How Insurance Can Affect Patient Care, Study Finds

WASHINGTON — People on Medicaid and the uninsured reported more unfair treatment from health care providers and office workers than those with private insurance, a study shows.

About 10% of adults with public health benefits such as Medicaid said they had been victimized or unfairly judged because of their insurance compared to 1.3% of adults with private insurance, according to the learning By Dulce Gonzalez, MPP, and staff at the Urban Institute, a left-leaning think tank here.

“The experience of unfair treatment or judgment in medical procedures due to the type of insurance has been related to health needs that can lead to poor health, which can harm the health of patients and health, and contribute to health inequalities by race and ethnicity,” he said. the authors noted in their introduction.

“Considerations of providers or events related to the Medicaid system” — including lower Medicaid payments — can also lead to unfair treatment, they added.

The researchers analyzed data through April 2021 from the Urban Institute’s Health Reform Monitoring Survey (HRMS), a nationally representative, online survey of people ages 18 to 64 that began in 2013 to provide timely information on the Affordable Care Act (ACA). . The data included households with and without internet access. The HRMS is conducted annually and 9,067 respondents participated in April 2021.

Gonzalez and colleagues looked at outcomes with the following types of health insurance: year-round private coverage, year-round public coverage, and year-round coverage. Public insurance included Medicaid and Medicare, and about 90% of respondents with public insurance said they had Medicaid. Private insurance included employer-sponsored insurance, the ACA marketplace and other non-memberships, and TRICARE or other military assistance.

Respondents were asked if, in the past 12 months, they felt they were not treated fairly in a doctor’s office, clinic, or hospital because of one or more of the following reasons: race or ethnicity, gender or gender, sexual orientation, nationality. origin, first language, type of health insurance, disability, health, income, or other reasons.

As for what “unfair treatment” means for patients, the authors were not able to look at the study, Gonzales said in a telephone interview, adding that “we have results that we are trying to find out more about.”

In this study, “patients self-reported that they received inappropriate treatment… [instances where] felt that they had been treated or judged unfairly in the past year in the medical field, so people could have expressed this in a number of ways,” he added.

Overall, 9.8% of non-elderly adults reported being abused in a health care setting in the past year for one or more of the reasons listed above, and adults who were publicly exposed and uninsured were twice as likely. adults with private information to report that they have been bullied for one or more reasons (17.4% and 13.9% vs 6.4%), the researchers found.

Of the 9.8% of adults who reported unfair treatment for any reason, nearly one-third (3.6%) said they were treated unfairly because of their type of health insurance, either alone or in combination with one or more other factors. This includes 2.8% of adults who were treated unfairly because of the type of health insurance and other reasons, and 0.8% who were treated unfairly because of their health insurance alone.

“Publicly informed and uninsured adults were more likely than those with private coverage to report unfair treatment because of their type of health insurance including one or more (7.8% and 5.7% vs 1.0%),” the authors he wrote. he wrote.

And even after “adjusting for the demographic, social, health, and geographic characteristics of the non-elderly population in our sample, differences in the proportion of people reporting coverage by type of health insurance remain among the insured adult population.” in the group and those with private insurance and between uninsured adults and those with private insurance, the difference narrows,” he added.

As for why people are treated unfairly because of their insurance, Gonzales said previous work by researchers has found that patients are treated unfairly because “people don’t accept their type of insurance, or they’re denied because they don’t. Other reasons may be related to the difficulty of having insurance.” government versus private insurance — for example, having more difficulty getting approval for a particular drug or medicine. There are many different reasons.”

People’s emotional responses weren’t the only thing that determined whether they felt victimized or unfairly judged, the researchers found. In unadjusted analyses, black adults with private coverage were more likely than whites with private coverage to report being neglected because of their type of health insurance (3.2% vs 0.9%). Privately insured adults with household incomes at or below 138% of the federal poverty level were also more likely to report unfair treatment because of the type of health insurance than those with higher incomes (4.8% vs 1.1%).

  • Joyce Frieden oversees MedPage Today’s Washington coverage, including coverage of Congress, the White House, the Supreme Court, medical institutions, and government agencies. He has 35 years of experience in the healthcare field. Follow up