Different Countries, Different Healthcare Systems: Understanding the Roles of Perception on Healthcare Systems between the U.S. and Korea in Purchasing Health Insurance Among Self-Employed Korean Immigrants

Background and Purpose:

The low health insurance coverage among Korean immigrants has often been deemed due to their high rates of self-employment. However, a recent study revealed that even after controlling for employment types and income, Korean immigrants still showed lower insured rates than other Asian immigrants. Such unexplained gap might be attributed to the different healthcare systems between the U.S. and Korea because Korean immigrants who were accustomed to universal healthcare system in Korea. This study explored how the healthcare systems between the U.S. and Korea were perceived by self-employed Korean immigrants and how these perceived differences would affect their intention to purchase voluntary health insurance plans. 

Methods:

Purposive sampling was conducted to recruit 24 self-employed Korean immigrants in the Greater Los Angeles, who barely had health insurance prior to the implementation of the ACA (50% females; mean age=51; monthly income=$5,650; 21% currently uninsured). In-depth interviews were conducted between March and June 2015. Participants were asked to describe their perceived experiences within the healthcare systems in Korea and the U.S. They were also asked to evaluate the levels of satisfaction with healthcare systems using a scale of 1-10 with 10 being the most satisfied. Interviews were transcribed verbatim, thematically coded, and analyzed using “Coding Consensus, Co-occurrence, and Comparison” methods. Paired sample t-test was used to examine whether the observed differences in the level of satisfaction with healthcare systems between the countries were statistically significant.

Results:

Korean immigrants showed significantly higher level of satisfaction with the Korean healthcare system compared to the U.S. healthcare system in regard to “costs”, “simple and convenient insurance plans”, “easy access to medical facilities”, and “quality of care”. Of note, respondents showed a tendency to use Korean healthcare system as a standard to evaluate the U.S. healthcare system. Interestingly, those who immigrated to the U.S. around early 1980s when the Korean universal health insurance system had not been established were highly satisfied with U.S. health insurance system and had purchased health insurance for substantial periods of time. Respondents perceived purchasing health insurance as a waste of money because they felt the costs for the private health insurance were unreasonably high given the benefits they received compared to the cost and benefits they experienced within the healthcare system in Korea. The perceived availability of health care in Korea and other coping strategies also functioned as a disincentive to purchase health insurance.

Conclusions and Implications:

The findings of the study provide an empirical evidence to support culturally-competent intervention to improve access to healthcare for immigrants by disclosing that the pre-migratory experience of immigrants in the healthcare systems of home countries can shape their perceptions on the healthcare systems in the host countries, resulting in facilitating maladaptive health-seeking behaviors. Future studies could to examine how the negative perceptions on the U.S. healthcare system affect the utilization of health insurance among Korean immigrants in the contexts of the recent U.S. healthcare reform.