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

12 Citations (Scopus)

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

Fingerprint

Patient Acceptance of Health Care
Health Services Accessibility
Patient Protection and Affordable Care Act
Delivery of Health Care
Preventive Medicine
Medicaid
Insurance
Public Health
Logistic Models

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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

Barriers to Care and Health Care Utilization Among the Publicly Insured. / Allen, Elizabeth M.; Call, Kathleen T.; Beebe, Timothy J.; McAlpine, Donna D.; Johnson, Pamela Jo.

In: Medical Care, 30.08.2016.

Research output: Contribution to journalArticle

Allen, Elizabeth M. ; Call, Kathleen T. ; Beebe, Timothy J. ; McAlpine, Donna D. ; Johnson, Pamela Jo. / Barriers to Care and Health Care Utilization Among the Publicly Insured. In: Medical Care. 2016.
@article{57e03cf43ed24a089c9b90b6d4e12c8d,
title = "Barriers to Care and Health Care Utilization Among the Publicly Insured",
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.",
author = "Allen, {Elizabeth M.} and Call, {Kathleen T.} and Beebe, {Timothy J.} and McAlpine, {Donna D.} and Johnson, {Pamela Jo}",
year = "2016",
month = "8",
day = "30",
doi = "10.1097/MLR.0000000000000644",
language = "English (US)",
journal = "Medical Care",
issn = "0025-7079",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Barriers to Care and Health Care Utilization Among the Publicly Insured

AU - Allen, Elizabeth M.

AU - Call, Kathleen T.

AU - Beebe, Timothy J.

AU - McAlpine, Donna D.

AU - Johnson, Pamela Jo

PY - 2016/8/30

Y1 - 2016/8/30

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84984669432&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84984669432&partnerID=8YFLogxK

U2 - 10.1097/MLR.0000000000000644

DO - 10.1097/MLR.0000000000000644

M3 - Article

C2 - 27579910

AN - SCOPUS:84984669432

JO - Medical Care

JF - Medical Care

SN - 0025-7079

ER -