Dismantling Barriers to Equitable Access to Care: Does the Type of Health Insurance Matter?

Background and Purpose: Korean immigrants in the United States have exhibited significantly low rates of health insurance coverage, largely attributed to their high involvement in self-employment or employment at small businesses that do not offer employer-sponsored health insurance (ESHI). The implementation of the Affordable Care Act (ACA) prompted many self-employed Korean immigrants to purchase health insurance through marketplaces by providing subsidies. However, challenges persist in the effective utilization of health insurance among this vulnerable immigrant population. Furthermore, depending on their health insurance type, individuals may experience disadvantages in obtaining information regarding healthcare, due to limited availability from ethnic social networks, which have served as important sources of healthcare information for Korean immigrants. To comprehend these disparities, we investigated the associations of health insurance type (ESHI or not) with various factors including health insurance utilization, overall satisfaction with health plans, perceptions of the quality of health coverage, as well as access to health discussion networks where they can obtain information regarding healthcare.

Methods: Our sample consists of 377 working-age Korean immigrants (aged 26 – 64) with health insurance, recruited through Korean community churches in the Greater Los Angeles area. Half of the sample had ESHI (52%). We collected survey data on the frequency of health insurance usage for healthcare services, rated on a five-point Likert scale from never use to always use. For analysis, we dichotomized this into “always use” versus “not always use.” Additionally, we gathered overall satisfaction levels and perceptions of health coverage quality, including affordability, accessibility, and comprehensibility, rated on a five-point scale. We also measured whether they had access to the health discussion networks at work and within their close circles (binary). We examined the data using logistic and OLS regressions, supplemented by rigorous testing with Inverse Probability Treatment Weighting.

Results: The results indicated that individuals with ESHI are more likely than non-ESHI holders to consistently use health insurance when accessing healthcare services (AOR = 2.76, 95% CI = 1.67 – 4.54). The overall satisfaction and accessibility of health insurance were marginally higher among the ESHI holders (b=.2, p<.10). The affordability and complexity of health plans were not significantly associated with health insurance type. Those with ESHI exhibited significantly higher access to health discussion networks at work (AOR = 1.75, 95% CI = 1.03 – 2.97), whereas their access within close circles was not significantly different than those without ESHI.

Conclusion and Implications: The findings of this study underscore that merely having health insurance does not comprehensively address challenges related to accessing healthcare services. Despite the ACA’s effort to weaken the ties between employment and health insurance in the US healthcare system, Korean immigrants who are not covered by ESHI still encounter difficulties in fully leveraging their health insurance benefits. Furthermore, individuals without ESHI may lack a robust social capital pool, hindering their access to crucial information necessary for optimal health insurance utilization. This amplification of existing inequities within Korean immigrant communities accentuates the importance of addressing these disparities in healthcare services.