Public Health Insurance Enrollment among Immigrants and Nonimmigrants: Findings from the 2001 California Health Interview Survey

The personal and workplace characteristics of uninsured expatriate males in Saudi Arabia

Background

A major concern by the health decision makers in Gulf Cooperative Council (GCC) countries is the burden of financing healthcare. While other GCC countries have been examining different options, Saudi Arabia has endeavoured to reform its private healthcare system and control expatriate access to government resources through the provision of Compulsory Employment-Based Health Insurance (CEBHI). The objective of this research was to investigate, in a natural setting, the characteristics of uninsured expatriates based on their personal and workplace characteristics.

Methods

Using a cross-sectional survey, data were collected from a sample of 4,575 male expatriate employees using a multi-stage stratified cluster sampling technique. Descriptive statistics were used to summarize all variables, and the dependent variable was tabulated by access to health insurance and tested using Chi-square. Logistic analysis was performed, guided by the conceptual model.

Results

Of survey respondents, 30% were either uninsured or not yet enrolled in a health insurance scheme, 79.4% of these uninsured expatriates did not have valid reasons for being uninsured, with Iqama renewal accounting for 20.6% of the uninsured. The study found both personal and workplace characteristics were important factors influencing health insurance status. Compared with single expatriates, married expatriates (accompanied by their families) are 30% less likely to be uninsured. Moreover, workers occupying technical jobs requiring high school level of education or above were two-thirds more likely to be insured compared to unskilled workers. With regard to firm size, respondents employed in large companies (more than 50 employees) are more likely to be insured compared to those employed in small companies (less than ten employees). In relation to business type, the study found that compared to workers from the agricultural sector, industrial/manufacturing, construction and trading sectors, workers were, respectively, 76%, 85%, and 60% less likely to be uninsured.

Conclusion

Although the CEBHI is mandatory, this study found that the characteristics of uninsured expatriates, in respect of their personal and workplace characteristics have similarities with the uninsured from other private employment-sponsored health insurance schemes. Other factors influencing access to health insurance, besides employee and workplace characteristics, include the development and extent of the country’s insurance industry.

Immigration status and use of health services among Latina women in the San Francisco Bay Area

OBJECTIVE

To assess the relationship between immigration status and use of health services among Latina women.

METHODS

From 2001 to 2004, information on immigration status and use of health services was collected from 710 Latina women in the San Francisco Bay Area. The dependent variable was use of health services during the previous 12 months, which we defined as use of preventive health, dental, urgent care, and emergency services. The primary independent variable was self-reported immigration status, which we categorized as undocumented immigrant, documented immigrant, or citizen.

RESULTS

More than half of the women were undocumented immigrants, one quarter were documented immigrants, and 18% were citizens. Forty percent of women were uninsured, one third had no preventive health visits in the previous year, and 58% had not used dental services. In adjusted logistic regression analyses, undocumented Latinas were 60% less likely and documented Latinas were 46% less likely to have dental visits in the previous year, relative to citizens. Health insurance status was independently associated with all four health service outcomes. Uninsured women were less likely to use preventive health, dental, or urgent care services compared with privately insured women. In addition, publicly insured women were less likely to use dental care and more likely to use emergency care than privately insured women.

CONCLUSIONS

Immigration and health insurance status were associated with use of preventive and nonpreventive services among Latina women in the San Francisco Bay Area. Clinical and policy efforts must address the barriers to care that affect Latina immigrants, particularly undocumented women.

Review: immigrants and health care access, quality, and cost

Inadequate access and poor quality care for immigrants could have serious consequences for their health and that of the overall U.S. population. The authors conducted a systematic search for post-1996, population-based studies of immigrants and health care. Of the 1,559 articles identified, 67 met study criteria of which 77% examined access, 27% quality, and 6% cost. Noncitizens and their children were less likely to have health insurance and a regular source of care and had lower use than the U.S. born. The foreign born or non-English speakers were less satisfied and reported lower ratings and more discrimination. Immigrants incurred lower costs than the U.S. born, except emergency department expenditures for immigrant children. Policy solutions are needed to improve health care for immigrants and their children. Research is needed to elucidate immigrants' nonfinancial barriers, receipt of specific processes of care, cost of care, and health care experiences in nontraditional U.S. destinations.

Occupational status and health insurance among immigrants: effects by generation, length of residence in U.S., and race

BACKGROUND

The occupational mobility of immigrants may be an important link between length of US residence/generation and health insurance status.

METHODS

2003 and 2005 Current Population Survey data are analyzed to assess the relationship between occupation and length of residence/generation and their association with health insurance for immigrant workers. Using a decomposition method, we measure how much of the differences in coverage are due to length of residence/generation versus occupation.

RESULTS

Newly-arrived immigrants have lower insurance rates across all occupations, compared to longer-settled immigrants and native-born persons. Improvements are observed among immigrants with longer length of residence while the second generation reaches parity with the third+ generations. Coverage differs by occupation, with high-skilled occupations maintaining high levels and lower-skilled occupations experiencing the largest gains. While differences in coverage are mostly due to shifts in length of residence, occupational attainment makes significant contributions-particularly among Hispanics.

DISCUSSION

The inclusion of occupational status increases understanding of the role that length of residence/generation plays in determining insurance status.

Breast cancer among Asian Americans: is acculturation related to health-related quality of life?

PURPOSE/OBJECTIVES

To examine the association of acculturation with health-related quality of life (HRQOL) among Asian American breast cancer survivors.

DESIGN

Cross-sectional.

SETTING

Analysis of an Asian American subsample of breast cancer survivors from a larger multiethnic study.

SAMPLE

206 Asian Americans, including Chinese, Filipinos, Koreans, and Japanese. Most were diagnosed with early-stage breast cancer (stage 0-II) and were an average of 54 years old.

METHODS

Participants completed a mailed questionnaire or answered a telephone survey in English, Mandarin, or Korean. HRQOL was measured using the Functional Assessment of Cancer Therapy Breast Version 4. Acculturation was measured using an eight-item scale adapted from Marin's Short Acculturation Scale.

MAIN RESEARCH VARIABLES

HRQOL, acculturation, health insurance, life stress, and social support.

FINDINGS

Acculturation was significantly associated with HRQOL when demographic, medical, socioecologic, and healthcare access factors were controlled. However, the significant association between acculturation and HRQOL disappeared when Asian subgroup membership was considered. Subgroup differences in HRQOL remained after controlling for covariates, with Korean Americans reporting lower HRQOL than the other Asian American subgroups.

CONCLUSIONS

The absence of a significant association between acculturation and HRQOL in the final model is likely a result of the strong association between acculturation and Asian American subgroup membership. The results suggest that the correlation between acculturation and HRQOL is not an effect of having health insurance, life stress, and social support.

IMPLICATIONS FOR NURSING

Closer attention is needed regarding acculturation level; Asian American subgroup differences, including language capacity; and socioecologic characteristics in nursing practice and research.