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

Abstract

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.

Predictors of Human Papillomavirus Vaccine Initiation and Completion Among Latino Mothers of 11- to 17-Year-Old Daughters Living Along the Texas-Mexico Border

“…64 Furthermore, low-income girls with private insurance may also have to cover additional out-of- pocket vaccine costs and/or may encounter other barriers to care. 65 At the time of this study, the Affordable Care Act did not exist to reduce out of pocket costs for this vaccine, and although the VFC Program covers the vaccine itself, patients would still need to pay an administration fee for each vaccine received. 63 In addition, unlike Federally Qualified Health Centers in rural areas, private doctors may not have the HPV vaccine readily available.…”

Linguistic Acculturation and Perceptions of Quality, Access, and Discrimination in Health Care Among Latinos in the United States

“…Among participants who indicated they had received poor quality health care, less acculturated Latinos were more likely to indicate that it was the result of not being able to pay for their services. Latinos tend to have higher rates of poverty (Bledsoe, 2008) and lower rates of health insurance coverage than other racial/ethnic groups (Laverreda, Brown, & Bolduc, 2011), which may impact their ability to pay for health care services. The results of this study indicate that less acculturated Latinos perceive that poor quality medical treatment is due to their inability to pay for services and this may impact returning for follow-up medical care, which could lead to more serious health issues among this population.…”

Exploring the Role of Neighborhood Socio-Demographic Factors on HPV Vaccine Initiation Among Low-Income, Ethnic Minority Girls

“…Those with insurance coverage are more likely to receive any type of recommended vaccinations [45], especially if they rely on safety-net clinics that are traditionally focused on preventive care for adolescents. Low-income girls with private insurance, however, often face additional out-of-pocket costs for vaccinations as well as increased barriers to care [46]. Multiple studies have documented the sizeable increase in the costs of adolescent vaccinations over the past decade and how these costs have been passed on from insurance companies to patients [42, 47].…”