Access to Health Care

Although this isn't a problem with the health of women, it can lead to health problems because many women can't get the right health services, medicines, and supplies when they need them. Some reasons include:

• They can't pay for it and don't have health insurance.
• They have no way to get to a doctor.
• They have physical limitations that make it hard to get to a doctor.
• They don't understand the language.

On average, Asian American/Pacific Islander women have much lower breast and cervical cancer screening rates, and lower cholesterol and blood pressure screening rates than the national average. And overall, about 21% of Asian American/Pacific Islanders lack health insurance, compared to 16% of all Americans. Even with health insurance, culturally accepted medical models such as acupuncture and herbal medicines often are not covered services, a fact that further limits access to health care. Asian American women are more likely to report using traditional health practices and medicines than Asian men -- 69% versus 39%. By ethnic group, nearly all Cambodian women (96%), nearly a fifth (18%) of Laotian women, and nearly two-thirds of Chinese women (64%) report using traditional health practices.

Nearly one out of two Asian American/Pacific Islanders will have problems using mental health treatment because they do not speak English or cannot find services that meet their language needs. And not all English medical/health terminology can be readily translated into the various Southeast Asian languages, nor can many Southeast Asian expressions describing physical and mental conditions be directly translated for U.S. health care providers. Thus, it may be difficult for Asian patients to accept their diagnoses as real or to accept western treatment regimens for them. Fear of difficulties in communicating, compounded by shame, guilt, anger, depression, and other responses to certain stigmatized conditions such as mental illnesses, also may deter Asian Americans from seeking care promptly.

Access to health care among Samoans living on American Samoa is unique, in part because of the political relationship between the United States and its territory. Although this set of islands, located 240 miles southwest of Hawaii (the nearest site for tertiary care for residents of American Samoa), is medically underserved, American Samoa has operated a locally appropriate form of Medicaid since 1983. All inpatient and most outpatient services are provided at the Lyndon Baines Johnson (LBJ) Tropical Medical Center in the village of Faga'alu on the island of Tutuila. For persons living in the urban areas of Tutuila, this aging facility built in 1968 is convenient; however, for persons in rural areas of Tutuila or on other islands within the U.S. Territory of American Samoa, it is difficult to access care. Financial access to services at LBJ is not a problem for the Samoan population because of the Medicaid program. However, other things, such as an insufficient number and scope of needed health professionals, the unavailability of sophisticated diagnostic tools, and the lack of financing to replace the aging and increasingly outdated medical center, hinder the access to quality care in American Samoa. Samoans living on the United States mainland are more likely to be poor than other Americans and also are less likely to hold higher paying jobs that provide insurance coverage for families. Other barriers in access to health care for American Samoans result from their linguistic isolation, their culture and traditions, and their beliefs about the etiology of disease. Among groups on the U.S. mainland, urban American Samoans are one of the most linguistically isolated. Linguistic isolation makes it difficult for Samoans to seek and receive appropriate health care. Only in Hawaii, where the Samoan community is visible and concentrated in three distinct areas (Laie, Kalihi, and Waianae), have community-centered clinics been developed to provide culturally appropriate health care and education.