Health Insurance and Health Service Utilization among Korean Americans.docx

HEALTH INSURANCE AND HEALTH SERVICES 11Running Head: HEALTH INSURANCE AND HEALTH SERVICES

The Impact of the Affordable Care Act on Health Insurance and Health Services Utilization among the Korean American PopulationCharles ChoiResearch Methodology HFIT 555-001American University

IntroductionMr. Kim is a 54 year old Korean American male who describes himself as a healthy person. He moved to the United States in 2005 to study mechanical engineering and find a better life for his wife and two daughters. To support his family, he currently works as an auto mechanic at the local gas station auto repair shop. He was recently diagnosed with a carcinoid tumor in the rectum after finding blood in his stool. The cost of the entire procedure, which involves scans, testing, anesthesia, surgery, and recovery, is estimated at over $30,000. Due to his lack of health insurance, Mr. Kim cannot afford the procedure and has decided to delay service in hopes that the metastasized tumor spreads slowly as doctors anticipate. Mr. Kim is very lucky that he was able to find out about the carcinoid tumor at a very early stage and has the option to delay surgery, even though doctors say he must have it removed as soon as possible. This is just one example of how health insurance can affect health service utilization. Many Korean Americans face the same problem concerning health services. Without proper health insurance, Korean Americans are unable to afford the high costs of health services. Before the year 2000, data on race was only categorized as one large group labeled as Asian or Pacific Islander. In the 1980s the majority of immigrants coming into the United States were from Asia (Aday, 1993). Of the total US population, Asian Americans constituted 1.44% in 1980. The 1990 US Census reported that there were 7.3 million Americans from Asia and the Pacific Islands which doubled since 1980, to 2.92%. The 1990 Census estimated that by the year 2050 Asian and Pacific Islanders will comprise 10.7% of the total US population (US Bureau of the Census, 1992). In the 2000 Census, 11.9 million people reported as being Asian, which represented 4.2% of the entire US population, almost doubling that of 1990. Between 1990 and 2000 the Asian population increased faster than the total US population, 48-72% versus 13% (Barnes and Bennett, 2002). Between 2000 and 2010 the Asian population, again, grew faster than any other group in the US. The US population grew by 9.7 % versus the Asian population that grew by 43%. Additionally, the Asian population grew in every state between 2000 and 2010 (Hoeffle, Rastogi, Kim, & Shahid, 2012). Using this form of categorization, different studies were conducted on the overall Asian population that concluded with results such as one conducted by the National Center for Health Statistics, which stated, Asian Americans and Pacific Islanders are the only major US racial/ethnic group for which the annual number of deaths from cancer exceed that for heart disease (McCracken, Olsen, Chen, Jemal, Thun, Cokkinides, Deapen, & Ward, 2007). However, the standard use of five ethnic categories (White non-Hispanic, Black or African-American, Hispanic, Native American, and Asian/Pacific Islander or other) over-generalizes differences and masks unique health status, service needs, and utilization patterns within these broad categories (Uehara, Takeuchi, & Smukle, 1994). According to Aday (1994), health care professionals who provide services to address the unique health care needs and utilization patterns of Asian Americans need to know any and all important health and health related differences among the various Asian American groups. A lack of attention to ethnic diversity among Asian Americans can lead to oversimplification and assumptions about individual health risks (Ryu, Young, & Kwak, 2002). The Center for Disease Control and Prevention (1992) further emphasized that one broad category of Asian and Pacific Islanders creates missed opportunities to observe the unique health needs of specific Asian ethnic groups. Health service providers know that the services they provide are most effective when they are tailored or customized toward the specific health needs of the target community being served (Ryu et al., 2002). Therefore, after the Asian and Pacific Islander category was broken down by different ethnicities in the 2000 Census, studies were be done on specific ethnicities to further educate health service providers and the general public.Over the decade from 1980 to 1990, the Korean American population grew dramatically, from 354,000 to 799,000 and were the fifth largest Asian American subgroup (US Bureau of the Census, 1995). The number of Korean American increased by 125%, largely because of continuing immigration. Korean Americans comprised 11% of the number of total Asian Americans in 1993 (Lin-Fu, 1993). Between 1990 and 2000, the Korean American population grew to 11,898,828 (Barnes et al., 2002). Between 2000 and 2010 there was a 38.9% change in the Korean American population going from 11.9 million in 2000 to 17.3 million in 2010, the fourth fastest population growth. The Korean American population was not distributed equally among the different US regions. The majority of the population was located in the west with 43.7%. Next, the south was at 24%, then, the northeast at 20.5%, and the midwest at 11.8% (Hoeffle et al., 2012). Despite their continuous demographic growth, little is known about the Korean American population, which showed a population increase of more than 1,500% since 1970 (Jang, Kim, & Chiriboga, 2005). Korean Americans have been identified as one of the most understudied populations relative to their size (Jang, Kim, & Chiriboga, 2005). Studies have shown that the Korean American population is one of the most homogeneous Asian immigrant populations in terms of race, language, and other cultural factors (Kim, Ha, Kim, & Duong, 2002). Korean Americans have also had the one of the lowest rates of health insurance coverage among all racial and ethnic groups in the last decade (Yoo & Kim, 2008). Korean Americans have the highest uninsured rates among all Asian and Pacific Islanders (Shin, Song, Kim, & Probst, 2005). Because of a lack in health insurance, the Korean American population is known for underutilizing health services more than other ethnic minorities, despite having a higher prevalence of health risk factors (Shin et al., 2005). There are many factors that contribute to lack of health service utilization, which include income, education, citizenship, acculturation, and employment-based health insurance. However, for Korean Americans, past research has shown that the lack of health insurance was the strongest predictor of health service utilization (Shin et al., 2005; Ryu, Young, & Park, 2001). Acculturation and income were also important factors that contributed to health insurance coverage and health service utilization (Shin et al., 2005; Kim & Yoo, 2006). To combat health disparities such as lack of health insurance and health service utilization, the US government has enacted the Healthy People 2010 Initiative and the Affordable Care Act. The Healthy People 2010 Initiative was developed to eliminate health disparities in six areas specifically chosen because of their impact on minorities: infant mortality, immunizations, diabetes, cardiovascular disease, HIV/AIDS, and cancer (Ghosh, 2003; Shin et al., 2005). Among the numerous items within the Affordable Care Act, one of the most important aspects is the implementation of mandatory health insurance coverage for all Americans beginning in January 2014. The Affordable Care Act will help make health insurance coverage more affordable and accessible (US Department of Health & Human Services, 2013). In effect, the Korean American population should have increased access to quality, affordable health coverage, more incentive to invest in prevention and wellness, and more overall control concerning health care. The purpose of this study is to understand the impact of health insurance on health service utilization among Korean Americans after the implementation of the Affordable Care Act. Through the use of a survey, the researcher will examine current health insurance and health service utilization among the Korean American communities in Los Angeles, CA, New York, NY, and the Washington, DC metro area. Research questions that this study will help answer are how health insurance is related to health service utilization among Korean Americans and in what ways health insurance and health service utilization for the Korean American population has changed from the past to the present. Using Ronald M. Andersens Behavioral Model of Health Services Use as the grounding principle, the overall goal of this study is to aid in the creation and implementation of better health care services tailored specifically for the Korean American population.Review of Relevant LiteratureAccording to a study done by Ryu et al. (2001), Health insurance coverage has a larger impact on the health services utilization of the Korean American population than the impact on Asian Americans as a whole. Even the sickest Korean Americans who lack health insurance have less access to health services. The Korean American population consistently was less likely to be insured across all variables. In the 1994 Current Population Survey, it was noted that half of Korean Americans ages 0-64 did not have health insurance. In the 2001 California Health Interview Survey, 21.7% of Korean American children and 33.6% of Korean American adults ages 18-64 did not have health insurance (Brown, Ponce, Rice, & Lavarreda, 2002). In the 2000 Korean American Health Survey of Koreans living in Los Angeles County, 46% of the respondents did not have health insurance coverage (Shin et al., 2005). Factors that influence health insurance coverage among the Korean American population include income, education, self-employment, and acculturation. These factors create situations, like that of Mr. Kim, which force Korean Americans to choose whether to have health insurance or not to have insurance.Factors Affecting Health Insurance Coverage and Health Services UtilizationThe affordability of health insurance and health services is a major factor for the Korean American population. According to Yoo & Kim, (2008) uninsured participants of the Korean American population in California most frequently stated that affordability was the top reason why they lacked health insurance for themselves and their spouses. Participants stated that insurance payments were a financial burden and too expensive. Participants chose not to pay for expensive health insurance premium every month but opted to pay fee-for-services as needed instead. The fee-for-service system, however, can have a catastrophic impact on the finances of uninsured Korean Americans. During an interview from the study done by Yoo et al, a participant stated the following about how the fee-for-service system caused financial burden on the family:

If it wasnt so expensive I would denitely have health care. I try to live as healthy as possible by taking supplements and having a good diet so that I dont have to visit the doctor as much. There was an incident 7 years ago when my youngest son got sick when he was a month old and was hospitalized for 4 days. Those 4 days cost $43,000...The bill was put onto our credit card.

Another participant also experienced overwhelming financial burden due to the fee-for-service system:

...last year, my youngest broke her arm. There was also a hairline fracture. That took about $6000, $7000 for same-day surgery, cast, etc. So when you have one incident like that, its really difculty. I think [the physician] saw her for about 20 minutes and put a cloth sling on it a bandage? And then we were charged $670 ... I was so upset. This was on top of a $200 deposit that they made us pay, just to see someone, even if they didnt have anyone who could take care of it.

Like the first participant interview many uninsured Korean Americans try to take care of their health through exercise, diet, and taking traditional Korean herbal medicine. However, traditional Korean medicine creates educational knowledge differences between Eastern and Western medicine that can interfere with proper care of health.The use of traditional Korean medicine in health practice is quite common among immigrants (Kraut, 1990). Hanbang is the traditional Korean medicine and is an inseparable component of Korean culture within and outside Korea. According to Pang, in traditional Korean medicine, health is seen as harmony between the environmental, social, and physical, known as um and yang. Acquiring a disease is a result from a deficiency or excess of vital energy that causes an imbalance of um and yang. Treatment is designed to heal the whole person by balancing the two forces (1989). When Korean Americans immigrate to the US, they bring with them the hanbang education that they learned in Korea and pass this on to future generations. Traditional medicine and Western medicine are used alternately or concurrently by Korean Americans (Pourat, Lubben, Wallace, & Moon, 1999). The combined use of hanbang and Western medicine may be related to health insurance status and health care utilization among Korean Americans (Kim et al., 2002). Korean Americans generally utilize traditional Korean medicine for preventive care and treatments for ongoing symptoms such as allergies and backaches. Consistent use of traditional medicine among Korean Americans may be because traditional Korean medicine physicians care for the whole person, taking into consideration the persons social, mental, emotional, and spiritual well-being (Ma, 1999). The costs to see a Korean traditional medicine practitioner were, also, more affordable than seeing a medical provider (Yoo & Kim, 2008). This can all contribute to the lack of health insurance. Despite average to above-average economic and educational levels, Korean American communities are vulnerable to isolation from complex health care system networks and specialists because of the low rate of health insurance coverage (Ryu et al., 2001).Another factor that contributes to the lack of health insurance among Korean Americans is self-employment. According to Ryu et al. (2001), self-employment is the strongest predictor for being uninsured. Most Korean Americans work in small or self-owned businesses, so they must either pay directly for health services or purchase an individual or family policy at an individually risk-rated premium. The Korean American population is faced with excessively high costs of employer sponsored health insurance for small and self-owned businesses. (Ryu et al., 2001). Because of the high rates of self-employment and working in small businesses that do not provide employment-based health insurance, Korean Americans do not purchase personal health insurance for themselves and their spouses. Also, most Korean Americans do not qualify for Medicaid because of their income level (Yoo & Kim, 2008). This results in the Korean American population having one of the highest rates of uninsured in the US.Acculturation is another factor that can contribute to not having health insurance. According to Sohn & Harada (2004), acculturation is one cultural factor that has generated much interest in health studies of minority populations. Acculturation is defined as when an individuals attitudes, beliefs, and behaviors become more congruent with those of the dominant society. In this case, it would be the attitudes, beliefs, and behaviors of the Korean American population becoming more like those of the US. Previous studies have found that acculturation significantly influences health care and health status of certain racial/ethnic groups (Huff & Kline, 1999). One measure of acculturation that has been used in studies for other ethnicities such as the Hispanic community (Marin & Marin, 1991) is length of residence in the US. For the Korean American population, increased length of residence in the US was found to be correlated with employment, income, and health insurance (Shin et al., 2005). Shin et al., however, noted in their study that many other studies document no relationship between acculturation and health care services utilization. One measure of acculturation that showed no relationship was English language fluency. Due to limited English language fluency, many of the Korean American population was found to have an inhibiting effect on health service utilization. Furthermore, in a study done of Vietnamese immigrants, increased English language fluency and length of residence in the US were not related to health service utilization (Jenkins, le, McPhee, Stewart, & Ha, 1996). The 1998 Korean Elderly Survey found that acculturation measures such as English language fluency and length of residence in the US were not related to the utilization of health services like physician visits and hospitalization (US Department of Health & Human Services, 2000). Although acculturation may not be related to health service utilization, there is proven evidence that it correlates with health insurance coverage.The Andersen Behavioral Model of Health Services UseUsing the Andersen Behavioral Model of Health Services Use a connection can be made within the factors of income, education, self-employment, acculturation and health insurance. Andersens Behavioral Model of Health Services Use is one of the most widely acknowledged models for health service utilization (Babitsch, Gohl, & Lengerke, 2012). It is useful for separating the unique health care utilization risks of one ethnic group from the risks known for an aggregate category of that ethnic group and several others (Ryu et al., 2001). It was developed in 1968 by the US medical sociologist and health services researcher Ronald M. Andersen. The multilevel model incorporates individual and contextual determinants of health services use. The model has three major components: predisposing factors, enabling factors, and need factors. According to Andersen, an individual is more or less likely to use health services based on demographics (predisposing factors), position within the social structure (enabling factors), and beliefs of health services benefits (need factors). An individual who believes health services are useful for treatment will likely utilize those services (Babitsch et al., 2012). Predisposing factors for the model include, age, sex, education, occupation, ethnicity, social relationships, mental factors of health beliefs, demographic and social composition of communities, collective and organizational values, cultural norms, and political perspectives (Babitsch et al., 2012). Enabling factors are the resources available to those predisposed to use health services (Ryu et al., 2001). This includes income, wealth, effective price of health care, health insurance status, source of care, means of transportation, travel time, waiting time for health care, resources available within the community for health services, per capita community income, affluence, rate of health insurance coverage, relative prices of goods and services, methods of compensating providers, health care expenditures, amount, varieties, locations, structures, and distribution of health services facilities and personnel, physician and hospital density, office hours, provider mix, quality management oversight, outreach and education programs, health policies, and overall resources found within the family and the community. Family resources comprise economic status and the location of residence. Community resources incorporate access to health care facilities and the availability of persons for assistance (Babitsch et al., 2012). Need factors are the immediate reasons for seeking health services (Ryu et al., 2001). This includes, perceived needs (how people view and experience their own general health, functional state and illness symptoms), evaluated needs (professional assessments and objective measurements of patients health status and need for medical care), environmental need characteristics (occupational and traffic and crime-related injury and death rates) and population health indices (overall measures of community health, epidemiological indicators of mortality morbidity, and disability) (Babitsch et al., 2012). In the study done by Ryu et al., (2002) for the Korean American population, family size, family income, self-employment, length of residence in the US, and respondent-assessed health status were significant toward explaining health insurance coverage. Factors that were statistically significant related to health service utilization were age, sex, education, marital status, employment type, years lived in US health insurance, respondent-assessed health status, number of conditions and bed days. The study concluded that health insurance plays an important role in health service utilization. The same conclusion was found in the study done by Ryu et al., one year earlier, the results show that the expected positive influences on health services utilization of predisposing, enabling, and needs factors are, at least for Korean Americans, diminished by lack of one enabling factor, health insurance (2001). MethodologyTo try and make the findings generalizable to the overall Korean American population the study will be conducted in Los Angeles, CA, New York City, NY, and the Washington, DC metro area (DC, MD, VA) with collaboration from local organizations. These three areas were chosen for having the highest density of Korean Americans in the US. Participants in each city will be recruited through local Korean churches, Korean community resource centers, Korean American civic associations, and through referrals from other participants. Announcements about the study will be done via the internet and flyers distributed at local Korean businesses and community centers. The study will be conducted through a survey consisting of a structured questionnaire and interview. Parts of the survey will be adapted from the 2000 Korean American Health Survey (KAHS) that were used to assess the health status and medical needs of Korean Americans living in Los Angeles County. Questions on the survey will include demographics such as age, gender, education level, and length of residence in the US. Income will be categorized into sixteen categories with $5,000 intervals and will be adjusted according to family structure. Education will be categorized by highest level of education received in Korea and separately in the US. Other questions taken from the 2000 KAHS will include, type of health insurance (public, private, uninsured), access to health insurance and care for all family members, utilization of health care services, and barriers and challenges to health insurance and health care access. A final set of question will pertain to the participants knowledge of the Affordable Care Act and how it could or has impacted their health insurance and health service utilization decisions. To check for wording and overall readability and comprehensiveness, a pretest will be conducted with 25 separate participants with different socioeconomic backgrounds such as age, sex, educational level, length of residency in the US, and annual family income. The questionnaire will be written in both Korean and English to accommodate for those who are less comfortable with English. Each version will be translated by trained professionals into the other language (English to Korean, Korean to English) to check for consistency between the two versions. Interviewers will also be trained for language consistency because additional interview questions will also be conducted in English or Korean depending on which language the participant was more comfortable speaking. All surveys will then be translated back to English for processing. The collected data will be cleaned, coded, and entered into SPSS for evaluation. Descriptive frequencies will be conducted for demographics, health insurance, and health service utilization. Tests will be run to compare the variables of health insurance, health service utilization, and knowledge of the Affordable Care Act for the sample of Korean Americans and find statistical significance among the variables. All data collection will be conducted at convenient locations for the participants (community centers, churches, etc.) All participants will be required to sign a consent form prior to the survey. After the conclusion of the survey, each participant will receive a voucher for free admission to their local Korean spa and bath house. This will serve two purposes. The first purpose is as a reward for participating in the study. The second purpose is for referrals. Participants will be asked to share their experience of the survey with others in hopes of acquiring future participants. ConclusionIn the US, nearly 25% of the uninsured have no usual source of care, essential for preventive services and timely treatment (Schoen, Lyons, Rowland, Davis, & Puleo, 1997). The Affordable Care Act was enacted to specifically tackle this problem for the US and the many different ethnicities that reside in the US. The overall goal of this study is to aid in the creation and implementation of better health care services tailored specifically for the Korean American population. To do this, health professionals need a more adequate understanding of the beliefs and health service utilization habits among the Korean American population, so that cultural sensitivity can be integrated into all aspects of health care service. A need for accurate identification of key factors that contribute to a lack of health insurance among the Korean American population is an important step to any policy initiative to increase insurance coverage and, in turn, access to health services (Ryu et al., 2001). This study hopes to find more significant data to give health insurance companies and health service providers a road map on how to provide affordable, quality services to the Korean American population.

Work CitedAday LA. (1993). At Risk America: Health and Health Care Needs of Vulnerable Populations in the United States. Jossey-Bass: San Francisco.

Aday LA. (1994). Health Status of Vulnerable populations. Annu Rev Public Health 15: 487-509

Babitsch, B., Daniela Gohl, Thomas von Lengerke. (2012) Re-revisiting Andersens Behavioral Model of Health Services Use: a systematic review of studies from 1998-2011 GMS Psycho-Social-Medicine 2012, Vol. 9

Barnes, Jessica S. and Claudette E. Bennett (2002). The Asian Population: 2000. US Census 2000 Brief. Issued February 2002.

Brown, E. R., Ponce N., Rice T., & Lavarreda S. A. (2002). The state of health insurance in California: Findings from the 2001 California health interview survey. Retrieved on April 23, 2014, from http://healthpolicy.ucla.edu/pubs/les/shic062002.pdf

Centers for Disease Control and Prevention (CDC). (1994). Chronic Disease in Minority Populations. Centers for Disease Control and Prevention: Atlanta.

Ghosh, C. (2003) Healthy People 2010 and Asian Americans/Pacific Islanders: Defining a Baseline of Information. Am J Public Health. 2003 December; 93(12): 20932098.

Hoeffle, Elizabeth M., Sonya Rastogi, Myoung Ouk Kim, and Hasan Shahid. (2012). The Asian Population: 2010 2010 Census Briefs. Issued March 2012.

Huff RM, Kline MV. (1999) Promoting Health in Multicultural Populations. Thousand Oaks, CA: Sage Publications Inc., 1999.

Jang, Yuri , Giyeon Kim, and David A. Chiriboga. (2005). Health, Healthcare Utilization, and Satisfaction with Service: Barriers and Facilitators for Older Korean Americans. Journal of the American Geriatrics Society (JAGS) 2005. 53:16131617.

Jenkins CN, Le T, McPhee SJ, Stewart S, Ha NT. (1996) Health care access and preventive care among Vietnamese immigrants: Do traditional beliefs and practices pose barriers? Soc Sci Med 1996; 43(7):10491056

Juon HS, Choi Y, Kim MT. (2000). Cancer screening behaviors among Korean-American women. Cancer Detect Prev 2000; 24:113.

Kim, B., & Yoo, G. (2006). Saving for health and the future: Korean immigrant entrepreneurs. Paper presentation at the National Association of Ethnic Studies, April, San Francisco, CA.

Kim, Miyong, Hae-Ra Han, Kim B. Kim, Diep N. Duong. (2002) THE USE OF TRADITIONAL AND WESTERN MEDICINE AMONG KOREAN AMERICAN ELDERLY Journal of Community Health. Vol. 27, No. 2, April 2002.

Kraut AM. (1990). Healers and strangers: Immigrant attitude toward the physician in AmericaA relationship in historical perspective. JAMA 1990; 263:18071811.

Leong F. (1994). Guest editors introduction. Asian Am Pacific Islander J Health 1994; 2:8991.

Lin-Fu JW. (1993). Asian and Pacific Islanders: An overview of demographic characteristics and health care issues. Asian Am Pacific Islander J Health 1993; 1:2136.

Ma GX. (1999) Between two worlds: The use of traditional and Western health services by Chinese immigrants. J Community Health 1999; 24:421437.

Marin G, Marin BV. (1991) Research with Hispanic Populations. Newbury Park, CA: Sage Publications Inc., 1991. McCracken, Melissa, Miho Olsen, Moon S. Chen, Jr., Ahmedin Jemal, Michael Thun, Vilma Cokkinides, Dennis Deapen, Elizabeth Ward. (2007) Cancer Incidence, Mortality, and Associated Risk Factors Among Asian Americans of Chinese, Filipino, Vietnamese, Korean, and Japanese Ethnicities. CA Cancer J Clin 2007;57:190205. Pang KY. (1989). The practice of traditional Korean medicine in Washington, D. C. Soc Sci Med 1989; 28:875884. Ryu, Hosihn, Wendy B. Young, Changgi Park. (2001) Korean American Health Insurance and Health Services Utilization. Research in Nursing & Health, 2001, 24, 490-505

Ryu, Hoshin, Wendy B. Young, and Hoil Kwak. (2002). Differences in health insurance and health service utilization among Asian Americans: method for using the NHIS to identify unique patterns between ethnic groups. Int J Health Plann Mgmt 2002; 17: 55-68.

Schoen, C., Lyons, B., Rowland, D., Davis, K., & Puleo, E. (1997). Insurance matters for low-income adults: Results from a five-state survey. Health Affairs, 16, 163-171. Shin, H., Song, H., Kim, J., & Probst, J. (2005, April). Insurance, Acculturation, and Health Service Utilization Among Korean-Americans. Journal of Immigrant Health, 7(2), 65-74.

Sohn, Linda and Nancy D. Harada. (2004). Time Since Immigration and Health Services Utilization of Korean-American Older Adults Living in Los Angeles County. Journal of the American Geriatrics Society NOV. 2004. VOL. 52, NO. 11 Uehara ES, Takeuchi DT, Smukle M. (1994). Effect of combining disparate groups in the analyses of ethnic differences. Variation among Asian American mental health services consumers in level to community functioning. Am J Commun Pyschol 22: 83-99.

U.S. Bureau of Census. (1992). Population Projection of the United States. By Age, Sex, Race, and Hispanic Origins. 1992 to 2050. Current Population Reports: Series P.25 No. 1092. U.S. Government Printing Office: Washington, DC.

U.S. Department of Health and Human Services (2000) Healthy People 2010, 2nd edn. With Understanding and Improving Health and Objectives for Improving Health (2nd edn.). Washington, DC: Government Printing Ofce; 2000

U.S. Department of Health & Human Services. (2013). The Affordable Care Act and Asian Americans and Pacific Islanders. Retrieved on April 23, 2014, from http://www.hhs.gov/healthcare/facts/factsheets/2012/05/asian-americans05012012a.html Yoo, G.R., Kim, B.W. (2008) Korean Immigrants And Health Care Access: Implications For The Uninsured And Underinsured. Research in the Sociology of Health Care, Volume 25, 7794. 2008