Objective: To examine patterns and factors associated with the utilization of health care services among Korean American elderly (KAE).
Study Design: A cross-sectional study design, based on the Behavioral Model of Health Service Utilization for Vulnerable Populations.
Population, Sample, Setting, Year: A total of 205 KAE aged 60 years and older, residing in the Greater Baltimore Metropolitan area, participated in this study in 1999.
Concepts, Variables, Intervention, Outcomes: Following the Behavioral Model of Health Service Utilization, concepts were measured in four dimensions explaining the patterns of health care utilization: predisposing, enabling, needs, and health behavior factors. Predisposing factors included: traditional predisposing domains (gender, employment status, marital status, education, and age) and vulnerable population-specific predisposing domains (length of stay in the U. S., perceived level of acculturative stress, and English fluency, in particular communication with English-speaking doctors without a translator). Enabling factors included: regular source of care, insurance, public assistance, and community health services. Need factors included: the perceived health status and clinically determined medical needs. Health behavior factors included: smoking status and exercise. Finally, the outcome variables included: the number of physician visits, hospitalizations, and the number of visits to Oriental medicine doctors during the 6 months prior to the interview.
Methods: Data were collected using face-to-face interviews. Poisson regression was used to explain patterns of health service utilization among KAE.
Findings: More than half (60%) of the respondents reported that they could not get medical care when needed . Furthermore, the majority (86%) had experienced difficulty getting care. Reasons for not getting care were tight money/no insurance, language barrier, no transportation, and no time. About 71% had health insurance, but only 10% of them had private insurance and the rest were on Medicare or Medicaid. Of those having a regular source of care (88%), 72% indicated that they had a Korean doctor.
About 71% of respondents visited a physician and one fourth (25%) used Oriental medicine at least once during the previous 6 months. Only a small fraction (5%) of KAE was admitted to a hospital. Among KAE with public health insurance, those having Korean regular doctors were about twice as likely as those with English-speaking regular doctors to visit a physician for their health care. Having a non-Korean doctor as a source of regular care was significantly associated with a higher usage of Oriental medicine, in addition to being unhealthy compared to others. For hospital admissions, those who had public insurance were 34.8 times more likely than the uninsured to be admitted to the hospital. The level of acculturation was significantly associated with none of the outcome variables.
Conclusions: Korean American elderly grossly underutilized ambulatory heath facilities despite high medical and perceived needs. This study also indicated that KAE frequently relied on Oriental medicine for their health care. Enabling factors such as public insurance and having a regular physician were important to the utilization of physician care and hospitalization, whereas perceived or evaluated needs were crucial to the utilization of Oriental medicine.
Implications: With a low rate of health insurance coverage and a likely language barrier, KAE appear to encounter more barriers to obtaining adequate health care, including inadequate detection, delayed entrance into and poor retention into care, and inadequate adherence to long-term treatments. There is an urgent need to enhance their access to health care and reduce health disparity by providing them with culturally effective interventions, such as translation assistance, appropriate policy change, and more education about available community sources of care and welfare benefits. In addition, future research should focus on developing and testing a valid and comprehensive theoretical model that can guide culturally effective interventions and policies for this underserved population.
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