We investigated the association of divorce status of married immigrants' access to their access healthcare services by sex. Further, we compared the use of healthcare services of married immigrants according to divorce status (Yes versus No). The married female immigrants differed in the use of healthcare services depending on their divorce status, but married male immigrants did not. Divorced immigrants were more likely to not use healthcare services than non-divorced immigrants. Our findings would inform clinicians or healthcare policy-makers about critical implications for divorced versus non-divorced immigrants' use of healthcare services.
The number of married immigrants residing in Korea is increasing, and divorce rate among them is also increasing accordingly [5]. Divorce is one of the social determinants of health and has a profound impact on the lives of married immigrants [16]. In previous studies, divorce has affected the lives of married female immigrants. Life satisfaction was low, and due to low income, they experience difficulty in social adaptation [17]. However, there are insufficient studies on the effect of divorce on the use of healthcare services. The purpose of this study was to overcome the limitations of previous studies. Our results suggest that there is a link between the divorce of married immigrants and the use of healthcare services. Social determinants of health are factors to be considered to improve the quality of public health [18]. Public health should prevent diseases and promote health, and to this end, must consider the background and environment of individuals [19]. However, our research results suggest the insufficiency of public health policies for married immigrants. Further, our results also point to the need for in-depth study on the effects of social determinants of married immigrants’ health on public health and the necessity of establishing a holistic and comprehensive health policy.
The association between divorce and healthcare service access differed according to sex. For married male immigrants, there was an association between divorce and access to healthcare services. However, there was an association between divorce and the access to healthcare services for married female immigrants. Previous studies have reported that the access to healthcare services is influenced by socioeconomic status [20]. Finance is a factor that varies greatly depending on the sex of marriage immigrants. According to the literature, the employment rate of married male immigrants was significantly higher than that of married female immigrants [8]. It is expected that these economic factors have influenced the access to healthcare services. Our results support existing research findings that finance capability affects the access to healthcare services. In addition, Korea is currently conducting several projects to increase the employment rate of married female immigrants [21], thereby increasing the employment rate of married female immigrants. Increased employment rates may be associated with increased access to health services. In a future study, it is necessary to analyze the current status of the married immigrant policy promulgated in South Korea through a study comparing the increase in the employment rate of married immigrants and the access to healthcare services.
In preparation for the expansion of a multicultural society, welfare policies such as multicultural family support project are increasing for married immigrants residing in South Korea [22]. Consequently, the experience of social discrimination and depression among married immigrants has decreased. However, the use of healthcare services has been constant or has decreased [7]. This suggests the insufficiency of public health policies for married immigrants. The role of public health is to prevent disease and promote health [19]. For social integration, public health should consider the background and environment of individuals [23]. The divorce status was factors influencing divorce have been well studied [24]. However, research on the effects of divorce on healthcare utilization is insufficient. To improve the quality of public health, in-depth research is needed on the association between the social determinants of health and healthcare utilization.
The decrease in access to healthcare services can lead to a decrease in health literacy. In a previous study, finances capabilityand language barriers were reported as reasons for low use of healthcare services in married immigrants [25]. Health literacy of immigrants is significantly lower than that of ordinary Koreans, and studies have revealed that lower health literacy is associated with higher dissatisfaction with life [26]. In addition, although married male immigrants have had lower health literacy skills than married female immigrants [1], studies on the former’s access to healthcare services are insufficient. South Korea discloses information about the use of healthcare services and necessary vocabulary to married immigrants, but it is not possible to confirm whether the disclosed information is actually used by married immigrants [27]. In addition, married immigrants still have a high demand for healthcare service education, suggesting the need for direct healthcare education services [28]. Therefore, we recommend the need to include healthcare service education to the social integration program currently being implemented in South Korea. The implementation of healthcare service education is expected to not only improve the health literacy of married immigrants but also improve access to healthcare services.
In this study, selection bias, which is a typical limitation of observational research, was addressed by propensity score matching. Homogeneity verification indirectly confirmed that the sample that was statistically analyzed was representative of the population. It is also necessary to question the heterogeneity of variance if there are differences in the demographics and covariates across comparison groups [29]. If the homogeneity of each group is not verified, robust results cannot be obtained in determining the effect of the independent variables on the dependent variable. In the case of experimental studies, the effectiveness of the interventions applied by the researchers can be questioned [30]. In this study, we analyzed the association between divorce and the access to healthcare services by securing the homogeneity of all demographic characteristics and covariates across the comparison groups using propensity score matching methods. We found that access to healthcare services is affected by several factors (e.g., financial support, economic problems). We controlled variables related to the access to healthcare services in our analysis. The results were robust, and divorce was found to be associated with access to healthcare services, even after controlling for other variables.