Barriers to Care and Health Care Utilization Among the Publicly Insured

Abstract

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.

Current Prevalence of Major Cancer Risk Factors and Screening Test Use in the United States: Disparities by Education and Race/Ethnicity

“…Similarly, nearly a quarter of the 39.42 million Hispanics represented in the 2017 NHIS were uninsured, 28% of AI/ANs, and 12% of blacks were uninsured. Furthermore, even the insured may face logistical and financial barriers to timely care, which may be addressed with other policies and navigation efforts (134). Additionally, targeted, tailored communication may be needed to address cultural and language barriers (135,136).…”

Vaccination Coverage Among Children Aged 19–35 Months — United States, 2016

“…Children living below poverty and up to a certain percentage above the poverty level are eligible for Medicaid (42.5% of 2016 NIS-Child population met the minimum Medicaid eligibility level of 138%) and are entitled to VFC vaccines. Barriers to health care access and use among the publicly insured include language barriers, lack of trust in providers, transportation problems, inconvenient office hours, and other provider- and system-level factors ( 4 ). Medicaid patients also tend to experience more breaks in insurance coverage than do privately insured children, and discontinuities in insurance coverage have been associated with lower vaccination coverage ( 5 ).…”

The short‐term effects of the earned income tax credit on health care expenditures among US adults

“…Alternately, more regular and reliable income distributed throughout the year—for example, changes to the minimum wage—may be more effective than an annual lump‐sum refund. Other potential barriers to timely and appropriate care that might be investigated in future interventional work include health care access, transportation difficulties, perceived or actual racial discrimination, awareness of when to seek care, and social or cultural norms around health care utilization …”

“…Of note, we found that EITC-eligible individuals were more likely to have lower expenditures overall but higher ex- health care access, transportation difficulties, perceived or actual racial discrimination, awareness of when to seek care, and social or cultural norms around health care utilization. [52][53][54] Our study has several strengths. First, we used over 15 years of data from a large diverse sample of over 1 million individuals drawn from a nationally representative dataset, ensuring that we were well powered to detect small effects.…”