Health Insurance and Access to Care for Symptomatic Conditions

Baker, David W.; Shapiro, Martin F.; Schur, Claudia L.

doi:10.1001/archinte.160.9.1269

Cited by 107 publications

(77 citation statements)

References 20 publications

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“…7,21,22,[42][43][44] With the advent of the Affordable Care Act (ACA), lack of health insurance may become less of a barrier, but our results indicate that inadequate health insurance and high co-pays are also reasons for avoiding medical care, as well as numerous other reasons that may not be abated by the ACA. Interventions targeting these barriers are an important area for continued research.…”

Section: Discussionmentioning

confidence: 74%

“…17 To date, research on avoidance of medical care has been limited in the extent to which it examines the broad spectrum of reasons for avoidance (but see 7 ), often focusing on specific factors such as barriers or psychological characteristics (e.g., lack of insurance, fear of a diagnosis). [4][5][6]15,[18][19][20][21][22][23][24] A conceptual review of reasons people avoid medical care identified only six qualitative or mixed-methods studies assessing participantgenerated reasons, all of which used convenience samples with predominately white participants. 1 Moreover, five of the six studies reviewed assessed avoidance of specific procedures.…”

Section: Introductionmentioning

confidence: 99%

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Why do People Avoid Medical Care? A Qualitative Study Using National Data

2014

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BACKGROUND: Many studies have examined barriers to health care utilization, with the majority conducted in the context of specific populations and diseases. Less research has focused on why people avoid seeking medical care, even when they suspect they should go. OBJECTIVE: The purpose of the study was to present a comprehensive description and conceptual categorization of reasons people avoid medical care. DESIGN: Data were collected as part of the 2008 Health Information National Trends Survey, a cross-sectional national survey. PARTICIPANTS: Participant-generated reasons for avoiding medical care were provided by 1,369 participants (40% male; M age =48.9; 75.1% non-Hispanic white, 7.4% non-Hispanic black, 8.5% Hispanic or Latino/ a). MAIN MEASURES: Participants first indicated their level of agreement with three specific reasons for avoiding medical care; these data are reported elsewhere. We report responses to a follow-up question in which participants identified other reasons they avoid seeking medical care. Reasons were coded using a general inductive approach. KEY RESULTS: Three main categories of reasons for avoiding medical care were identified. First, over one-third of participants (33.3% of 1,369) reported unfavorable evaluations of seeking medical care, such as factors related to physicians, health care organizations, and affective concerns. Second, a subset of participants reported low perceived need to seek medical care (12.2%), often because they expected their illness or symptoms to improve over time (4.0%). Third, many participants reported traditional barriers to medical care (58.4%), such as high cost (24.1%), no health insurance (8.3%), and time constraints (15.6%). We developed a conceptual model of medical care avoidance based on these results. CONCLUSIONS: Reasons for avoiding medical care were nuanced and highly varied. Understanding why people do not make it through the clinic door is critical to extending the reach and effectiveness of patient care, and these data point to new directions for research and strategies to reduce avoidance.

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Section: Discussionmentioning

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Why do People Avoid Medical Care? A Qualitative Study Using National Data

2014

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“…Individuals without health insurance are also more likely to forgo preventive and routine care for chronic conditions (Ayanian et al 2000). Perhaps most alarming, the uninsured are less likely to receive care for conditions that are judged by physicians to be serious and to require medical attention (Baker, Shapiro, and Schur 2000). Consequently, the uninsured are more frequently hospitalized for conditions that are potentially avoidable (Kozak, Hall, and Owings 2001;Weissman, Gatsonis, and Epstein 1992).…”

Section: The Consequences Of Being Uninsuredmentioning

confidence: 99%

Unhealthy and uninsured: Exploring racial differences in health and health insurance coverage using a life table approach

2010

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Millions of people in the United 2002a;Osteen et al. 1994;Roetzheim et al. 1999). Being uninsured also poses serious fi nancial threats to Americans, with millions carrying a large burden of debt from medical expenses ( Himmelstein et al. 2005). Although public programs-such as Medicaid and the State Children's Health Insurance Program (SCHIP)-provide health insurance to many who would otherwise not be able to afford coverage, millions are without health insurance.In this article, we argue that current research offers a limited description of health insurance coverage in the United States, especially with respect to racial disparities. More specifi cally, the literature to date does not give a sense of the duration of exposure to being uninsured over a typical lifetime, nor does it address the joint risk of being uninsured and being unhealthy. Yet, having an estimate of the duration of time that individuals typically live with these risks is essential in assessing the magnitude of the insurance-related challenges facing the United States. Moreover, having durational measures of the joint risk of being uninsured and in different health states is particularly important when examining disparities between whites and blacks because blacks are not only more likely to be uninsured but also more likely to experience adverse health events. In this study, we use a life table approach to examine racial differences in health insurance coverage in the United States by calculating health-and insurance-specifi c life expectancies for whites and blacks. These measures capture the duration of exposure to different insurance and health states during a typical lifetime. In the absence of individual data on lifetime insurance coverage, life table analysis is a valuable tool that enables us to simulate life course experiences with health insurance coverage and health. By creating measures with a focus on the lifetime exposure to the joint risks of being uninsured and less healthy, we hope not only to provide a better understanding of issues related to health insurance coverage in the United States but also to elucidate racial disparities in the current U.S. health care system. Specifi cally, we address three important questions. First, how does the proportion of time spent in different health and insurance states over the course of one year differ by age and race? Second, given current age-specifi c mortality, subjective health, and health insurance rates in the United States, how many years can individuals expect to live with different types of insurance coverage and in different health states over a typical lifetime? Third, how large are the differences between blacks and whites in the expected number of years lived in different health-specifi c insurance states? BACKGROUND

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“…Hence, the uninsured are less likely to utilize emergency services, as well as overall health services, regardless of need. This has been associated with the dual challenges of failure to seek medical care when needed [27][28][29] and societal burden of uncompensated medical care when the uninsured do not pay their medical bills. 30,31 The analyzed data was from non-Medicare aged patients, so the bulk of the publically insured are low income, working-age individuals.…”

Section: Discussionmentioning

confidence: 99%

Association of increased emergency rooms costs for patients without access to necessary medications

Watanabe

Ney

2015

Research in Social and Administrative Pharmacy

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Background: Prescription medications are an important component of chronic disease management. They are vital in preventing unnecessary ER visits. However, few studies have examined the association between patients' self-reported inability to receive necessary medications and emergency room costs. Objectives: The study objectives were to: 1) determine differences in ER costs based on self-reported ability to obtain necessary medications. 2) identify differences in ER costs based on self-reported ability to obtain necessary medications among medication users. The association was also examined by insurance category. Methods: Respondent data from 10 years (2002-2011) of the U.S. Medical Expenditure Panel Survey was analyzed. The models employed estimated the association of respondents reporting being 'unable to receive necessary medications' on ER expenditures. Secondarily, the relationship was assessed by insurance category: private, public, and uninsured. Two-part cost regression models with bootstrapped estimates to produce 95% confidence intervals of cost differences were applied for these analyses. Significance was set at a ¼ 0.05. Analyses were completed using SAS 9.4 (Cary, NC) and Stata 13 (College Station, TX). Estimates were in 2011 US dollars. Results: People unable to receive necessary medications experienced increased average annual ER costs of $46.62 with 95% a confidence interval [CI] of 34.76-58.49) compared to patients able to receive necessary medications. By insurance category, respondents unable to receive necessary medications experienced increased ER costs ), for Publically Insured, Privately Insured, and Uninsured, respectively. Findings were similar for those already using medications. Conclusions: Inability to obtain necessary medications is associated with increased emergency room costs. Those with public insurance have a larger increase in ER costs if they are without necessary medications compared to those insured privately or without insurance.

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Health Insurance and Access to Care for Symptomatic Conditions

Abstract: Lack of health insurance is a major barrier to receiving medical care, even for highly serious and morbid symptoms.

Cited by 107 publications

References 20 publications

Why do People Avoid Medical Care? A Qualitative Study Using National Data

Why do People Avoid Medical Care? A Qualitative Study Using National Data

Unhealthy and uninsured: Exploring racial differences in health and health insurance coverage using a life table approach

Association of increased emergency rooms costs for patients without access to necessary medications

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