Barriers to Care and Health Care Utilization Among the Publicly Insured.
Med Care
; 55(3): 207-214, 2017 03.
Article
in En
| MEDLINE
| ID: mdl-27579910
ABSTRACT
BACKGROUND:
Although the Affordable Care Act has been successful in expanding Medicaid to >17 million people, insurance alone may not translate into access to health care. Even among the insured, substantial barriers to accessing services inhibit health care utilization.OBJECTIVES:
We examined the effect of selected barriers to health care access and the magnitude of those barriers on health care utilization. RESEARCHDESIGN:
Data come from a 2008 survey of adult enrollees in Minnesota's public health care programs. We used multivariate logistic regression to estimate the effects of perceived patient, provider, and system-level barriers on past year delayed, foregone, and lack of preventive care.SUBJECTS:
A total of 2194 adults enrolled in Minnesota Health Care Programs who were mostly female (66%), high school graduates (76%), unemployed (62%), and living in metro areas (67%) were included in the analysis.RESULTS:
Reporting problems across all barriers increased the odds of delayed care from 2 times for provider-related barriers (OR=2.0; 95% CI, 1.2-3.3) to >6 times for access barriers (OR=6.2; 95% CI, 3.8-10.2) and foregone care from 2.6 times for family/work barriers (OR=2.6; 95% CI, 1.3-5.1) to >7 times for access barriers (OR=7.1; 95% CI, 3.9-13.1). Perceived discrimination was the only barrier consistently associated with all 3 utilization outcomes.CONCLUSIONS:
Multiple types of barriers are associated with delayed and foregone care. System-level barriers and discrimination have the greatest effect on health care seeking behavior.
Full text:
1
Collection:
01-internacional
Health context:
10_ODS3_salud_sexual_reprodutiva
/
11_ODS3_cobertura_universal
/
1_ASSA2030
/
2_ODS3
Database:
MEDLINE
Main subject:
Medicaid
/
Health Services
/
Health Services Accessibility
Aspects:
Determinantes_sociais_saude
/
Equity_inequality
/
Implementation_research
Limits:
Adolescent
/
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
America do norte
Language:
En
Journal:
Med Care
Year:
2017
Document type:
Article