Out-Of-Pocket Health Spending And The Rural Underinsured

Ziller, Erika C.; Coburn, Andrew F.; Yousefian, Anush

doi:10.1377/hlthaff.25.6.1688

Cited by 42 publications

(39 citation statements)

References 7 publications

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“…Our finding of the percentage of underinsured is much higher than estimates of 7% to 12% found in national samples of nonelderly adults, 6,7 and higher than the 4.5% estimate for Colorado in 1995. 3 The definition used in this study was based on experiential criteria as opposed to financial criteria used in many other studies.…”

Section: Discussioncontrasting

confidence: 81%

“…Those who spend more than 10% of their income on health care, or 5% for those below 200% of the federal poverty level, are considered to be underinsured. [3][4][5][6] Other studies have defined underinsurance based on patient's self-reported experience about being unable to afford recommended health care despite having insurance; it may not necessarily be related to their income. 7,8 This study follows this experiential definition.…”

mentioning

confidence: 99%

“…Recent studies using income-based definitions of underinsurance and general population surveys have found that underinsured patients have outcomes as equally poor as uninsured patients. 6,7 The purpose of this study was to determine the prevalence of underinsurance in primary care practices. Previous studies have not evaluated this.…”

mentioning

confidence: 99%

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Underinsurance in Primary Care: A Report from the State Networks of Colorado Ambulatory Practices and Partners (SNOCAP)

Voorhees¹,

Fernald²,

Emsermann³

et al. 2008

The Journal of the American Board of Family Medicine

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Background: There has been considerable focus on the uninsured from national and state levels. There are also many Americans who have health insurance but are unable to afford their recommended care and are considered underinsured. This purpose of this study was to determine the prevalence of underinsurance among patients seen in primary care clinics.Methods: Patients in 37 primary care practices in 3 practice-based research networks completed a survey to elicit the prevalence of underinsurance among those who had insurance for a full 12 months, including private insurance, Medicare, and Medicaid. Being underinsured was based on patients reporting the delay or omission of recommended care because of their inability to afford it.Results: Of those with insurance for a full year, 36.3% were underinsured. Of those who were underinsured, 50.2% felt that their health suffered because they could not afford recommended care, a rate similar among those who were uninsured.Conclusions: When evaluating underinsurance in primary care offices, using an experiential definition based on self-reports of patients about their inability to pay for recommended health care despite having insurance, the prevalence is quite high. It is important for the primary care physician to understand that a substantial percentage of their patients may not follow through with their recommendations because of cost, despite having insurance. This also has significant implications when considering health care reform, particularly considering that these patients reported that their health suffered at a rate equal to that of the uninsured.

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Section: Discussioncontrasting

confidence: 81%

mentioning

confidence: 99%

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Underinsurance in Primary Care: A Report from the State Networks of Colorado Ambulatory Practices and Partners (SNOCAP)

Voorhees¹,

Fernald²,

Emsermann³

et al. 2008

The Journal of the American Board of Family Medicine

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“…Still, these factors merit discussion here because they are key elements to the concept of underinsurance, even as their practical application will be much less in the future. "percentage of household income" marker that accounts for the fact that lower-income families are unable to divert resources to cover their health-related expenses (1,13,14,28,29,38).…”

Section: Economic Factorsmentioning

confidence: 99%

Underinsurance in the United States: An Interaction of Costs to Consumers, Benefit Design, and Access to Care

Lavarreda

Brown

Bolduc

2011

Annu. Rev. Public Health

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Underinsurance is most commonly defined as the state in which people with medical coverage are still exposed to financial risk. We argue that the adequacy of health insurance coverage should also be assessed in terms of the adequacy of specific benefits coverage and access to care. Underinsurance can be understood conceptually as comprising three separate domains: (a) the economic features of health insurance, (b) the benefits covered, and (c) access to health services. The literature provides ample evidence that people who are underinsured have high financial risk and face barriers in access to care similar to those who are completely uninsured. In response to the growing recognition of the problems associated with underinsurance, the Patient Protection and Affordable Care Act of 2010 includes numerous provisions designed to limit costs to consumers, to assure a minimum set of benefits, and to enhance access to care, especially primary care.

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“…[3][4][5] Increasing coverage for adults through Medicaid expansions is thought to be a way of improving adequacy of coverage. 2 However, considerably less attention has been paid to underinsurance among low-income adults, 2,[5][6][7] especially those with public insurance. While underinsurance has been examined among children in public programs, 8 previous research has not explored the possibility that adults in Medicaid might be underinsured.…”

Section: Introductionmentioning

confidence: 99%