Methods: We used purposive sampling to recruit 549 non-elderly Korean Americans (aged 26 – 64) through Korean community churches in the Greater Los Angeles area. From July to October 2018, we conducted a cross-sectional, self-administered survey. Of the 549 participants, we included in the analysis 438 Korean Americans who were currently enrolled in health insurance. Respondents were asked to rate how often they use health insurance when they need health care services on a 5-point Likert scale from never use to always use. We dichotomized the frequency of health insurance use for health care into ‘always use’ vs. ‘not always use’ for the analysis. We measured various aspects of health insurance experience, including affordability of health insurance, accessibility to healthcare providers, and comprehension of insurance policies, using nine items on a 5-point Likert scale. We conducted multiple logistic regression analysis with missing values imputed by the multiple imputation with chained equation (MICE) method.
Results: In our sample, 42.8% of respondents were new enrollees after the ACA implementation. Of the study sample, 43% reported not always using health insurance for healthcare services, with a significant difference found between post-ACA (51%) and pre-ACA enrollees (37%) (χ2=9.0, df=1, p<.01). Post-ACA enrollees reported lower accessibility (t=-2.84, p<.01) and comprehension of health insurance policies (t=-2.31, p<.05) compared to pre-ACA enrollees. Multiple logistic regression found affordability (AOR=1.15, 95% CI=1.05–1.26) and accessibility (AOR=1.2, 95%CI=1.05–1.37) significantly associated with health insurance use among Korean Americans, controlling for demographic, socioeconomic, immigration-related, and healthcare-related characteristics.
Conclusion and implications: The study found that a significant proportion of Korean Americans did not always use their health insurance for health care services. Post-ACA enrollees encountered more difficulties in accessing health care providers and understanding health insurance policies compared to pre-ACA enrollees. The study also revealed affordability and accessibility as critical factors related to health insurance use among Korean Americans. To enhance the utilization of health insurance among Korean Americans, policy interventions could focus on addressing affordability and accessibility issues, as well as improving health insurance literacy among Korean Americans. Further discussion is needed on effective approaches to help Korean American patients navigate the complex U.S. healthcare system and learn how to best utilize their health insurance.