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Contextual effects on health care access among immigrants: Lessons from three ethnic communities in Hawaii

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  • Choi, Jin Young

Abstract

Immigrant health care is the product of the dynamic interaction between societal factors and the individual's socio-economic and cultural characteristics. Our knowledge about immigrant health care, however, has been limited to individual characteristics, without paying attention to the social context in which immigrants reside. This paper explores the effects of social contexts on access to health care among recent immigrants. As a natural experiment, it compares health care experiences of three immigrant groups in Hawaii - Filipinos, Koreans, and Marshallese - who are situated in different social contexts including immigrant health policy, ethnic community, and individual networks. Through household surveys conducted between October 2005 and January 2006, information of 378 recent immigrant adults on health care access, health insurance status, socio-demographic characteristics, linguistic and cultural factors, health status, ethnic community social capital, and social networks was obtained. The results of analyses show that Marshallese respondents have better access to health care than the other two groups, in spite of their lowest socioeconomic status. The high insurance rate of the Marshallese, mainly associated with a state health policy that provides health insurance assistance for the Marshallese, is the major contributor of their greater health care access. While Filipino immigrants do not benefit from state insurance assistance, high levels of health care resources and social capital within the Filipino community enable them to have significantly better health care access than Koreans, who have higher income and educational attainment. Interestingly, the advanced family/kinship networks are associated with better levels of immigrant health care access, while the increase of co-ethnic friend networks is related to lower access to health care. This study implies that restoration of immigrants' eligibility for public health insurance assistance, development of health care resources and social capital within ethnic communities, and mobilization of immigrant networks would be effective starting points to improve health care access among immigrants.

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  • Choi, Jin Young, 2009. "Contextual effects on health care access among immigrants: Lessons from three ethnic communities in Hawaii," Social Science & Medicine, Elsevier, vol. 69(8), pages 1261-1271, October.
    • Handle: RePEc:eee:socmed:v:69:y:2009:i:8:p:1261-1271
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    2. Martine AUDIBERT & Jean-Yves LE HESRAN & Stéphanie DOS SANTOS & Hervé LAFARGE & Richard LALOU & Georges Karna KONE, 2013. "Use of health care among the urban poor in Africa: Does the neighbourhood have an impact?," Working Papers 201319, CERDI.
    3. Danan Gu & Haiyan Zhu & Ming Wen, 2015. "Neighborhood-health links: Differences between rural-to-urban migrants and natives in Shanghai," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 33(17), pages 499-524.
    4. Philip Q. Yang & Shann Hwa Hwang, 2016. "Explaining Immigrant Health Service Utilization," SAGE Open, , vol. 6(2), pages 21582440166, May.
    5. Georges Kone & Richard Lalou & Martine Audibert & Hervé Lafarge & Stéphanie dos Santos & Jean-Yves Le Hesran, 2013. "Use of health care among the urban poor in Africa: Does the neighbourhood have an impact?," CERDI Working papers halshs-00878946, HAL.
    6. Viladrich, Anahí, 2012. "Beyond welfare reform: Reframing undocumented immigrants’ entitlement to health care in the United States, a critical review," Social Science & Medicine, Elsevier, vol. 74(6), pages 822-829.
    7. Solome Kiribakka Bakeera & George Pariyo & Max Petzold & Sandro Galea & Wamala SP, 2012. "Associations between Socioeconomic Factors and Social Capital amongst Child Caregivers in Eastern Uganda," Review of Economics & Finance, Better Advances Press, Canada, vol. 2, pages 51-62, February.

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