A photo of a healthcare worker putting their palms out in a refusal gesture to a man holding out an insurance card.

Insurance status may affect quality of patient treatment, study finds

WASHINGTON — People with Medicaid and those without insurance said they experienced more unfair treatment from health care providers and office staff than those with private insurance, data shows. of an investigation.

Nearly 10% of adults with public health coverage such as Medicaid reported experiencing unfair treatment or judgment in a clinical setting because of their insurance status, compared to 1.3% of adults with private insurance, according to research by Dulce Gonzalez, MPP, and colleagues at the Urban Institute, a left-wing think tank here.

“Experiences of unfair treatment or judgment in health care settings due to type of insurance have been associated with unmet health care needs that can lead to poorer quality of health care, which can harm health and to patient well-being and contribute to health inequities by race and ethnicity,” the authors note in their introduction.

“Provider perceptions or experiences regarding structural aspects of the Medicaid program” — including low Medicaid payment rates — can also result in unfair treatment, they added.

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

Gonzalez and his colleagues examined the results by the following types of health insurance coverage: year-round private coverage, year-round public coverage, and year-round non-insurance. Public insurance included Medicaid and Medicare, and about 90% of respondents with public insurance reported having Medicaid. Private insurance included employer-sponsored insurance, ACA market and other non-group coverage, and TRICARE or other military coverage.

Respondents were asked if, in the past 12 months, they felt they had been treated unfairly in a doctor’s office, hospital or clinic due to one or more of the following factors: racial or ethnic origin, sex or gender identity, sexual orientation, country of origin, primary language, type of health insurance coverage, disability, medical condition, income level or any other reason.

As for what “unfairly treated” means to patients, the authors were unable to examine that for this study, Gonzales said in a phone interview, adding that “we have a follow-up where we try to get more information on this.”

For this survey, “patients self-reported being treated unfairly… [instances where] they had felt unfairly treated or judged in the past year in a health care setting, so people could have defined that in many ways,” she added.

Overall, 9.8% of non-elderly adults said they had experienced unfair treatment in a healthcare facility in the past year due to one or more of the above factors, and adults receiving ‘public coverage and those who were uninsured were more than twice as likely as adults with private coverage to report that they had experienced unfair treatment for one or more reasons (17.4% and 13.9% versus 6.4 percent), the researchers found.

Of the 9.8% of adults who said they had been treated unfairly for some reason, about one-third (3.6%) said they had been treated unfairly because of their type of health insurance, either alone or in combination with one or more other reasons. This included 2.8% of adults who were treated unfairly because of their type of health insurance and other reasons, and 0.8% who were treated unfairly because of their type of health insurance alone.

“Adults with public coverage and those who were uninsured were more likely than those with private coverage to report unfair treatment due to their type of health insurance in combination with one or more other reasons (7.8% and 5.7% vs. 1.0%),” the authors wrote.

And although “after adjusting for observed demographic, socioeconomic, health, and geographic characteristics of non-elderly adults in our sample, differences in the proportions of people reporting unfair treatment due to type of health insurance coverage remain between publicly and privately insured adults and between uninsured and privately insured adults, the differences are narrowing,” they added.

As for why people were treated unfairly because of their insurance status, Gonzales said previous work by researchers found that patients attributed mistreatment to “people not accepting their type of insurance, or they’re turned down because they don’t. “I don’t have insurance. Other potential reasons could relate to the difficulty of having public insurance compared to private insurance – for example, having more difficulty obtaining authorization for specific treatments or specific drugs. There are so many different reasons.”

People’s coverage types weren’t the only factor in whether they felt they were treated or judged unfairly, the investigators found. In unadjusted analyses, black adults with private coverage were more likely than white adults with private coverage to report unfair treatment due to their type of health insurance (3.2% vs. 9%). Privately insured adults with family incomes at or below 138% of the federal poverty level were also more likely to report unfair treatment due to type of health insurance than those with higher incomes (4.8% against 1.1%).

  • Joyce Frieden oversees MedPage Today’s coverage in Washington, including stories about Congress, the White House, the Supreme Court, professional health associations and federal agencies. She has 35 years of experience in health policy. Follow


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