HPM Research Brief Dec. 2015

									Mona Rath |
																			December 4, 2015

Hard to Get: Despite Insurance, Using Health Care Still Challenging for Many

Kathleen Call & Mary Cobb

Kathleen Thiede Call, Ph.D, professor
Mary Cobb, HSRP&A Ph.D student

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Even for people with insurance, getting health care can be wrought with challenges. There is the need for time off work, a transportation requirement, finding a trustworthy doctor or clinic accepting new patients, maybe the need for childcare or a bilingual interpreter or a dreaded co-payment. These barriers to getting health services are often so difficult to overcome that many people – despite having insurance – delay going for needed care, or never go at all. This can cause diseases to go undiagnosed and untreated, and in addition to the preventable suffering of the illness, ultimately may also cost the nation even more when the patient finally arrives, very sick and with advanced disease at an Emergency Department or doctor’s office.

Study Design

Researchers at the University of Minnesota conducted a study1 to find out which types of barriers were most common among participants in public health insurance programs (like Medicaid), and whether different barriers were more problematic for different ethnic groups. They used 2008 data from a survey that asked approximately 1,700 publicly insured adult (i.e. Medicaid or similar) Minnesota residents about cost, access, and healthcare provider-related challenges they faced in getting healthcare. Then, the researchers broke down the results by ethnic group to see if Hmong, Somali, American Indian, African American, Hispanic, and white respondents had, in general, the same or different challenges in getting needed healthcare.

Key Findings

Overall (among all ethnic groups), 72% of the respondents said they had a barrier related to cost or uncertainty about their insurance coverage, nearly 63% faced some kind of access barrier (getting an appointment, transportation, clinic hours, etc.), and 29% said they experienced provider-related challenges (language, cultural, trust, or similar barriers regarding doctors). However, when responses are further examined by ethnic group, differences emerge both in the pervasiveness of these barriers and in their relative importance (for example, cost is the most common barrier for the whole sample on average, but is not the top barrier for every ethnic group).

Hmong and Hispanic respondents reported significantly greater financial barriers compared to whites, while access barriers topped the list for American Americans, with 77% citing access problems. Populations of color and American Indians faced significantly greater provider-related barriers than whites; 23% of whites experienced this type of barrier but the figure was highest among Hmong, at 71%.

Policy Implications

Implementation of the Affordable Care Act (ACA) has resulted in large increases in insurance coverage rates, including more than 11 million people newly enrolled in Medicaid.2 With so much attention focused on these impressive coverage gains, it can be easy to overlook the rest of the story. Insurance coverage is important, but is not a panacea for the nation’s health problems. The study’s authors summarize it this way: “Many challenges to care persist for publicly insured adults, particularly minority racial and ethnic groups. The ACA expansion of Medicaid, although necessary, is not sufficient for achieving improved and equitable access to care.”

To move beyond insurance coverage, policymakers may wish to consider programs that directly address these other challenges in their communities, through outreach programs to better communicate cost and coverage information, provision of transportation or child care, better availability of translators, or other relevant approaches, ideally developed with input directly from the communities themselves.

Furthermore, this study was informative for groups of publicly insured adult residents of Minnesota, but the mix and relative importance of barriers likely varies among other ethnic groups, for children, for residents of other states, and for people insured by private plans. State governments or researchers interested in identifying the barriers relevant to their own populations are encouraged to undertake similar studies in order to inform policy and programming decisions to meet their needs.


To read the full study, access the journal Medical Carethrough your library.

Call KT, McAlpine DD, Garcia CM, Shippee N, Beebe T, Adeniyi TC, Shippee T. (2014) Barriers to Care in an Ethnically Diverse Publicly Insured Population: Is Health Care Reform Enough? Medical Care, 52(8): 720-7.
2. Medicaid enrollment figure from HHS Blog, March 20, 2015: hhs.gov/healthcare/facts/blog/2015/03/medicaic-chip-enrollment-january%20.html


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