Trust in physicians, health insurance, and health care utilization among Chinese older immigrants

Abstract

Objective

Trust in physicians (TIP) plays a critical role in the health care utilization (HCU) of minority older adults and older immigrants. Although previous studies suggested that TIP was positively associated with primary care visits, negatively associated with Emergency Room (ER) visits and hospitalization among African Americans in the United States (U.S.), it is unclear whether and how TIP influences various types of HCU among Chinese older immigrants, a fast-growing group of minority older immigrants in the U.S. Furthermore, despite the important role insurance plays in HCU and health disparities, few studies have tested whether TIP influences the HCU of the insured and uninsured Chinese older immigrants differently. Therefore, this study aims to examine the role of TIP in three types of HCU (physician visits, ER visits, and hospitalization) among Chinese older immigrants and whether the associations differ by insurance status.

Design

The data were derived from the Population Study of ChINese Elderly in Chicago (PINE), N = 3,157. The sample is representative of Chinese older immigrants (60+ years) in Chicago. Guided by Andersen's behavioral model, hierarchical regression analyses examined the role of TIP in physician visits, ER visits, and hospitalization among Chinese older immigrants. An interaction term was added to examine whether the aforementioned associations differed by insurance status.

Results

TIP was positively associated with the likelihood of physician visits (Odds Ratio [OR] = 1.07, p < 0.001) but not with ER (OR = 1.02, p = 0.054) or hospitalization (OR = 1.01, p = 0.13). The results of the moderation analyses further showed that TIP was more positively associated with ER visits (OR=0.94, p=0.006) and hospitalization (OR = 0.93, p = 0.004) among the uninsured population, compared to those insured.

Conclusions

TIP played an important role in facilitating primary care visits among Chinese older immigrants regardless of insurance status. Additionally, TIP facilitated the ER visit and hospitalization among uninsured Chinese older immigrants.

KEYWORDS:

• Chinese older immigrants
• trust in physicians
• health care utilization
• health insurance
• moderation analysis

Acknowledgments

We express our gratitude to Mengting Li and Stephanie Bergren who provided valuable insight on the conceptualization of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.