Immigrant health care is the product of the dynamic interaction between societal factors and the individual's socio-economic and cultural characteristics. Our knowledge about immigrant health care, however, has been limited to individual characteristics, without paying attention to the social context in which immigrants reside. This paper explores the effects of social contexts on access to health care among recent immigrants. As a natural experiment, it compares health care experiences of three immigrant groups in Hawaii - Filipinos, Koreans, and Marshallese - who are situated in different social contexts including immigrant health policy, ethnic community, and individual networks. Through household surveys conducted between October 2005 and January 2006, information of 378 recent immigrant adults on health care access, health insurance status, socio-demographic characteristics, linguistic and cultural factors, health status, ethnic community social capital, and social networks was obtained. The results of analyses show that Marshallese respondents have better access to health care than the other two groups, in spite of their lowest socioeconomic status. The high insurance rate of the Marshallese, mainly associated with a state health policy that provides health insurance assistance for the Marshallese, is the major contributor of their greater health care access. While Filipino immigrants do not benefit from state insurance assistance, high levels of health care resources and social capital within the Filipino community enable them to have significantly better health care access than Koreans, who have higher income and educational attainment. Interestingly, the advanced family/kinship networks are associated with better levels of immigrant health care access, while the increase of co-ethnic friend networks is related to lower access to health care. This study implies that restoration of immigrants' eligibility for public health insurance assistance, development of health care resources and social capital within ethnic communities, and mobilization of immigrant networks would be effective starting points to improve health care access among immigrants. © 2009 Elsevier Ltd. All rights reserved.

Hawaii Health care access Health insurance immigrants ethnic community Health care disparity USA Social capital policy

educational status immigrant social capital Filipino Korea public health service health care policy demography health insurance human Insurance Coverage language ability Ethnic Groups ethnic group social aspect controlled study social network health status socioeconomic status Logistic Models social support Insurance, Health Micronesia United States income North America social status ethnic difference family life Humans Interviews as Topic male Emigrants and Immigrants female Socioeconomic Factors cultural factor Hawaii [United States] Marshall Islands Article health care major clinical study adult household survey health care access Health Policy ethnicity Public Assistance Healthcare Disparities Philippines Hawaii Health Services Accessibility Culture health care delivery