Factors Associated with Unmet Healthcare Needs By Economic Activity Among Marriage Immigrants in South Korea

Background and Purpose: For the last two decades, marriage migration is constantly increased in South Korea. Marriage immigrants have diverse ethnic/cultural backgrounds with different socioeconomic status, which could affect their own health status and healthcare needs. This study aimed to investigate the factors associated with unmet healthcare needs by economic activity among immigrants living in South Korea, using Andersen’s Behavioral Model of health services use.

Methods: We analyzed the 2018 National Survey of Multicultural Families, including 17,073 immigrants. We considered predisposing factors, enabling factors, and need factors, guided by the Andersen’s behavioral model of healthcare services use. Age, gender, length of residence, educational level, marriage status, and proficiency in Korean were included as predisposing factors. Household economic status, region (e.g. urban and rural area), and social network for help (e.g. friends, neighbors, or relatives who can ask for help when one is sick) were included as enabling factors. For need factors, self-rated health was included. For those who worked for 18 hours or more during the last week to make earnings or were employed were considered as economically active. The age group was classified into three groups (e.g. aged < 40, aged 40 to 59, and aged 60+ years). Self-rated health was classified into “good” (very good, good, and fair) and “poor” (poor and very poor). Survey participants who ever been unable to go to a hospital or a clinic when needed in the past 12 months were considered as having unmet healthcare needs. Multiple logistic regression was used to identify the determinants of unmet healthcare needs.

Results: The odds of unmet healthcare needs were 1.40 times higher in economically active immigrants than those who are economically inactive (95% confidence interval [CI] = 1.25-1.58, p<0.001). In both economically active (EA) and inactive (EI) immigrants, the likelihood of unmet healthcare needs is higher in those with poor self-rated health (EA: OR=4.41, 95% CI = 3.66–5.32 p<0.001; EI: OR=3.24, 95% CI=2.52–4.17, p<0.001) and aged less than 40 years (reference group: age 60+, EA: OR=2.45, 95% CI = 1.70–3.54 p<0.001; EI: OR=1.77, 95% CI=1.26–2.48, p<0.01). Also, immigrants who are female, lower level of proficiency in Korean, no social network for help had a higher odds ratio of experiencing unmet healthcare needs in both groups. Economically active immigrants with higher household income ($3,000/month) had a lower odds ratio of experiencing unmet healthcare needs compared to those with lower household income (OR=0.63, 95% CI=0.51-0.76, p<0.001). Among economically inactive immigrants, those who are divorced or widowed had a higher chance of experiencing unmet healthcare needs compared to those who are married (OR=1.49, 95% CI=1.11-2.00, p<0.01).

Conclusions and Implications: Self-rated health, marriage status, and age were the three most significant factors that contributed to unmet healthcare needs among immigrants living in South Korea. Public policies and interventions that emphasize improvements in healthcare access for immigrants in South Korea are needed. Further research is required to understand the factors related to economic activity, such as employment status and economic hardship to develop a target-oriented intervention for immigrants.