Trust in Physicians, Health Insurance, and Health Care Utilization Among Chinese Older Immigrants

Background/Purpose:

Trust in physicians (TIP) plays a critical role in the health care utilization (HCU) of minority older adults and older immigrants. Although previous studies suggested that TIP was positively associated with primary care visits, negatively associated with Emergency Room (ER) visits and hospitalization among African Americans in the United States (U.S.), it is unclear whether and how TIP influences various types of HCU among Chinese older immigrants, a fast-growing group of minority older immigrants in the U.S. Furthermore, despite the important role insurance plays in HCU disparities, few studies have tested whether TIP influences the HCU of the insured and uninsured Chinese older immigrants differently. Therefore, this study aims to examine the role of TIP in three types of HCU (physician visits, ER visits, and hospitalization) among Chinese older immigrants and whether the associations differ by insurance status.

Methods:

The data were derived from the Population Study of ChINese Elderly in Chicago (PINE), a population-based epidemiology study of community-living Chinese older immigrants (60+ years) in the greater Chicago area, N=3,157. The sample is representative of Chinese older immigrants in the Greater Chicago Area. Guided by Andersen's behavioral model, hierarchical logistic regression analyses examined how TIP influenced the likelihood of physician visits, ER visits, and hospitalization among Chinese older immigrants. Predisposing, enabling, and need factors to HCU, were entered step by step. An interaction term was added to examine whether the aforementioned associations differed by insurance status.

Measures

TIP. The 11-item TIP scale in PINE assessed trust from three perspectives, including physician dependability, confidence in physician knowledge/skills, and reliability/confidentiality of information communicated with the physician. The TIP score ranged from 11-55 and higher scores indicated higher levels of trust. The Cronbach's alpha of the TIP scale was .84.

HCU. Given the skewed data, HCU was measured by three dichotomous variables that indicated whether participants had any physician visits, emergency room visits, and hospitalization in the past two years.

Results:

TIP was positively associated with the chance of physician visits (Odds Ratio [OR] =1.07, p<0.001) but not with ER visits (OR=1.02, p=0.054) or hospitalization (OR=1.01, p=0.13). The relationship between trust and physician visits did not change when accounting for the predisposing, enabling, and need factors in the model. In contrast, the relationship between trust and ER visits was only significant when accounting for the predisposing and need factors in the model. TIP was not significantly associated with hospitalization in any model, which may reflect the distinct nature of hospitalization as a healthcare pathway rather than an individual choice.

The results of the moderation analyses further showed that TIP had a stronger positive relationship with ER visits (OR=0.94, p=0.006) and hospitalization (OR=0.93, p=0.004) among the uninsured population than those insured.

Conclusions and Implications:

TIP played an important role in facilitating primary care visits among Chinese older immigrants regardless of insurance status. Additionally, TIP facilitated the ER visit and hospitalization among uninsured Chinese older immigrants. Findings have implications for research and interventions on HCU disparities.