Dissertations, Theses, and Capstone Projects

Date of Degree

6-2014

Document Type

Dissertation

Degree Name

Ph.D.

Program

Political Science

Advisor

Christa Altenstetter

Subject Categories

Political Science | Public Health Education and Promotion | Public Policy

Keywords

Access to healthcare, Affordable Care Act, Healthcare disparities, Immigrant health, Minority health

Abstract

Objectives: This dissertation examines the barriers for access to healthcare for the top four most uninsured Asian American subgroups (Bangladeshi, Cambodian, Korean, and Pakistani communities). Methods: Combining quantitative and qualitative approaches, this study consisted of: (1) an in-depth review of the Health Services Research literature; (2) qualitative interviews with 24 national health experts and advocates on Asian American health; (3) a survey of a non-probability sample of 107 Koreans in the tri-state region (Connecticut, New Jersey, and New York) using the Access to Healthcare Survey for Koreans in the U.S. instrument, which includes a Likert scale with 21 barrier questions and 40 questions capturing demographic, healthcare, health status, beliefs, and civic engagement indicators; and (4) a comparative approach, which draws lessons from other countries facing similar access to healthcare issues, as described in the Comparative Health Policy literature. Results: 57% of the Korean sample is self-employed, with 40% having no health insurance at all and 42% having no regular source of care. 67% achieved a Bachelor's degree or above but bivariate analyses show that those who completed their education outside of the U.S. have significantly lower levels of access to healthcare (53%). 63% had resided in the U.S. for more than 20 years and 44% do not speak English well or not at all. Conclusions: Structural barriers, such as cost and employment/occupation types, have a significant impact on access to healthcare. Asian American subgroups' increased propensity to be self-employed or be employed in the ethnic economy cannot be explained as a cultural phenomenon but should be understood as a pragmatic approach to integrating into the U.S. labor market. Due to their high limited English proficiency levels, Asian immigrants face challenges finding employment commensurate with their previous education and job experience. Despite the expected impact of the Affordable Care Act in reducing uninsured rates, future efforts to remedy the barriers to access to healthcare for these Asian American subgroups will require a multifaceted approach that moves towards integrating vulnerable populations, such as immigrants, into the mainstream healthcare system and establishes targeted interventions such as language assistance and comprehensive case management services.

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