Research Activities, June 2013
Perceptions of quality and access among the insured are affected by the uninsured in their community
Being without health insurance just doesn’t affect individuals. A new study suggests that high numbers of people without insurance in communities can negatively impact the cost, quality, and accessibility of services available to residents who are insured.
The researchers asked insured Latina mothers living in two communities with different insurance levels to rate their perceptions of health care quality and access. Women living in the community with a low level of insurance had substantially lower perceptions of quality and access compared to those living in the community with higher numbers of persons with health insurance. The two communities studied were Minneapolis, MN, and McAllen, TX.
In Minneapolis, more than 90 percent of its residents had health insurance coverage. By contrast, only 41 percent of McAllen residents were insured. Whereas only 10.8 percent of residents in Minneapolis reported being unable to see a physician because of cost, 48.6 percent of those living in McAllen report having this problem. Latina mothers with private health insurance in each city were asked questions about health care accessibility, quality, and affordability in focus groups.
Most of the mothers in both cities agreed that health care costs too much and is unaffordable. Those in McAllen felt the costs of the insurance itself, along with deductibles, were high. Some had trouble paying premiums or deductibles and sometimes delayed care as a result. Many felt travel to Mexico to receive care was a cheaper and better option. Whereas the women in McAllen felt the health care system was corrupt, those in Minneapolis did not. Out-of-pocket costs were perceived to be higher by the Minneapolis women. They also cited payment plan arrangements as being helpful.
Women in both cities expressed frustration with wait times in clinics and hospitals. However, the McAllen mothers expressed dissatisfaction with their medical encounters, complaining that they were extremely rushed. Minneapolis mothers also admitted frustration with the limited time they had with providers, but attributed this to cultural differences and lack of trust in their providers. These mothers also commonly reported language barriers, which were not mentioned by the McAllen group.
Most participants from both cities said they did not fully understand their health care plans and provider networks. McAllen mothers reported having trouble with the referral process to a specialist, whereas Minneapolis participants felt they could access a specialist. However, they did complain about the length of time it took between contacting the specialist and having to wait for the appointment. The researchers conclude that Minneapolis could benefit from policies that advocate culturally and language-appropriate care. In McAllen, doctors could be incentivized to focus more on quality than quantity.
The study was supported in part by AHRQ (HS17003). See "Where would you rather live if you were insured? Assessing community uninsurance spillover effects on the insured," by Rachel R. Hardeman, M.P.H., Carolyn García, Ph.D., M.P.H., R.N., and José A. Pagán, Ph.D., in the Journal of Immigrant and Minority Health 14, pp. 706-714, 2012.