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Health Care Access, Coverage Uneven Among Ethnic Subgroups

By Kathy Gurchiek  4/11/2008
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There is a wide disparity among certain subgroups of Asian Americans, Native Hawaiians and Pacific Islanders in the United States when it comes to health care access and coverage, according to a new analysis by the Kaiser Family Foundation.

The analysis is based on data from annual government surveys—the 2004, 2005 and 2006 National Health Interview Survey and Current Population Survey. Subgroups consisted of Native Hawaiians/Pacific Islanders, Chinese, Japanese, Koreans, Vietnamese, Filipinos, Asian Indians, third-plus generations (people who reported their and their parents’ country of birth as the United States), “other Southeast Asian,” “other South Asian” and “other Asian.”

The foundation found a “substantial difference in the health care experiences” of the subgroups of the nation’s estimated 13 million Asian Americans and more than half a million Native Hawaiians and Pacific Islanders.

Compared with 12 percent of non-Hispanic whites who are uninsured, the proportion of uninsured nonelderly people in the various subgroups varies widely, Kaiser found:

    • Koreans, 31 percent.

    • Native Hawaiians/Pacific Islanders, 24 percent.

    • Vietnamese, 21 percent.

    • Filipinos, 14 percent.

    • Japanese and Asian Indians, 12 percent.

Disparities in care have health consequences such as misdiagnoses and less likelihood of receiving preventive services. The disparities can increase health care costs and contribute to absenteeism, disability and productivity loss, according to the National Business Group on Health.

Most Americans get their health coverage through their employer, and this was true for 69 percent of non-Hispanic whites from 2004 to 2006.

For the subgroups studied, the percentage during that period that had employer-sponsored coverage ranged from a high of 77 percent among Asian Indians to a low of 49 percent among Koreans.

That may be attributable in part to the size of the organization where people in those subgroups were employed.

For example, workers at employers with fewer than 100 employees are less likely to have employer-sponsored coverage than those at organizations with 100 or more employees, noted a Kaiser fact sheet. And, the foundation pointed out, 60 percent of nonelderly adult Korean workers are employed at an organization with fewer than 100 employees, compared with 40 percent of other Asian Americans and Native Hawaiians/Pacific Islanders.

The Kaiser analysis noted that, in addition to the size of the employer, some variation in health care coverage may be attributable to how recently certain groups arrived in the United States and what regions of the country they live in.

Income also plays a factor: 42 percent of nonelderly Vietnamese, 43 percent of Native Hawaiians/Pacific Islanders and 44 percent of “other Southeast Asians,” for example, are poor or nearly poor compared with the other subgroups.

A 2006 Trends in Health Insurance Coverage study by the Society for Human Resource Management (SHRM) found that “disparities in health insurance for Hispanics, relative to whites, are in great part due to disparities in employment by firms that offer health care coverage,” as well as low income related to their employment, prompting them to opt out of health insurance coverage.

The SHRM paper pointed out that while one option for many people is to be covered under a spouse’s employer-sponsored plan, Hispanics and blacks are less likely than whites to have spousal coverage “because of lower marriage rates (particularly among blacks) and because their spouses are less likely to have coverage from their employment.”

The Kaiser analysis is a “timely reminder,” Asian & Pacific Islander American Health Forum President and CEO Ho Luong Tran said in the Kaiser press release, as policy-makers and health leaders consider the best way to cover the uninsured and underinsured in the United States.

Kathy Gurchiek is associate editor for HR News. She can be reached at

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