Survey data showed that people using Medicaid and those without health insurance reported more unfair treatment from health care providers and office workers than those with private insurance.
Nearly 10% of adults with public health coverage such as Medicaid said they were treated or judged unfairly in a clinical setting because of their insurance status compared to 1.3% of adults with private insurance, according to study by Dulce Gonzalez, MPP, and colleagues at the Urban Institute, a left-leaning think tank here.
“Experiences of unfair treatment or judgment in health care settings due to type of insurance have been associated with unmet health needs that can lead to poor quality health care, which can undermine patient health and well-being, and contribute to health inequalities by race and ethnicity,” the authors note in their introduction.
They added that “provider perceptions or experiences with structural aspects of Medicaid” — including low Medicaid payment rates — may also lead to unfair treatment.
Researchers analyzed April 2021 data from the Urban Institute Health Reform Monitoring Survey (HRMS), a nationally representative, internet-based study of adults ages 18 to 64 that began in 2013 to provide timely information on the Affordable Care Act. Reasonable (ACA). The data included households with or without internet connection. The HRMS is conducted annually and 9,067 respondents participated in April 2021.
Gonzalez and colleagues looked at the results through the following types of health insurance coverage: full-year private coverage, full public coverage, and full-year no-insurance. Public insurance included Medicaid and Medicare, and about 90% of respondents with public insurance reported getting Medicaid. Private insurance includes employer-sponsored insurance, ACA Market and other non-group coverage, and TRICARE or other military coverage.
Respondents were asked whether, during the past 12 months, they felt they had been treated unfairly in a doctor’s office, hospital, or clinic because of one or more of the following factors: racial or ethnic background, gender or gender identity, sexual orientation, or Country of origin, primary language, type of health insurance coverage, disability, health status, income level, or any other reason.
Regarding what “unfair treatment” means for patients, the authors weren’t able to look at that in this study, Gonzalez said in a phone interview, adding, “We have a follow-up as we try to get more information about which — which.”
For this survey, “Patients themselves reported unfair treatment… [instances where] They felt they had been treated or judged unfairly over the past year in a healthcare setting, so people could have identified that in any number of ways.”
Overall, 9.8% of non-elderly adults reported having been unfairly treated in a healthcare setting in the previous year due to one or more of the above factors, and adults with public coverage who did not have health insurance were twice as likely to be exposed. The researchers found that adults with special coverage reported being treated unfairly for one or more reasons (17.4% and 13.9% versus 6.4%).
Among the 9.8% of adults who reported unfair treatment for any reason, nearly a third (3.6%) said they were treated unfairly because of their type of health insurance, either alone or in combination with one or more other reasons. This included 2.8% of adults who were treated unfairly because of their type of health insurance and other reasons, and 0.8% who were unfairly treated because of their type of health insurance alone.
Adults with public coverage and those without health insurance were more likely than those with private coverage to report unfair treatment due to their type of health insurance along with one or more other reasons (7.8% and 5.7% vs. 1.0%), According to the authors wrote.
Although, “After adjusting for demographic, socioeconomic, health, and geographic characteristics observed for non-elderly adults in our sample, differences in the shares of people reporting unfair treatment due to type of health insurance coverage remain between publicly insured and sector insured adults And between the uninsured adults and the privately insured, the differences narrow.”
On why people are treated unfairly because of their insurance status, Gonzalez said that researchers’ previous work has found that patients attribute abuse to the fact that “people don’t accept their type of insurance, or they decline because they don’t. They don’t have insurance. That other potential causes be related to the kind of hassle of getting public versus private insurance — for example, having greater kinds of challenges getting permission for certain treatments or medications. There are many different reasons.”
Investigators found that people’s coverage types were not the only factor determining whether they felt they had been treated or judged unfairly. In unadjusted analyses, black adults with private coverage were more likely than white adults with private coverage to report unfair treatment due to type of health insurance (3.2% vs. 0.9%). Privately insured adults with household incomes of 138% or less of the federal poverty level were also more likely to report unfair treatment due to the type of health insurance than those with higher incomes (4.8% vs. 1.1%).