Reports of Insurance-Based Discrimination in Health Care and Its Association With Access to Care

Han, Xinxin; Call, Kathleen Thiede; Pintor, Jessie Kemmick; Alarcon-Espinoza, Giovann; Simon, Alisha Baines

doi:10.2105/ajph.2015.302668

Cited by 67 publications

(55 citation statements)

References 35 publications

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“…It is unknown if a lack of sufficient Spanish language services, turnover of providers at safety-net healthcare facilities, overbooked appointment schedules, or patients not requesting appointments with a specific provider were the causes. Perceived discrimination, both insurance-based and due to being Hispanic, was described, similar to findings of other studies with Hispanics in various regions of the U.S. (Calo et al, 2015; Han, Call, Pintor, Alarcon-Espinoza, & Simon, 2015; Keller et al, 2010; Reininger et al, 2014). Persons without insurance or having publically supported health insurance have reported greater difficulty getting a timely appointment and higher odds of forgoing needed care as compared to those with private insurance (Han et al, 2015).…”

Section: Discussionsupporting

confidence: 87%

US Healthcare Experiences of Hispanic Patients with Diabetes and Family Members: A Qualitative Analysis

Amirehsani

Wallace

et al. 2017

Journal of Community Health Nursing

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Hispanics in the U.S. experience significant health disparities. Using focus groups conducted in Spanish, we explored the perspectives of 172 Hispanic adults regarding their healthcare experiences. Many participants were female (64.5%) and primarily from Mexico (80%). Four major qualitative themes emerged: 1) provide us with information, 2) want attentive and respectful relationships, 3) want better care, and 4) perceived discrimination. Suboptimal patient-provider interactions were described. Research is needed to explore interventions that address these issues. Incorporating person-centered care principles and practices such as clear and understandable communication, culturally competent care, and customer service skills may benefit provider interactions with Hispanics.

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Section: Discussionsupporting

confidence: 87%

US Healthcare Experiences of Hispanic Patients with Diabetes and Family Members: A Qualitative Analysis

Amirehsani

Wallace

et al. 2017

Journal of Community Health Nursing

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“…Similar studies report a relationship between discrimination and unmet health needs 15,17 where the number of experiences with discrimination is positively associated with a greater odds of delay in seeking medical care. 27 Some contrary studies have found that experiences with discrimination are not independently predictive of preventive healthcare utilization.…”

Section: Discussionmentioning

confidence: 63%

“…10–13 In 2013, the average rate of Medicaid acceptance was 45.7% in the U.S’s largest 15 cities. 14 Medicaid beneficiaries often report experiences of discrimination based on their insurance 15,16 including provider-patient interactions that felt demeaning. 17 Importantly, people who report experiencing this form of insurance-based discrimination are less likely to receive preventive health services.…”

Section: Introductionmentioning

confidence: 99%

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Barriers to Care and Health Care Utilization Among the Publicly Insured

Allen¹,

et al. 2017

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Background Though the Affordable Care Act has been successful in expanding Medicaid to more than 17 million people, insurance alone may not translate into access to healthcare. Even among the insured, substantial barriers to accessing services inhibit healthcare utilization. Objectives We examined the effect of selected barriers to healthcare access and the magnitude of those barriers on healthcare utilization. Research Design Data come from a 2008 survey of adult enrollees in Minnesota’s public health care programs. We used multivariate logistic regression to estimate the effects of perceived patient, provider, and system-level barriers on past year delayed, foregone, and lack of preventive care. Subjects A total of 2,194 adults enrolled in Minnesota Health Care Programs who were mostly female (66%), high school graduates (76%), unemployed (62%), and living in metro areas (67%) were included in the analysis. Results Reporting problems across all barriers increased the odds of delayed care from two times for provider-related barriers (OR = 2.0, 95% CI: 1.2–3.3) to more than six times for access barriers (OR = 6.2, 95% CI: 3.8–10.2) and foregone care from 2.6 times for family/work barriers (OR = 2.6, 95% CI: 1.3–5.1) to more than seven times for access barriers (OR = 7.1, 95% CI: 3.9–13.1). Perceived discrimination was the only barrier consistently associated with all three utilization outcomes. Conclusions Multiple types of barriers are associated with delayed and foregone care. System-level barriers and discrimination have the greatest effect on healthcare seeking behavior.

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“…Some health care institutions and providers refuse to give care based on health insurance status and type of insurance. 30 Also, Jacobs et al 26 examined AA perceptions of providers and found that many AAs believed providers were only after profit and were interested in experimentation during routine care visits. Some AAs additionally mentioned hearing about or witness- We also investigated the extent to which sex, SES, and insurance status moderated the relationship between perceived discrimination and provider trust and satisfaction.…”

Section: Discussionmentioning

confidence: 99%

Perceived Discrimination and Reported Trust and Satisfaction in African Americans: The Jackson Heart Study

2017

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Objectives: 1) To examine the association of multiple dimensions of discrimination with reported trust and satisfaction with providers; 2) to report within-group differences among African Americans (AAs). Methods: Descriptive cross sectional study. The study population included AAs aged 35 to 84 years from the Jackson Heart Study (JHS) (N=5,301). Poisson regression (PR) was used to quantify the association between perceived discrimination and reported trust and satisfaction with providers before and after controlling for selected characteristics. Main Measures: Measures of perceived discrimination included everyday, lifetime, burden from lifetime discrimination, and stress from discrimination. Outcomes included trust and satisfaction with providers. Results: The mean everyday discrimination score was 2.11 (SD±1.02), and the mean lifetime discrimination score was 2.92 (SD±2.12). High (vs low) levels of everyday discrimination were associated with a 3% reduction in the prevalence of trust in providers (PR .97, 95% CI .96, .99) in all models. In fully-adjusted models, high (vs low) lifetime discrimination was associated with a 4% reduction in the prevalence of trust and satisfaction (PR .96, 95% CI .95, .98). Burden of discrimination was not associated with trust or satisfaction, but stress from discrimination was inversely associated with satisfaction. Conclusions: The significant association between discrimination and mistrust and dissatisfaction suggests that health care providers should be made aware of AA perceptions of discrimination, which likely affects their levels of trust and satisfaction.Ethn Dis. 2017;27(3):209-216; doi:10.18865/ed.27.3.209

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Reports of Insurance-Based Discrimination in Health Care and Its Association With Access to Care

Abstract: Further research and policy interventions are needed to address insurance-based discrimination in health care settings.

Cited by 67 publications

References 35 publications

US Healthcare Experiences of Hispanic Patients with Diabetes and Family Members: A Qualitative Analysis

US Healthcare Experiences of Hispanic Patients with Diabetes and Family Members: A Qualitative Analysis

Barriers to Care and Health Care Utilization Among the Publicly Insured

Perceived Discrimination and Reported Trust and Satisfaction in African Americans: The Jackson Heart Study

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