Barriers to Care and Health Care Utilization Among the Publicly Insured

Bibliographic Data

ID9103219
AuthorsElizabeth Allen (0000-0002-2689-6939, corresponding author), Elizabeth M Allen (0000-0001-6921-4144, Department of Family Medicine & Community Health), Kathleen Thiede Call (0000-0003-2731-1573, University of Minnesota), Timothy J Beebe (0000-0003-4700-2436, Department of Health Sciences Research, Mayo Clinic, Rochester), Donna D Mcalpine (Division of Health Policy & Management), Donna Mcalpine (0000-0002-1855-6272), Pamela Jo Johnson (0000-0003-3034-1378, University of Minnesota)
Year2017
Volume55
Issue3
Pages207-214
Publication date2017-03-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000644
PMID27579910
OpenAlexW2513845465
LanguageEN
Citations received36
References cited20

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

Behavioral Risk Factor Surveillance System · Environmental health · Family medicine · Health care · Health insurance · Logistic regression · Medicaid · Multivariate analysis · Odds · Odds ratio · Patient Protection and Affordable Care Act · Public health · Geriatric Care and Nursing Homes · Healthcare Policy and Management · Healthcare Systems and Reforms · Medicine · Nursing

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