Public Insurance Enrollees Report Unfair Treatment and Fear Cost of Care

Charlie Plain | August 30, 2017
Professor Kathleen Call
Professor Kathleen Call

Minnesota and other states across the country offer public health insurance — like Medicaid — to guarantee medical coverage for people encountering hard times. The intent of the programs is to provide people with coverage for preventative or emergency care. But, according to a new study by the University of Minnesota School of Public Health, many publicly insured people forgo routine health care — like yearly physicals — due to the complexity and stigma associated with using their health insurance.

“Insurance should provide a sense of security and not be another stressor,” says study author Professor Kathleen Call. “We need to work on helping people with public insurance use it when they have it and making sure that they feel welcome in the health care system.”

The study, which was led by alum John Loftus, was published in The Journal of Rural Health.

The study looked at survey data from more than 4,000 urban and rural people with insurance through the Minnesota Health Care Program. The researchers found that 24 percent of the rural people and 19 percent of the urban people reported that they didn’t visit a health provider in the past year.

When the researchers took a closer look at why the patients weren’t visiting their providers, they found that many people were concerned that their care wouldn’t be covered by insurance or that the care would cost more than expected.

“If insurance is supposed to translate into good access to health care, this indicates that there’s a barrier for socio-economically vulnerable people,” says Call. “Insurance has become so complicated that people are sometimes afraid to use it.”

The study also found that many people reported unfair treatment by providers based on their enrollment in public insurance and ability to pay for care.

“Insurance-based discrimination was one of the biggest barriers that people identified,” says Call. “It makes these patients feel like they are not really welcome and are not being treated well, which may keep them from making use of health care services.”

Skipping preventative visits means the enrollees aren’t being screened for chronic diseases, like colorectal cancer or diabetes. Call points out that this leads the people who can least afford to be sick to wait to seek care until there are very ill, which costs medical assistance programs lots of money down the road.

According to Call, using public health insurance could be made easier through plan administration improvements — such as notifications of coverage changes and making care costs clear — and ensuring that enrollees receive similar access to those who are privately insured.

Call is expanding on the findings of this study by taking a focused look at the issues of health insurance literacy and insurance-based discrimination.

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