Pathways from English Proficiency to Health Service Use: A Mediation Analysis of Insurance Literacy Among Korean Immigrants

Background and Purpose: Health insurance literacy plays a vital role in equitable healthcare access and use, especially among immigrants facing language and systemic barriers. For Korean immigrants in the U.S., limited English proficiency may hinder access to information about health insurance, understanding of benefits, and actual use of health services. This study examined the pathways through which English proficiency influences healthcare service utilization, focusing on access to insurance information, awareness and use of insurance benefits as mediating variables.

Methods: Data were collected via a cross-sectional survey administered between October and December 2018 to non-elderly Korean immigrants (aged 26–64) with health insurance. Participants were recruited through Korean American churches in the Greater Los Angeles area using purposive sampling and completed self-administered survey questionnaires (N = 310). English proficiency was measured using a self-rated item on a 5-point Likert scale and dichotomized into “well” versus “not well.” Access to health insurance information, awareness of insurance benefits, and use of insurance benefits were each measured using single items rated on 5-point Likert scales, with higher scores indicating greater access, awareness, or usage, respectively. Doctor visits in the past six months were treated as a count variable using negative binomial regression. Path analysis was conducted using Mplus, with robust maximum likelihood estimation (MLR) and Monte Carlo integration.

Results: English proficiency significantly predicted greater access to health insurance information (B = 0.404, p = .004), which was strongly associated with awareness of insurance benefits (B = 0.749, p < .001). Awareness significantly predicted increased use of insurance benefits (B = 0.453, p < .001), which in turn predicted more doctor visits (B = 0.253, p < .001). The total indirect effect of English proficiency on doctor visits was statistically significant (B = 0.134, p = .010), with specific indirect pathways through benefit use (B = 0.076, p <.05) and the full mediation chain also reaching significance (B = 0.035, p < .05). The direct effect of English proficiency on doctor visits was marginally significant (B = 0.297, p = .050). Several covariates, including marital status, education, income, years in the U.S., and chronic health conditions, were also significant predictors of doctor visits.

Conclusion and Implications: Findings reveal a clear pathway from language proficiency to healthcare use, mediated by insurance literacy—especially access to and comprehension of benefit-related information. This study highlights the importance of integrated interventions that target both language proficiency and insurance literacy to improve healthcare utilization among Korean immigrants. Community-based organizations, particularly churches and ethnic service providers, may be instrumental in delivering linguistically and culturally appropriate education on health insurance. Policy efforts should prioritize accessible, translated resources and outreach strategies to ensure equitable healthcare access for immigrant populations.