Uninsured, Publicly Insured Report Unfair Treatment in Patient Experience

Coverage type may be a factor in unfair treatment in the patient experience among the uninsured and those with public insurance coverage, according to an Urban Institute study.

“Unfair treatment due to health insurance type could have many causes, including bias and discrimination on the part of providers and office staff members,” the researchers stated. “Understanding who is experiencing unfair treatment and patients’ perceptions of why they are being treated unfairly is necessary so that policymakers and payers can implement effective policies to prevent such treatment.”

The researchers leveraged data from the 2021 Health Reform Monitoring Survey, pooling responses from over 9,000 respondents in order to assess how different types of healthcare coverage might impact patent experience. The survey is nationally representative, available in English and Spanish, and online with the option of being provided with internet access in order to take the survey.

Across all adults, nearly one in ten respondents reported experiencing unfair treatment in a healthcare setting, offering a variety of reasons. The researchers offered the following possible reasons for unfair treatment as answer options: race or ethnicity, language, health condition, disability, sexual orientation, gender or gender identity, country of origin, and insurance coverage.

Those with public coverage--payers such as Medicaid--or who were uninsured were more likely to report unfair treatment. Individuals without coverage or with public payer coverage experienced unfairness at a rate more than double those of their counterparts with private coverage.

Among those who were treated unfairly, a small percentage reported being treated unfairly strictly due to insurance type. Nearly two percent of those with public coverage and those without insurance responded that they were treated unfairly solely due to their coverage type (1.8 percent and 1.7 percent, respectively).

Those with public payer coverage had the highest likelihood of saying that they were treated unfairly.

Of the 17.4 percent who reported unfair treatment, 7.8 percent said that the cause of this mistreatment was due to their health insurance type and another factor. Among these respondents, 5.9 percent said that the other reason was income, 4.6 percent said that the other reason was a disability or health condition, and 2.6 percent said that the other reason was race or ethnicity.

Among those with public insurance coverage, 7.8 percent said that the cause was not related to health insurance at all.

Among the uninsured, 6.5 percent said that their mistreatment was not tied to their coverage type. Another 5.7 percent said that their unfair treatment was due to their health insurance type and another reason.

With 9.6 percent of publicly insured respondents and 7.4 percent of uninsured respondents saying that they were treated unfairly due to health insurance type only or health insurance type and another reason, individuals in these categories were over five times more likely to report mistreatment due to healthcare coverage compared to their counterparts with private healthcare coverage.

After adjusting for factors such as race and socioeconomic status, the results remained the same: individuals with public coverage or no insurance were more likely to report unfair treatment in healthcare settings.

These results had implications for patients and their health. Among those with public coverage, 16.2 percent reported that insurance-related challenges resulted in unmet care, along with 11.0 percent of those with private coverage.

“There is still much to learn about the nature of the unfair treatment patients experience because of their health insurance type, especially to distinguish between treatment that may be related to aspects of the Medicaid program (e.g., hassles associated with seeking authorization for care or prescriptions) and negative interpersonal treatment at the point of care or when speaking to front office staff,” the researchers concluded.

“The types of solutions that would target unfair treatment due to insurance type in health care will depend on uncovering these distinctions.”

They suggested that addressing administrative barriers and payment barriers might help resolve some biases. Additionally, practices should train providers in cultural competency. Lastly, the researchers noted that providers may need to adjust their expectations regarding what uninsured patients can afford alongside efforts to reduce the number of Americans without insurance