Author's School

Brown School of Social Work

Author's Department/Program

Social Work


English (en)

Date of Award

January 2009

Degree Type


Degree Name

Doctor of Philosophy (PhD)

Chair and Committee

Nancy Morrow-Howell


The United States is becoming more ethnically diverse, with a rapidly growing Asian population. At the same time, the graying of America brings with it special consideration for America's ethnic minorities. The current research on service utilization among Asian American older adults is very limited. The purposes of this study are:: 1) to describe and compare health service needs and health insurance coverage among Chinese, Filipino, and Asian Indian older adults;: 2) to use modified Andersen's behavior model to identify what predisposing factors, enabling factors, need factors, and immigrant-related factors are associated with health service utilization; and: 3) to test whether the relation between these factors and service utilization vary by ethnic group. This dissertation pooled nine years of data: 1998-2006) of National Health Interview Survey: NHIS) to explore the health status, health insurance, and health service utilization among specific Asian American subgroups. The total sample size is 851,581. The subpopulation is 1412 persons aged 65 and older who self-identified as Chinese: 618), Filipino: 581), and Asian Indian: 213). Univariate, bivariate, path analysis, and multiple group analysis were used to answer the research questions. The univariate and bivariate results indicate that sociodemograhic characteristics, health needs, and health insurance status vary among Chinese, Filipino, and Asian Indian older adults. Asian Indian older adults are younger, higher percentage of male, less likely to live alone, bigger family size, higher education level, less likely to be poor, more likely to be non-citizens and foreign born, and significantly less likely to have health insurance coverage in general and Medicare coverage. Path analyses results show that there are different factors associated with two types of health services utilization - doctor visits and hospital stays. Having health insurance, poorer self-reported health and greater activities limitations are associated with higher likelihood of doctor visits and hospital stays. In addition, married older adults are less likely to have hospital stays. Multiple group analysis results reveal that path models of both types of health service utilization do not vary by ethnic groups. In spite of limitations of this study, these findings have important implications for social work practice and research.


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