The Quality of Health Insurance Service Delivery for Kidney Transplant Recipients: A Patient Perspective

Abstract

Increased attention has been devoted to improving quality care in kidney transplantation. The discourse on quality care has focused on transplant center metrics and other clinical parameters. However, there has been little discussion on the quality of health insurance service delivery, which may be critical to kidney recipients' access to transplantation and immunosuppression. This paper describes and provides a framework for characterizing kidney transplant recipients' positive and negative interactions with their insurers. A consecutive cohort of kidney recipients (n = 87) participated in semistructured interviews on their interactions with insurance agencies. Patients reported negative (37%) and/or neutral or positive (79%) interactions with their insurer (a subset [16%] reported both). Perceived negative experiences included: poor service, logistical difficulties with confusing and time-consuming paperwork, poor communication, rude behavior and concerns about adequate coverage. Positive experiences related to: having good coverage, a simple application process, straightforward transactions and helpful communication. Findings suggest that even when patients have insurance coverage, difficult interactions with insurers and limited skills in navigating insurance options may limit their access to needed medications and health services. Future research is needed to test this hypothesis in a larger population.

Relationships Among Health Insurance Literacy, Financial Toxicity, and Sociodemographic Factors in Patients With Cancer

“…It is also important to note that advocating for less complicated insurance pathways and more support from insurance companies might have an even larger impact on mitigating financial toxicity. 26 It is unrealistic to expect most patients to understand the intricacies of reimbursement and coverage in the US medical insurance system, especially while dealing with a life-changing diagnosis—thus, we hope that this study serves as a call to action for oncology clinicians to advocate on behalf of patients for policy changes that improve transparency and increase financial protections for people with cancer. Tangible changes like limiting out-of-pocket expenses, improving the preauthorization process, and reimbursing the nonmedical expenses that patients incur while undergoing treatment may do more to improve financial toxicity than any other intervention and should be pursued in conjunction with further intervention studies.…”

Disparities Persist Among Hispanic Patients: Completing Evaluation, Waitlisting, and Receiving a Kidney Transplant

“…In addition, patients face challenges interacting with their insurance companies. 27 Patients with HMO coverage must contact their primary care provider to obtain authorization for their tests in order for insurance to approve the coverage; the myriad communications required in these arrangements may be especially demanding and time-consuming to navigate. It is highly plausible that these social risks and structural factors contributed to our Hispanic study population’s disproportionate inability to complete their work-up and testing, which prevented them from being presented to the KP committee and being waitlisted.…”

NUTORC—a transdisciplinary health services and outcomes research team in transplantation

“…[45, 46, 48, 49] Together with a transplant surgeon (J.C.) a nationally recognized methodological expert (E.G. ), with training in medical anthropology and bioethics, who was hired from an outside institution in 2008 leads this team.…”