Barriers to Care and Health Care Utilization Among the Publicly Insured

Elizabeth M. Allen, Kathleen T. Call, Timothy J. Beebe, Donna D. McAlpine, Pamela Jo Johnson

Research output: Contribution to journalArticle

16 Scopus citations

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. RESEARCH DESIGN:: 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.

Original languageEnglish (US)
JournalMedical Care
DOIs
StateAccepted/In press - Aug 30 2016

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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  • Cite this

    Allen, E. M., Call, K. T., Beebe, T. J., McAlpine, D. D., & Johnson, P. J. (Accepted/In press). Barriers to Care and Health Care Utilization Among the Publicly Insured. Medical Care. https://doi.org/10.1097/MLR.0000000000000644