Reports of Insurance-Based Discrimination in Health Care and Its Association With Access to Care
Reports of Insurance-Based Discrimination in Health Care and Its Association With Access to Care
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DOI：
10.2105/ajph.2015.302668
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发表时间：
2015-07-01
影响因子：
12.7
通讯作者：
Simon, Alisha Baines
中科院分区：
文献类型：
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作者：
Han, Xinxin;Call, Kathleen Thiede;Simon, Alisha Baines
目标.我们研究了基于保险的歧视及其与保险类型和获得护理的患者保护和平价医疗法案的早期报告。我们使用2013年明尼苏达州健康访问调查的数据，确定了4123名年龄在18至64岁之间的明尼苏达州成年人，他们报告了他们基于保险的歧视经历。我们模拟了歧视和保险类型之间的关联，并预测了那些报告歧视的人获得医疗服务的机会减少的几率，控制了社会人口因素。数据进行加权，以代表国家的人口。基于保险的歧视报告在未投保（25%）和公共保险（21%）的成年人中高于私人保险的成年人（3%），这在回归分析中保持不变。那些报告歧视的人比那些没有歧视的人更有可能缺乏通常的护理来源，缺乏获得护理的信心，因为成本而放弃护理，并经历提供者层面的障碍。需要进一步研究和政策干预，以解决医疗保健环境中基于保险的歧视问题。
Objectives. We examined reports of insurance-based discrimination and its association with insurance type and access to care in the early years of the Patient Protection and Affordable Care Act.Methods. We used data from the 2013 Minnesota Health Access Survey to identify 4123 Minnesota adults aged 18 to 64 years who reported about their experiences of insurance-based discrimination. We modeled the association between discrimination and insurance type and predicted odds of having reduced access to care among those reporting discrimination, controlling for sociodemographic factors. Data were weighted to represent the state's population.Results. Reports of insurance-based discrimination were higher among uninsured (25%) and publicly insured (21%) adults than among privately insured adults (3%), which held in the regression analysis. Those reporting discrimination had higher odds of lacking a usual source of care, lacking confidence in getting care, forgoing care because of cost, and experiencing provider-level barriers than those who did not.Conclusions. Further research and policy interventions are needed to address insurance-based discrimination in health care settings.