect of English proficiency on health services use through access to care (health insurance and usual source of care) existed for the overall sample. However, pathways differed across ethnic subgroups. Specifically, for Chinese and Vietnamese immigrants, English proficiency was not associated with having health insurance, whereas Korean immigrants reported a significant association between English proficiency and health insurance. In contrast, Chinese and Vietnamese immigrants showed a significant association between having a usual source of care and health services use, an association not found among Korean immigrants.

Conclusions and Implications: These results suggest that the effects of English proficiency on health care-seeking behaviors could vary by ethnicity among Asian immigrants. Having a usual source of care might not increase health services use among some ethnic subgroups, such as Koreans. Ethnic-specific interventions to improve access to care and health services use are needed. Explanations for these ethnic differences include potential influences of ethnic social networks with different norms and cultures with respect to health care-seeking behaviors.