Differences in Access to Care for Asian and White Adults

1. Differences in Access to Care for Asian and White Adults Merrile Sing, Ph.D. September 8, 2008

2. Policy Context • Many Asians face significant linguistic and cultural barriers ~ 25% of Asians live in linguistically isolated households (Census 2000) ~ 63% of Asians are immigrants (Census 2000) • Some Asian American subgroups are at greater risk than non-Hispanic Whites for certain diseases, such as diabetes, stomach and liver cancer, hepatitis B, and tuberculosis 2

3. Research Objectives • To estimate adjusted differences in access to care between non-Hispanic White and Asian adults • To identify factors that have the greatest marginal effects on improving access to care 3

4. Previous Research • Moy et al. (2008). “Community Variation: Disparities in Health Care Quality Between Asian and White Medicare Beneficiaries.” • Miltiades and Wu (2008). “Factors Affecting Physician Visits in Chinese and Chinese Immigrant Samples.” • Snyder et al. (2000). “Access to Medical Care Reported by Asians and Pacific Islanders in a West Coast Physician Group Association” • AHRQ (2007), National Healthcare Disparities Report 4

5. Study Design • Data are from the Medical Expenditure Panel Survey (MEPS) & Area Resource File, 2002 - 2005 • MEPS contains a nationally representative sample of households in the U.S. civilian, non-institutionalized population • Sample includes non-Hispanic adults age 18 and older • There are 3,779 Asians and 52,498 Whites • Andersen typology of access to care is used • Outcome variables are binary • Usual source of care (excluding emergency room) • At least one office visit during past year 5

6. Access to Care 6

7. Andersen Typology:Control variables Access depends on: • Predisposing characteristics • Enabling Resources • Illness level or perceived need 7

8. Predisposing Characteristics • Demographic Age, sex, marital status • Social structure Education Acculturation Difficulty speaking English In linguistically isolated family Immigrant < 5 years in U.S. Immigrant 5 – 14 years in U.S. • Attitudes Overcome illness without medical professional More willing to take risk Always uses seat belt 8

9. Enabling Resources • Family Income Insurance coverage • Community Urban-rural (using Metropolitan Statistical Areas) Census Region (4) Active non-federal MDs/ 1,000 population (county) Number of Federally Qualified Health Centers (county) Percent Asian population in county 9

10. Illness/Perceived Need • Self-rated general health • Poor mental health (Mental Component Summary) • Number of chronic conditions 10

11. Methods 11

12. Estimation Methods • Unadjusted differences in means • Adjusted differences (multivariate logistic regressions) • Marginal effects estimated by method of recycled predictions • Standard errors estimated using balanced repeated replicates 12

13. Marginal effects onAccess to care Which factors have the greatest marginal effects on improving access to care? • Predisposing conditions with and without acculturation variables • Enabling resources • Perceived need • All control variables 13

14. Unadjusted Differences 14

15. Access to CareAdults Age 18+ ** ** * (**) Significantly different from White at 0.05 (0.01) level or better Source: MEPS 2002 – 2005, adults eligible for access supplement 15

16. AcculturationImmigrants ** ** ** * (**) Significantly different from White at 0.05 (0.01) level or better Source: MEPS 2002 – 2005, Adults eligible for Access Supplement 16

17. AcculturationEnglish Language ** ** * (**) Significantly different from White at 0.05 (0.01) level or better Source: MEPS 2002 – 2005, Adults eligible for Access Supplement 17

18. Factors Associated with Access to Care 18

19. Variables associated withUsual Source of Care Marginal effect Asian - 0.039* (0.019) EnablingPredisposing Income immigrant < 5 yrs in U.S. Insurance status immigrant 5 - 14 yrs in U.S. MSA Difficulty w/ English Census Region Asian * Difficulty w/English family size Perceived need age number of chronic cond. gender self-rated health marital status attitudes Year 2004 - Year 2005 - Source: MEPS 2002 - 2005 19

20. Variables associated withOffice Visit(s) Marginal effect Asian - 0.077** (0.015) EnablingPredisposing Income immigrant < 5 yrs in U.S. Insurance status Difficulty w/ English MSA Census Region education Active MDs/ 1000 pop. family size age Perceived need gender number of chronic cond. marital status self-rated general health attitudes self-rated mental health Year 2004 + Source: MEPS 2002 - 2005 20

21. Estimated Marginal Effects 21

22. Marginal Effects on Access to Care Unadjusted Usual Source of Care Office Visit(s) White 0.811 (0.004) 0.784 (0.003) Asian 0.701 (0.013) 0.630 (0.011) Difference -0.110 ** - 0.154 ** Adjusted differences: Marginal effects controlling for: Usual Source of Care Office Visit(s) Predisposing (w/o acculturation) - 0.115 ** - 0.143 ** Predisposing (w/ acculturation) - 0.055 **- 0.102 ** Enabling - 0.078 ** - 0.123 ** Perceived need - 0.068 ** - 0.098 ** All variables - 0.039 ** - 0.077 ** 22

23. Conclusions • Asian adults were less likely than Whites to have a usual source of care or an office visit, after controlling for predisposing and enabling characteristics and perceived need Greatest Marginal Effects on Access to Care Predisposing Enabling Perceived w/ acculturation Need Usual Source of Care√ Office Visit √ 23

24. Policy Relevance Findings suggest areas to focus on for improving access to care for Asian adults: • Translating general medical information and Medicaid applications into Asian languages may improve access to care for some Asians • Educating providers about differences in culture and disease incidence for Asians compared with non-Hispanic Whites 24