title: Longitudinal changes in access to health care by immigrant status among older adults: the importance of health insurance as a mediator.
abstract: OBJECTIVE
  This longitudinal study examined the role of health insurance in access to health care among older immigrants.
  
  
  METHODS
  Using data from the Second Longitudinal Study of Aging, the longitudinal trajectories of having a usual source of care were compared between 3 groups (all 70+ years): (a) late-life immigrants with less than 15 years of residence in the United States ("recent immigrants"; n = 133), (b) "earlier immigrants" (15 years or longer in the United States, n = 672), and (c) U.S. born (n = 8,642). A series of hierarchical generalized linear models were run to test the mediating relationship of health insurance between immigrant status and having a usual source of care.
  
  
  RESULTS
  Although the probabilities of having a usual source of care increased over time across all three groups, recent immigrants were less likely to have Medicare and private insurance over time; this in turn was related to lower probabilities of having a usual source of care (indirect relationship). There was no direct relationship between immigrant status and having a usual source of care.
  
  
  CONCLUSIONS
  To prevent the use of more expensive forms of care in the long run, policy efforts should expand late-life immigrants' health insurance coverage by increasing affordable health insurance options.
authors.affiliation: Department of Social Work, State University of New York at Binghamton, Binghamton, NY 13902-6000, USA. shchoi@binghamton.edu
authors.forename: Sunha
authors.initials: S
authors.lastname: Choi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000191:economics; D054242:Emigrants and Immigrants; D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data*; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D017057:Medically Uninsured; D011320:Primary Health Care; D012959:Socioeconomic Factors; D014481:United States