Doctoral Dissertations

Date of Award

5-2019

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Nursing

Major Professor

Joel G. Anderson

Committee Members

Cristina Barroso, Sandy Mixer, Carole Myers

Abstract

Findings from prior studies revealed that foreign-born persons remain a fast-growing segment of the U.S. population. However, little is known about differences in health care access among this population relative to the Affordable Care Act (ACA). Guided by Andersen’s model, comparisons regarding access to healthcare by birth origin were assessed before, during, and after implementation of the ACA. Data for this non-experimental correlational study were obtained from three years of the National Health Interview Survey. Chi-square tests and logistic regression models were used to assess differences in access indicators and the influence of various independent and covariate variables of interest, accounting for needs and insurance coverage. Findings from this study revealed citizens, women, married/partnered, older adults, and respondents with chronic illness and in poor health status more frequently reported emergency room (ER) visits, regardless of nativity. Among foreign-born adults, males, those who were married/partnered, and the uninsured were less likely to report ER visits, while uninsured non-white foreign-born adults (FBAs) post-ACA had a four-fold increased likelihood of visiting the ER. Middle-aged, uninsured, low-income, newly arrived, and noncitizens were less likely to visit a physician or have a usual source of care. Uninsured married/partnered FBAs were less likely to report unmet needs and delayed care. The odds of having unmet needs were four-fold higher among the uninsured and two-fold higher among low-income FBAs. Compared with uninsured from the Americas, uninsured FBAs from Asia, Africa, and Europe were three times as likely to report unmet needs and delayed care. Although commonalities in health care access factors were found in both native-born and FBAs; this study’s findings suggest even after controlling for confounding factors, health care access and utilization among FBAs continues to be driven by enabling resources. These findings confirm that the use of health care services by FBAs is unequal and lays the groundwork for the evolution of monitoring systems and frameworks for stakeholders interested in reducing health disparities further. Future studies should examine how the factors identified in this analysis differ years after implementation of the ACA and how these influence overall health care outcomes for this underserved population.

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