Quality health care, as defined by the effectiveness of quality of care and access to care, patient safety, timeliness (in terms of speedy access to care), and patient centeredness, has been elusive for many Asian American and Pacific Islanders (APIs), according to the National Healthcare Disparities Report.
The recent national debate around American healthcare has revealed this to be an expensive system with disparate experiences between Americans based in part on their racial identities.
Traditional barriers to care have been issues of cultural competence and linguistic barriers. Studies have found health disparities due to “access to care, provider biases, poor provider-patient communication, poor health literacy, and other factors,” according to the 2008 report.
APIs are one of the fast-growing minority populations in the US, with approximately 14.9 million in 2006, or 5 percent of the total national population, according to the US Census Bureau.
In the past 5 years, at least 60 percent of the 220 measures of quality of health care have not improved for Asians, Blacks, American Indians/ Alaska Natives, Hispanics, and the poor; these indicators have stayed the same or worsened.
A 2002 “Quality of Health Care for Asian Americans” report by the Commonwealth Fund found that Asian Americans reported poorer “quality of health care than the overall population,” even though this group has higher socioeconomic status (SES) than the mainstream. SES is often correlated with higher health status.
The report continues: “Asian Americans had greater communication difficulties with their physicians, fewer preventive services and less chronic disease care, and less satisfaction with the quality of their health care.”
The rates of those without health insurance vary greatly across the Asian American population. The 2002 report found: “One of five Asian American adults ages 18 to 64 is uninsured or has been uninsured at some point in the past year, with especially high rates for Korean and Vietnamese Americans.”
Sub-group disparities extended to whether Asian Americans have access to a regular doctor. Sixty-eight percent of Asian Americans have such access, but only 46 percent of Korean Americans and only 59 percent of Vietnamese respondents. Only a third of Asian American respondents of the survey felt they had “a great deal” of choice in their selection of healthcare, compared to 50 percent for the US population overall.
Asian Americans were much less likely than the overall population “to rate their care highly, less likely to be confident about their care, and more likely to indicate having a communication problem with their doctor.“ Many expressed belief that their doctor understood their background and values, and many felt that their doctor looked down on them. “Twice as many Asians (11 percent) believe that they would get better care if they were of a different race or ethnicity than the overall population (5 percent),” noted the report.
Preventive care services were more rare for Asian Americans, with only 41 percent of Asian Americans reporting having had a physical exam in the past year and only 70 percent having had their blood pressure checked (vs. 48 percent and 79 percent for the mainstream population). Cancer screenings were also lower for Asian Americans as well. Asian Americans were also less likely to receive physician counseling about smoking cessation, healthy diet and weight, exercise, and mental health.
This 2002 report also found Asian Americans less likely than Americans in general to use herbal medicine (20 vs. 23 percent overall) and chiropractors (10 percent vs. 15 percent overall); however, APIs were more likely than Americans to use acupuncture and the services of traditional healers.
Asians along with other minority groups “receive less adequate and less intensive health care than whites—and that such disparities persist even after taking into account health insurance status, age, sex, income, and education,” according to an article lead-authored by Dr. Quyen Ngo-Metzger, for The Commonwealth Fund. Ngo-Metzger writes: “While nearly four of five (79.6 percent) of white patients said that their doctors involved them in care decisions as much as they wanted, only three of five (59.4 percent) Asian Americans reported this. Nearly 70 percent of whites said that their doctor listened to everything they had to say, but less than half (47.1 percent) of Asian Americans said this.”
Anecdotally, health professionals who work with APIs suggest that language barriers, cultural incompetence, and prejudice have led to misdiagnoses of health and mental health problems.
While there have been efforts to improve outreach and healthcare to the many diverse communities in the US, individuals are expected to take initiative to learn about health issues, to attain sufficient health insurance coverage, to communicate with their physicians, and to reach out to the health establishment for proper advice and health care. Social service agencies working within the local Asian American communities may stand in the gap to assist APIs in their pursuit of health.