A study shows that insurance status can affect how well patients are treated

WASHINGTON. People on Medicaid and those without insurance reported experiencing more unfair treatment from health care providers and office staff than those with private insurance, according to survey data.

According to research by Dulce Gonzalez, MPP, and her colleagues, nearly 10% of adults with public health insurance, such as Medicaid, said they had experienced unfair treatment or judgment in a clinical setting because of their insurance status, compared to 1.3% of adults with private insurance. at the Urban Institute, a left-brain center here.

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

Providers’ “perceptions or experiences with structural aspects of Medicaid,” including low Medicaid payment rates, can also cause inequitable treatment, they added.

Researchers analyzed April 2021 data from the Urban Institute Monitoring Reform Survey (HRMS), a nationally representative online survey of adults 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. HRMS is conducted annually, and in April 2021, 9,067 respondents took part in it.

Gonzalez and colleagues looked at outcomes by type of health insurance coverage: full-year private coverage, full-year public coverage, and full-year no coverage. Public insurance included Medicaid and Medicare, and about 90% of respondents with public insurance reported having Medicaid. Private insurance included employer-sponsored insurance, ACA marketplace, and other nongroup coverage, as well as TRICARE or other military coverage.

Respondents were asked whether, in the past 12 months, they had experienced unfair treatment in a doctor’s office, hospital, or clinic because of one or more of the following factors: race or ethnicity, sex or gender identity, sexual orientation, country of origin, native language, type of health insurance, disability, health condition, income level or other reason.

As for what the “unfair treatment” means for patients, the authors were unable to address that for this study, Gonzalez said in a phone interview, adding that “we have a follow-up where we’re trying to get more information on that.”

For this survey, “patients self-reported unfair treatment… [instances where] they felt they had been treated or judged unfairly in the past year in the health care setting, so people could define that in different ways,” she added.

Overall, 9.8% of non-elderly adults reported experiencing unfair treatment in a health care setting in the previous year due to one or more of the above factors, and publicly insured and uninsured adults were twice as likely more likely than adults with private insurance to report being treated unfairly for one or more reasons (17.4% and 13.9% vs. 6.4%), the researchers found.

Among the 9.8% of adults who reported being treated unfairly for any reason, about one-third (3.6%) said they were treated unfairly because of their type of health insurance, alone or in combination with one or more other reasons. This included 2.8% of adults who were treated unfairly because of type of health insurance and for other reasons, and 0.8% of people who were treated unfairly because of type of health insurance only.

“Adults with public insurance and the uninsured were more likely than those with private insurance to report being treated unfairly because of type of health insurance combined with one or more other reasons (7.8% and 5.7% vs. 1, 0%)”, – the authors of the study. wrote

And although “after adjusting for observed demographic, socioeconomic, medical, and geographic characteristics of the non-elderly adults in our sample, differences in the proportions of people reporting unfair treatment due to health insurance type remain between publicly insured 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, Gonzalez said past work by researchers found that patients attributed mistreatment to the fact that “people don’t accept their type of insurance, or they’re denied because they don’t have insurance. Other potential reasons may be related to the hassles of public insurance rather than private insurance – for example, having more difficult problems getting permission for a particular treatment or medicine. There are just so many different reasons.”

The researchers found that the type of coverage people had was not the only factor in whether they felt they were treated or judged unfairly. In unadjusted analyses, black adults with private insurance were more likely to report unfair treatment based on type of health insurance than white adults with private insurance (3.2% vs. 0.9%). Privately insured adults with family incomes at or below 138% of the federal poverty level were also more likely to report being treated unfairly because of their health insurance type than those with higher incomes (4.8% vs. 1.1%).

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

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