Premigration Experience of Health Insurance, Perceived Satisfaction with U.S. Health Insurance, and the Intention to Maintain Health Insurance Among Korean Americans

Background and Purpose: After the implementation of the Affordable Care Act (ACA), health insurance coverage of Korean Americans increased. However, little is known about the extent to which Korean Americans are satisfied with U.S. health insurance and whether or not they will keep their health insurance given the recent changes in health policies to eliminate the individual mandate penalty. Even after the ACA was implemented, Korean Americans continued to have the highest uninsurance rates compared to other Asian ethnic subgroups. Research suggested that different health insurance systems between the U.S. and Korea might account for observed disparities in health insurance coverage among Korean Americans. With the socio-cultural framework of healthcare disparities, this study investigated the impact of premigration experience of Korean health insurance on the intention to maintain U.S. health insurance plans mediated by perceived satisfaction with U.S. health insurance.

Methods: Data were collected through community churches in the Greater Los Angeles from July to September in 2018. A total of 554 non-elderly Korean Americans completed a self-administered questionnaire asking their perceptions on various aspects of health insurance (cost, benefits, accessibility, simplicity of policies, awareness and utilization of benefits, and intention to hold health insurance regardless of the individual mandate) in both the U.S. and in Korea using 5 point-Likert scale. Overall satisfaction levels with health insurance in both countries were also assessed. Potential indirect effects of the perception of U.S. health insurance mediating the relationship between the experience of Korean health insurance and the intention to hold the U.S. health insurance were also examined.

Results: Among the total sample, 83% were currently insured, and 26% had enrolled in health insurance plans due to the requirements of the ACA. In terms of satisfaction with health insurance, 26% were satisfied with U.S. health insurance while 39% were not satisfied. Among the respondents with the experience of Korean health insurance (n=334), 74% were satisfied with Korean health insurance while only 3% were not satisfied. Controlling for other covariates, Korean Americans who experienced Korean health insurance showed significantly lower levels of satisfaction with U.S. health insurance (b=-0.34, p<0.01), and the levels of satisfaction with U.S. health insurance significantly affected the intention to hold health insurance (b=0.31, p<0.001). A statistically significant indirect effect of pre-migratory experience of Korean health insurance on the intention to hold U.S. health insurance via the levels of satisfaction with U.S. health insurance was found (b=-0.1, p<0.01).

 Conclusions and Implications: Premigration experiences of immigrants with their home country healthcare systems can affect their current behaviors in the U.S. healthcare system. Korean Americans who experienced Korean health insurance, which is perceived as relatively cheap and convenient, are more likely to have negative perceptions of U.S. health insurance, which, in turn, negatively impacted the intention to continue participation in U.S. health insurance plans. The result of this study extends our understanding of the determinants of health insurance coverage among Korean Americans and provides salient implications to health policy makers and health insurance providers given the unstable political climate around healthcare policies.