Improving Access to Healthcare

About the Issue: 

     When it comes to health insurance, Asian Americans are chronically underinsured when compared to their White American peers. According to research by the National Council of Asian Pacific Islander Physicians, 13.9% of Asian Americans were uninsured in 2015, compared to 12.9% of White Americans. While only 12.9% of Chinese Americans were uninsured, they represented the largest uninsured Asian American group by absolute numbers with 580,548 uninsured individuals (Cha et al. 2015).  The NCAPIP also found that 40.1% of Chinese Americans surveyed expressed having a limited English proficiency (the national average is 8.5%) and that 60.4% of Chinese Americans were born outside of the US (national average is 13.1%) (Cha et al., 2015). Both limited English proficiency and being born outside of the US are associated with having lower access and worse quality healthcare. In fact, according to a study published in the Journal of Immigrant and Minority Health, “being foreign born was negatively associated with having any health insurance. Foreign-born Asian adults were also less likely to report a regular primary care source” (Ye et al., 2012). The issue doesn’t end with uninsurance, however, as foreign-born Asian Americans were also far less likely to have “made a doctor visit in the past 12 months” (Ye et al., 2012). Further research by the Medical Care Research and Review found that 14-18% of Chinese American’s lower utilization of hospital resources could be attributed to language barriers and that “it is likely that English-speaking families are better assimilated and have a better understanding of the US healthcare system” (Chen et al., 2012). Limited access to translated materials and multilingual physicians decreases Chinese American utilization of the healthcare system.

    This issue becomes even more pressing when looking at Portland specifically. According to statistics collected by the Asian Health & Service Center in downtown Portland, of the 7,246 Asian American clients that visited their clinics about 49% did not have any form of insurance. Furthermore, 21% relied on public insurance on Medicaid, Medicare, and the Oregon Health Plan for their healthcare (AHSC, 2012). With an uninsured population well above the national average, Portland’s Chinese American community is receiving incommensurately low access to healthcare. Even with Oregon’s progressive health plan, the resources are clearly not being distributed ambivalent to racial lines. These issues may stem from the fact that the socioeconomic status of some Chinese Americans within Portland’s Chinatown is lower than the national average. Fewer individuals receiving healthcare from employers’ results in greater demand for public insurance or leaves some individuals uninsured. Given the Covid-19 pandemic still in full force at the time of this website’s publication, the importance for more racial equality and inclusivity in the current healthcare system is as important as ever. 

    Poor access to health insurance is not the only factor contributing to worse health for Chinese Americans in Portland. Chinese Americans have shown “the highest lifetime prevalence of depression among Asian American groups” and have “higher suicide rates than do the same age-gender groups in other ethnic communities” according to the National Alliance on Mental Illness (NAMI, 2011). Due to the stigmatization of mental health disorders, lack of community resources, and lack of healthcare access, Chinese Americans with mental health issues often go undiagnosed. Language and cultural barriers between therapists and patients make Asian Americans “three times less likely than their white counterparts to seek treatment for their mental health concerns” (ADAA, 2012). 

Our Recommendation:

     Solving the Chinese American health insurance crisis in Portland requires a multi-faceted plan. It is imperative that this issue is viewed not only from a government policy level, but also from the perspective of community organizations and community members. At a policy level, the objective must center around the lack of lingual and cultural support for foreign-born Chinese American immigrants and for Chinese Americans who are not fluent in English. As has already been discussed, low proficiency in English has a strong negative correlation with health insurance coverage. Federal, state, and local governments must bolster their efforts to provide public healthcare coverage to the uninsured that not only target at-risk communities, but also recognize the importance of culturally and linguistically adaptive marketplaces for healthcare. For instance, the Oregon Health Plan (OHP) provides effective public health insurance for low-income families in Oregon. However, recent concerns about the current federal administration’s stance on immigration have severely limited immigrant access to the OHP, among other public health services (Withycombe and Alexander, 2019). After warnings that using public services like OHP may inhibit one’s ability to gain citizenship, immigrants who qualified for OHP now fear signing up for OHP would prevent them from becoming citizens of the US. Communities like Chinatown in Portland are at high risk of going uninsured because of the relatively high foreign-born population. Furthermore, current research suggests that many low-income jobs currently do not provide health benefits but pay too much to allow their employees to apply for public health insurance plans (Sohn, 2017). By increasing accessibility and eligibility for public health insurance, at-risk and hard-to-reach communities like Chinatown are better protected. 

    Beyond expanding healthcare policy, further resources and attention must be allocated to educating Chinese Americans, particularly those in Portland’s Chinatown, about healthcare and health insurance. Currently, there are very few resources for Chinese Americans to use when attempting to learn more about the US healthcare system. Organizations like the Asian Health and Service Center and the Asian Pacific American Network of Oregon provide aid to Chinese Americans looking to apply to the Oregon Health Plan. However, these organization have limited resources that must be allocated to serve the Asian American community in Portland as a whole. Increasing community outreach efforts via social media campaigns, working with organizations like AHSC, and communicating with community leaders must be a top priority to provide access to better healthcare for Chinese Americans in Portland. Hosting workshop in Chinese and Cantonese on applying for OHP, Medicaid, and Medicare would give community members the freedom to take their health concerns into their own hands. 

    Finally, it is important to look cater to the individual, particularly with the issue of mental health. Mental health remains incredibly stigmatized for some Chinese Americans. According to one Filipina-American, Ryan Tanap, “there is an underlying fear in the Asian American community that getting mental health treatment means you’re crazy” (Tanap, 2019). This stigmatization results in Asian Americans being treated disproportionately less than other ethnic groups. This issue is made worse by the fact that the number of culturally adapted mental health services is significantly lower for Asian Americans than for most other Americans (Constante, 2018). To provide better healthcare to the Chinese American community of Portland, mental health services must be included in the solution. A study published in the Urban Education Journal found that “community-based youth centers are able to offer the following kinds of social and emotional support: sense of trust and caring, sense of ethnic self and identify, sense of home and safe space, and sense of being a teenager” for Chinese American teens (Wong, 2010). Incorporating cultural values into group-based therapy where the therapists and other group members are ethnically similar is far more effective for Chinese Americans. When suffering from mental health issues, visiting a therapist who is culturally and linguistically similar can provide better and more effective treatment. Therefore, it is crucial not only that the number of mental health services for community members in Chinatown increases, but also that those services are culturally adapted to better serve the community.

References:

Chen, J., Vargas-Bustamante, A., & Ortega, A. N. (2012). Health Care Expenditures Among Asian American Subgroups. Medical Care Research and Review, 70(3), 310–329. https://doi.org/10.1177/1077558712465773

Cha, L., Chi, L., Kantaria, T., Le, T., Mindanao, M., & Yousuf, J. (2015). (rep.). The Impact of the Affordable Care Act onAsian Indian, Chinese, Filipino, Korean, Pakistani, & Vietnamese Americans (pp. 29–34). Berkeley, CA: National Council of Asian Pacific Islander Physicians.

Ye, J., Mack, D., Fry-Johnson, Y., & Parker, K. (2011). Health Care Access and Utilization Among US-Born and Foreign-Born Asian Americans. Journal of Immigrant and Minority Health, 14(5), 731–737. https://doi.org/10.1007/s10903-011-9543-9

NAMI Multicultural Center. (2011). (rep.). Chinese American Mental Health Facts (pp. 1–3). Arlington, VA: NAMI Multicultural Action Center .

Asian-Americans. Anxiety and Depression Association of America, ADAA. https://adaa.org/asian-americans.

Tanap, R. (2019, July 25). Why Asian-Americans and Pacific Islanders Don’t go to Therapy. NAMI. https://www.nami.org/Blogs/NAMI-Blog/July-2019/Why-Asian-Americans-and-Pacific-Islanders-Don-t-go-to-Therapy.

Withycombe, C., & Alexander, R. (2019, August 19). Oregon immigrants fear signing up for OHP. Mail Tribune. https://mailtribune.com/news/state-news/oregon-immigrants-fear-signing-up-for-ohp.

Sohn, H. (2016). Racial and Ethnic Disparities in Health Insurance Coverage: Dynamics of Gaining and Losing Coverage Over the Life-Course. Population Research and Policy Review, 36(2), 181–201. https://doi.org/10.1007/s11113-016-9416-y

Wong, N.-W. A. (2010). “Cuz They Care About the People Who Goes There”: The Multiple Roles of a Community-Based Youth Center in Providing “Youth (Comm)Unity” for Low-Income Chinese American Youth. Urban Education, 45(5), 708–739. https://doi.org/10.1177/0042085909355766