Health insurance is no substitute for good health, study says

How a patient identifies among racial and ethnic groups may be a bigger indicator of their health than their insurance status, a new study suggests.

Health care inequities and access problems among people who receive health insurance through their employers, despite arguments that access to commercial insurance is more equal among patients, according to a study published Monday by NORC at the University of Chicago.

The report was sponsored by Morgan Health, JPMorgan Chase & Co.’s mission to revolutionize the health insurance market. The findings show that economic differences are not the cause of health disparities between different races and ethnicities, said Caroline Pearson, a study author and senior vice president for clinical strategies at NORC, a social research organization.

“When you look at and show the results of race and ethnicity, inevitably someone says, ‘How does this account for the income gap?’ Pearson said. “One of the things that was really interesting about our study was that we were able to control for differences in age, gender, income, and race and ethnicity. Health disparities persist even after these changes. They are deeply entrenched in our health care system.”

Researchers analyzed self-report data from people who were enrolled in their employer’s health plan from 2017 to 2019. They reviewed information that 12,372 patients reported in the federal National Health Interview Survey; 3,103 people reported to the Federal National Health and Nutrition Examination Survey; and 14,580 reported to the Federal National Survey of Drug Use and Health.

The study found that black, Asian and Hispanic women who had low-risk pregnancies were at least 3 percent more likely to have a Cesarean section than their white counterparts. C-sections carry a higher risk of maternal morbidity and mortality than cesarean delivery for low-risk pregnancies, and are associated with a higher risk of infection, longer hospital stays and hospital readmissions, according to the American College of Obstetricians and Gynecologists. . Twenty percent of black respondents, 17.7% of Asian respondents and 17% of low-risk Puerto Rican patients underwent C-sections, compared to 13.6% of white respondents.

“These are people who are connected to health care, and they’re all low-risk pregnancies,” Pearson said. “Why are we doing C-sections at such a high rate in people of color? We shouldn’t be.”

Gay, bisexual and bisexual people reported more anxiety, stress and depression than heterosexual people, the study said. More than 23% of LGBTQ people said they had experienced a serious mental health problem, compared to 8.8% of heterosexual patients who reported the problem, according to the report.

White respondents of all races and homosexuals were more likely than Black, Hispanic and Asian respondents to experience serious mental health problems, according to the report.

Of the total population, 30% of the population reported heavy drinking, 18.8% reported using drugs such as cocaine, and 19.8% reported using tobacco. White and Hispanic respondents reported heavy drinking, at 31.7% and 33.2%, respectively. About 21% of white patients reported drug use, compared to 16.4% of blacks, 16.6% of Hispanics and 8.9% of Asians, according to the report.

Chronic disease rates also vary among black, Asian, Hispanic, and white patients.

Asians, Hispanics and blacks were more likely to have diabetes than whites, the study found. Blacks were also more likely to have uncontrolled high blood pressure than whites.

Although almost all respondents said they have a source of care, the study showed differences in how different racial, ethnic and economic groups use the emergency department. Study authors identified emergency department utilization as an indicator of reliable access to care.

Black patients were more likely and Asians were less likely to visit the emergency room than whites, the researchers said. The lowest-income earners of less than $50,000 a year were 7.1 percent more likely to visit the emergency department than the highest-income earners of $150,000.

“The working poor in this country still face many challenges in terms of food security, and paying medical bills compared to other incomes, etc.,” Pearson said. “That’s hard for employers to digest.”

The findings make it easier for employers to use it to determine how their employees’ health compares to national averages, Pearson said. From there, companies should think about how to create health and wellness benefits to address health disparities, he said.

“They need to focus on what’s causing the research gap, rather than paying them,” Pearson said.