Is Insurance a More Important Determinant of Healthcare Access Than Perceived Health? Evidence from the Women's Health Initiative

Abstract

Our objectives were to explore health insurance status and insurance type, adjusted for self-reported and perceived health variables, as determinants of having and using a usual care provider in the Women's Health Initiative (WHI) Observational Study (OS). This analysis describes insurance status in a large, diverse group of older women and tests the hypothesis that insurance was a key predictor of their access to healthcare in the mid-1990s. Multiple logistic regression analysis was used to evaluate determinants of having visited a usual healthcare provider within the proceeding 12 months, using cross-sectional information provided by a population-based cohort of 55,278 postmenopausal women. Five percent of women younger than 65 years and 0.2% of women 65 or older in the OS cohort lacked health insurance. Among the 31,684 women, aged 50-64 years, Hispanic women and those with fewer years of education and lower household income and who were current smokers were less likely, and those lacking insurance were the least likely, to have seen their healthcare provider within the preceding year. Among 23,594 women, aged 65-79 years, African American and Hispanic women and those with lower household income, and Medicare only and those who were current smokers, were less likely to have seen their healthcare provider within the preceding year. In both age groups, women with chronic medical conditions and poorer perceived health scores and those with prepaid insurance were more likely to have seen their healthcare provider. In the WHI OS, both health (self-reported and perceived) and type of health insurance remained independently associated with having visited a usual healthcare provider after multivariate adjustment for one another as well as for pertinent sociodemographic characteristics.

Improving access to healthcare for women in Tanzania by addressing socioeconomic determinants and health insurance: a population-based cross-sectional survey

“…Having health insurance is an essential element for timely access to healthcare and better health-related outcomes. 37 38 Despite the availability of the National Health Insurance Fund in Tanzania since 2001 through Act no. 8 of 1999, more than 90% of women are still uninsured.…”

Educating Hispanic Women About Breast Cancer Prevention: Evaluation of a Home-Based Promotora-Led Intervention

“…Compared with non-Hispanic white women, Hispanic women may lack access to preventive services, 9 given lower income and more limited health insurance coverage. [10][11][12][13][14][15] Additionally, cultural beliefs and lack of knowledge or awareness about cancer risk are likely to influence screening and preventive behaviors and result in disparities in stage at diagnosis and subsequent survival. 13,[16][17][18][19][20] Fear of pain associated with the mammogram itself as well as fear of finding cancer have also been cited as psychological barriers to breast cancer screening among Hispanic women in the United States.…”

Metabolic syndrome risk components and mortality after triple‐negative breast cancer diagnosis in postmenopausal women in the Women's Health Initiative

“…As a result, a relatively healthy population was recruited, and 95% of the participants younger than 65 years had health insurance, whereas 98.2% of the older participants had health insurance. 31 Second, 3 of the 4 MetS components (blood pressure, waist circumference, and cholesterol) are risk factors rather than comorbidities likely to limit breast cancer therapy and/or follow-up. Finally, albeit with missing data, there were no significant differences in surgery, chemotherapy, or radiation therapy among the metabolic component-defined groups.…”