Patterns and Factors Associated with Health Care Utilization among Korean American Elderly

OBJECTIVE: To examine patterns and factors associated with the utilization of health care services among Korean American elderly (KAE). DATA SOURCES/STUDY SETTING: Data collected from a survey of face­to­face interviews with 205 KAE, aged 60 years and older, residing in the Greater Baltimore Metropolitan area in 1999. STUDY DESIGN: We employed a cross-sectional design, based on the behavioral model of health service utilization for vulnerable populations. Poisson regression was used to estimate parameters associated with physician visits, the utilization of Oriental medicine, and hospitalization. DATA COLLECTION: Data were collected using face-to-face interviews with 205 KAE. PRINCIPAL FINDINGS: About 60% of respondents reported that they could not get care when needed, and the majority (86%) had experienced difficulty getting care. About 71% of respondents visited a physician, and 25% used Oriental medicine at least once during the previous 6 months. Only 8% visited an emergency room. 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. The level of acculturation was not significant. CONCLUSIONS: Korean American elderly grossly underutilized ambulatory health facilities, a finding which suggests that this vulnerable population needs culturally effective interventions and policies. KEY WORDS: Korean American, Elderly, Health Service Utilization, Behavioral Model for Vulnerable Population     

Out-of-pocket expenditures on traditional and Western medicine in Taiwan

Objectives

Coexistence of traditional and modern medicine is common in Asian countries. This paper investigates out-of-pocket expenditures on traditional medicine, traditional medical service, and Western medicine by households in Taiwan.

Methods

Using a national sample of 13,765 households, the three expenditure equations are estimated with a censored system procedure. Effects of socio-demographic variables are explored by calculating marginal effects on probabilities and levels of medical expenses.

Results

Different types of medical expenditures are correlated. Households with higher income and more aging members use more traditional medicine than others, as do households in agricultural sector and in urban areas. In addition, households living in rural areas relative to those in the cities are more likely to use and also spend more on traditional service. Regional disparity of health care utilization is found.

Conclusions

Higher income households spend more on traditional medicine, likely due to the fact that patients usually pay out-of-pocket for herbal materials needed in preparation of traditional medicine. To ensure equity in health care utilization, establishment of hospitals and clinics in rural areas should be considered.     

Mental Health Service Use Types Among Asian Americans with a Psychiatric Disorder: Considerations of Culture and Need

Despite levels of need that are comparable with other groups, relatively few Asian Americans receive mental health care. While studies have described the tendency for Asian Americans to delay care until mental health symptoms are severe, relatively little research has examined how the severity of symptoms impact mental health service use. This study uses publicly available data from the National Latino and Asian American Study (NLAAS) and focuses solely on Asian American respondents with a psychiatric disorder (n?=?230). Unexpectedly, few Asian Americans with a psychiatric disorder received care in a medical setting. The perception of mental health needs increased the likelihood of using mental health specialist care. Social and systemic barriers together hinder mental health service use. Implications for addressing Asian American mental health service use within a changing health care environment are discussed.     

Health Status and Health Services Utilization Among Older Asian Indian Immigrants

This study examines the health status and utilization of physicians, hospitals, emergency departments, and traditional medicine among older Asian Indian immigrants (n = 100). The data for this study derives from the Asian American Elders in New York City (AAENYC) Study, which used a regional probability sampling. Multivariate analyses were guided by the Andersen behavioral model. The number of medical conditions is significant in predicting the likelihood of physician visits while age and having medical insurance predicted the likelihood of hospital stays. Having medical insurance was also a significant predictor for the use of emergency department services while poor English proficiency was associated with the use of traditional medicine.     

孕产妇对中医预防保健服务认知及利用研究

目的了解孕产妇对中医预防保健服务认知及利用情况,分析其影响因素,以便更好地提供中医预防保健服务。方法采用自制问卷对浦东新区周家渡社区卫生服务中心建册管理的453名孕产妇进行调查。调查内容包括孕产妇基本情况、中医预防保健服务知晓情况及接受程度等。结果 75.1%的孕产妇知晓中医预防保健服务,知晓途径前三位的是医院、朋友(家人)和媒体;77.6%的孕产妇接受过中医预防保健服务,选择服务机构前三位的是中医医院、社区卫生服务中心和妇幼保健院。不同年龄、文化程度、职业和收入的孕产妇对中医预防保健服务利用率的差异有统计学意义(P0.05)。结论中医预防保健服务逐渐被认知和接受,但服务延续性不强,有待整合共享,在满足共性服务的同时需要注重个性化服务的提升。     

Cultural barriers to health care for southeast Asian refugees.

Many Southeast Asians now living in the United States experience severe health problems, attributable to physical trauma and inadequate health care in Asia, and low socioeconomic status in this country. Evidence indicates that despite their health problems, Southeast Asian refugees underuse the American health care system. Cultural reasons for this underuse are examined. Southeast Asian cultural attitudes toward suffering, such as beliefs that suffering is inevitable or that one's life span is predetermined, can cause Southeast Asians not to seek health care. Cultural beliefs about the sources of illness and correspondingly appropriate forms of treatment can be a barrier to Western health care. Many lack familiarity with Western diagnostic techniques and treatments and thus are apprehensive. Health care providers' ignorance of Southeast Asian cultures can interfere with communication with patients, resulting in culturally irrelevant services or misinterpretation of side effects of Southeast Asian folk medicines. Southeast Asians' lack of familiarity with American culture can make health care services geographically and economically inaccessible and can cause Southeast Asians to be ignorant of available services or how to access them. An understanding of Southeast Asian cultures and additional outreach efforts by Western medical practitioners and health care providers are needed to improve the use of health care services by Southeast Asian refugees in this country.     

Between Two Worlds: The Use of Traditional and Western Health Services by Chinese Immigrants

This study examined the use of traditional and Western health services by Chinese immigrants, as well as the cultural and socioeconomic factors affecting health-seeking behaviors and health service utilization patterns among the study population from the perspectives of consumers and Chinese health care providers. Two instruments were used for data collection. The first, a consumer instrument, was designed for interviews of service recipients; the second, a health provider instrument, was designed to elicit information from traditional and Western providers. A few topics in the former instrument were cross-examined from the perspectives of health care providers. The investigation employed a combination of qualitative and quantitative research methods for data collection. Qualitative ethnographic methods used included: (1) participant-observation, (2) face-to-face interview, and (3) case study. To complement the qualitative data, structured quantitative survey were conducted with all selected informants. A total of 105 informants participated in the study: 75 Chinese consumers and 30 Chinese health professionals. The latter group was composed of Western physicians and traditional practitioners. Results revealed several patterns of health-seeking and service utilization behaviors among the Chinese of Houston and Los Angeles. These included high rates of self-treatment and home remedies (balanced diets and other alternative medicines); medium rates of utilization of integrated Western and traditional health services, including travel to country of origin for care; and low rates of exclusive utilization of Western or traditional Chinese treatments.     

中医药医养结合助力健康老龄化产业发展探讨

随着我国人口老龄化速度的加快,传统的养老方式已不能满足老年人日益增长的多层次、多元化健康养老需求,因此,为老龄化人口提供医疗和健康养老双重保障的“医养结合”服务模式及“健康老龄化产业”应运而生。文章在简要梳理中医药医养结合服务模式与健康老龄化产业发展现状的基础上,重点阐述了中医药医养结合在健康老龄化产业中的作用及其优势,并在描绘中医药医养结合发展前景的基础上提出了几点建议。     

Caring for Southeast Asian refugee patients in the USA

This paper concerns care of refugees from Southeast Asia who speak little English and are relatively unfamiliar with the formal health care system in the United States. It aims to demystify the behaviors of refugee patients and to support health practitioners who are attempting to care for them. Western medicine is discussed in terms of the expectations that refugees tend to hold of it, and of the conflicts with Southeast Asian beliefs and practices which it presents. Despite language differences, health care agents can increase the effectiveness of their communication with persons from Southeast Asia, primarily by allowing for their viewpoints. Topics discussed are: the first encounter with a refugee patient; use of interpreters; obtaining informed consent; "the passive obedient" patient; the "non-compliant" patient; body image; sources of social support for healing; use of medications; traditional self-care practices; and death and depression.     

Predictors of and health services utilization related to depressive symptoms among elderly Koreans

While the prevalence, comorbidity, risk profile and health care utilization for late-life depression have been described for many Western countries, much less is known about the recent epidemiology of late-life depression in East Asian countries such as Korea. We investigated predictors for depressive symptoms and the association between depressive symptoms and the utilization of both medical care and preventive services in elderly Koreans. Data were obtained from a nationally representative sample of Koreans aged 60 and above (2226 men, 2911 women) who participated in the 2008 wave of the Korean Longitudinal Study of Ageing. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies-Depression scale. Risk factors considered included sociodemographics, health behaviors, chronic diseases, and physical function. Health care utilization factors included hospitalization, outpatient clinic use and basic medical checkup. Being female, being unmarried, and having less education, lower household income, physical inactivity and lower weight were associated with depressive symptoms. Presence of chronic diseases and limited physical function also showed a significant association with depressive symptoms. Depressive symptoms were associated with increased odds of hospitalization and outpatient visits, but decreased the odds of utilization of basic medical checkup after controlling for potential confounders. Findings on most risk factors, except lower weight, were consistent with reports from Western countries. It is important to recognize the burden of depressive symptoms in the elderly. The interaction of such symptoms with chronic diseases should be acknowledged and considered in the clinical setting as well as in health care planning and policymaking.     

Older Korean American Men’s Prostate Cancer Screening Behavior: The Prime Role of Culture

East and South Asian male immigrants show markedly low odds of prostate cancer screening as compared to U.S.-born men. However, knowledge about these immigrants’ culture-based screening behavior and barriers to screening is extremely limited. This study investigates factors influencing receipt of prostate cancer screening among Korean American immigrant men, particularly investigating culture’s impact on screening behaviors. Data were collected through a convenience and purposive sampling technique from 134 Korean American males aged 50 and older recruited in New York City. A structured questionnaire was used and cultural variables were measured by adopting items from Tang and colleagues’ work. Approximately 60 % of the sample had received a prostate-specific antigen (PSA) test in their lifetime, and of these, about 66 % reported having done so in the previous 12 months. Logistic regression analysis revealed that a crisis-oriented intervention approach was associated with a substantially reduced likelihood of screening. A positive correlation was noted between the use of Eastern medicine and PSA test receipt. Further analysis revealed a significant interaction effect between use of Eastern medicine and age in predicting PSA test uptake. Culture-specific intervention strategies for increasing prostate cancer screening in this group are discussed, with particular attention to increasing pertinent health literacy. Health professionals should consider the cultural domain when working with Korean immigrant men in order to provide culturally competent care.     

Evaluating integrative medicine acute stroke inpatient care in South Korea

High demand for traditional Korean medicine led to a policy change in 2010 allowing hospitals to provide Integrative medicine care that combines Western medicine and Korean medicine. This study evaluated the effects of Integrative medicine compared to Western medicine-only for managing acute stroke in South Korean hospitals.A retrospective matched case-control observational study was conducted for acute stroke patients admitted nationwide in 2012 and 2013. Propensity score matching was used to adjust for the likelihood of selecting Integrative medicine. Hierarchical generalized linear models were used to control for patient characteristics at the episode of care (level 1) and cluster effects from the hospitals (level 2).A total of 1182 patients and 65 hospitals were matched and analyzed. Receiving Integrative medicine significantly increased the average length of stay (OR 1.27; 95% CI 1.13–1.42), total cost of inpatient care (OR 1.93; 95% CI 1.62–2.31), and per-day cost (OR 1.34; 95% CI 1.21–1.47). Receiving Integrative medicine did not affect all-cause 3-month emergency readmissions (OR 1.36; 95% CI 0.92–2.02). However, Integrative medicine was associated with a reduced risk of all-cause mortality at 3 months (OR 0.36; 90% CI 0.13–0.99) and 12 months (OR 0.34; 95% CI 0.15–0.75) after admission.Receiving Integrative medicine was associated with improved 3-month and 12-month survival, greater healthcare utilization and higher costs. Further economic evaluations are needed to guide policy for efficient integration of Korean medicine and Western medicine.     

社区中医药健康养老服务PPP模式的绩效评价指标体系构建

目的：构建社区中医药健康养老服务PPP模式的绩效评价指标体系,为我国社区中医药健康养老服务PPP模式的高质量发展提供参考。方法：采用文献分析法及深入访谈法确定初始指标,采用专家咨询法筛选指标体系并确定指标权重。结果：两轮专家咨询的问卷回收率分别为91.4%和95.2%,专家权威系数均大于0.8,协调系数分别是0.242和0.245（P<0.01）,达到一致性检验要求,最终构建了包含4个一级指标、12个二级指标和40个三级指标的绩效评价指标体系。结论：社区中医药健康养老服务PPP模式的绩效内涵具有复杂多维性,所构建的绩效评价指标体系具有科学性,指标的权重具有现实指导意义,但还需进一步优化指标并进行指标验证。     

Differences in Mental Health Service Sector Utilization among African American and Caucasian Youth Entering Systems of Care Programs

Differences in unmet need and access to services between African American and Caucasian youth have been established; less is known about differences in specific mental health service sectors. This study examined differences in past year outpatient, school-based, day treatment and residential/inpatient service utilization among African American and Caucasian youth (n = 3,649) entering a federally funded system of care program. Random effect logistic regression models were implemented to examine the relationship between race and past year service utilization. Analyses revealed that African American youth were less likely than Caucasian youth to have utilized school-based and residential/inpatient mental health services in the past year. Findings suggest that racial disparities exist in service use for certain types of service sectors and highlight the importance of understanding and identifying individual, family, and community factors that contribute to disparities in service utilization.     

以需求为导向的我国老年人医养结合影响因素研究

目的:分析我国老年人的健康需求、影响因素及存在的问题,为优化医养结合、促进健康老龄化提供依据。方法:利用2013年中国健康与养老追踪调查(CHARLS)数据,采用描述性统计、有序多分类logistic、二分类Logistic回归以及多重线性回归分析。结果:西部地区、农村地区以及患慢性病的老年人自我健康评价较差(P0.001),城镇老年人生活方式和健康行为优于农村老年人(P0.01),子女和配偶支持水平、老年人生活方式和健康行为呈正相关(P0.01);西部地区、患慢性病以及未参保老年人卫生服务利用低于中东部、未患慢性病以及参保老年人(P0.01);农村地区、与子女一起居住的老年人卫生支出占比较城镇地区和未与子女一起居住的老年人高(P0.01),患慢性病、和配偶生活在一起的老年人卫生支出占比较未患慢性病以及分居、离异、丧偶或未婚的老年人高(P0.01)。结论:我国老年人医养结合需求率较低,疾病经济负担仍然较大,支付意愿不够强烈,应推进社区居家养老,更加注重老年人的尊严问题,探索农村地区医养结合新模式,完善老年人长期护理保险制度。     

Role of Gender,Insurance Status and Culture in Attitudes and Health Behavior in a US Chinese Student Population

Introduction Asians are an understudied population in health research. Often their lower utilization of health care services and low participation in clinical trials has been attributed to socioeconomic factors and cultural beliefs. However, the role of gender and perceptions of health beliefs across generations in determining access have not been studied in this population. Objective This study seeks to examine the relationship of gender to the health beliefs and health utilization patterns of a group of undergraduate Chinese students in regard to their own use and what they perceived as their parents' use. Design Seventy-eight Chinese students responded to a health belief and utilization survey. They were asked to provide information on their perceptions and attitudes of health as well as what they perceived to be their parents' health attitudes and behavior. Results. Findings indicated that female students were more proactive in their health beliefs towards preventive care and getting regular check-ups than male students. This difference between genders remained true in the students' perceptions of their mothers being more likely to seek preventive care and to get regular check-ups than their fathers. Cultural factors including privacy and modesty were important factors in determining use of health care by Chinese women. Insurance status played an important role in determining health behavior among Chinese men. Uninsured fathers were perceived as more likely to use complementary and alternative therapies (CAM) than mothers. Male students and fathers who had private insurance were perceived to access and utilize health services equally as the women. Gender differences are seemingly less apparent among parents who are using CAM. Language difficulty was identified most frequently as the major barrier to accessing care among this population. Conclusions Considerations of socioeconomic factors, cultural and language barriers need to be made with particular focus on gender differences in attitudes and health behavior when making policy decisions for the Asian American population. Further studies are also needed on intergenerational attitudes and health behavior of older Asian Americans.     

Existing Roles of Traditional Healers (<Emphasis Type="Italic">mor baan</Emphasis>) in Southern Thailand

Traditional healers ( mor baan ) played an important role in Thai health long before the introduction of Western medicine. Although modern health professional play a key role of health care provider of Thai health care system, traditional healers and their practice still exist in most rural areas of Thailand. In this article, we address the roles and practices of traditional healers in southern Thailand. An ethnographic method was employed. This approach is the hallmark method used to describe the role and the practice of traditional healers and to grasp in-depth understanding of their everyday life. Participation observation and unstructured interview with 18 traditional healers were conducted. Thematic analysis method was used to analyse the data. Most of the traditional healers chose their role because they were influenced by their ancestors, although a few others chose it because of individual interests and a desire to help ill people. All are trained in multiple skills, using supernatural spirits, ceremonies and natural plant products as resources for counteracting various health problems. They refer patients to modern hospitals or other healers if they cannot adequately manage illness themselves. Their service provision is flexible and based on a holistic approach that suits people’s lifestyles and needs. The role of traditional healer tends not to attract the interest of younger generations, although traditional healers have contributed greatly to people’s health. Their presence improves people’s access to healthcare and offers an alternative to modern medicine, which often has a limited role. We conclude that the services of traditional healers should be incorporated into contemporary healthcare provision of Thai health care system.     

Model Minority at Risk: Expressed Needs of Mental Health by Asian American Young Adults

The objective of this study is to obtain and discuss in-depth information on mental health problems, including the status, barriers, and potential solutions in 1.5 and 2nd generation Asian American young adults. As a part of the Health Needs Assessment project, the researchers conducted two focus groups with 17 young adults (mainly 1.5 or 2nd generation) from eight Asian American communities (Asian Indian, Cambodian, Chinese, Indonesian, Korean, Taiwanese, Thai, and Vietnamese) in Montgomery County, Maryland. We developed a moderator’s guide with open-ended questions and used it to collect qualitative data. Using a software, we organized and identified emergent themes by major categories. Participants reported a several common sources of stress that affect the mental health of Asian American young adults including: pressure to meet parental expectations of high academic achievement and live up to the “model minority” stereotype; difficulty of balancing two different cultures and communicating with parents; family obligations based on the strong family values; and discrimination or isolation due to racial or cultural background. Young Asian Americans tend not to seek professional help for their mental health problems; instead they use personal support networks—close friends, significant others, and religious community. Participants suggested that Asian cultural norms that do not consider mental problems important, and associated stigma of seeking professional care might undermine their mental health help seeking behavior. Our findings support a need for delivering culturally appropriate programs to raise awareness of mental health and cultural training for health providers to deliver culturally appropriate care.