Cost-Related Access Barriers, Medical Debt, and Dissatisfaction with Care Among Privately Insured Americans

Overview

Journal J Gen Intern Med

Publisher Springer

Specialty General Medicine

Date 2022 Sep 28

PMID 36167955

Authors

Charlie M Wray

Lenny Lopez

Meena Khare

Salomeh Keyhani

Affiliations

Soon will be listed here.

Abstract

Background: Understanding experiences with private important to improving the quality of health care coverage.

Objective: To examine the association of health with cost-related access barriers, medical debt, and dissatisfaction with care among privately insured Americans.

Design: We classified Americans with private insurance by self-reported health status into five groups (excellent, very good, good, fair, and poor health). We examined self-reported difficulty seeing a doctor due to costs, not taking medications due to costs, medical debt, and dissatisfaction with care among individuals with differing health status. We used logistic regression to examine the association of health status with individuals' experiences after accounting for baseline characteristics. The analysis was repeated among individuals with different forms of private insurance. Odds ratios were converted to risk ratios to improve ease of interpretation of the results.

Setting: Behavioral Risk Factor Surveillance System of Americans in 17 states RESULTS: The sample included 82,494 US adults with private insurance. Following adjustment, compared to individuals with excellent health those in very good health, good health, fair health, and poor health reported increasingly higher risks of difficulty seeing a doctor due to costs with risk ratios of 1.02 (95% CI 1.01, 1.03), 1.07 (95% CI 1.06, 1.08), 1.18 (95% CI 1.17, 1.20), and 1.29 (95% CI 1.27, 1.31), respectively. Compared to individuals with excellent health, those in very good health, good health, fair health, and poor health reported increasingly higher risks of not taking medication due to costs, outstanding medical debt, and dissatisfaction with care. Similar relationships were seen across individually purchased and employer-sponsored insurance.

Conclusion: Cost-related access barriers, medical debt, and dissatisfaction with care were common among individuals with private insurance and most pronounced among those with fair and poor health who likely need and use their health insurance the most.

Citing Articles

Associations of Medical Debt With Health Status, Premature Death, and Mortality in the US.

Han X, Hu X, Zheng Z, Shi K, Yabroff K JAMA Netw Open. 2024; 7(3):e2354766.

PMID: 38436960 PMC: 10912961. DOI: 10.1001/jamanetworkopen.2023.54766.

Characteristics of employment history and self-perceived barriers to healthcare access.

Hoven H, Backhaus I, Gero K, Kawachi I Eur J Public Health. 2023; 33(6):1080-1087.

PMID: 37857366 PMC: 10710348. DOI: 10.1093/eurpub/ckad178.

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