Academic journal article The Qualitative Report

Insuring the Uninsured: Reducing the Barriers to Public Insurance

Academic journal article The Qualitative Report

Insuring the Uninsured: Reducing the Barriers to Public Insurance

Article excerpt

Health insurance is one of the essential enabling resources to gain access to medical care and ultimately increase health status. Over 11 million or one quarter of the nation's uninsured individuals are eligible for Medicaid or the State Children's Health Insurance Program (SCHIP), but are not enrolled. Interviews with 368 individuals from 1999 through 2003 identify eight primary barriers to enrollment in public insurance. These include: economic aspects of qualifying, lack of knowledge, benefit design of public programs, poor experiences and stigma, complexity and literacy, immigration status, poor customer service, and fear of fraud. These results suggest policy options alone are unlikely to result in reaching eligible uninsured individuals unless knowledge and instrumental support are offered to them about insurance. Key Words: Access to Health Care, Barriers to Insurance, Medicaid, SCHIP, Underinsured, and Uninsured

Introduction

The positive effect of health insurance on health status is well documented, with the uninsured consistently having worse health than insured individuals. Specifically, compared to the insured population, the uninsured are more likely to have cancer diagnosed at a late stage (Kaiser Family Foundation, 2004), have a 25% greater risk of premature death (Hadley, 2003), and are less likely to fill a prescription, see a specialist, or go for follow-up tests (Commonwealth Fund, 2001). Lack of insurance is responsible for 21% of medical-related bankruptcies, and medical care expenses accounts for 20 to 50 percent of all individual bankruptcies (Dranove & Millenson, 2006; Himmelstein, Warren, Thorne, & Woolhandler, 2005). Public health insurance is effective; a study using the 2001 California Health Interview Survey identified that poor people with Medicaid, who are likely to be a sicker population than the overall community, were more likely to take medications than those with private insurance (Rice, Lavarreda, Ponce, & Brown, 2005). In Tennessee, the fiscally at-risk public health insurance program known as TennCare is credited with decreasing the immunization gap involving enrollees and non-enrollees as well as African Americans and Caucasians (Kirschke et al., 2004). Further, Medicaid is associated with timely initiation of prenatal care in a study of Hispanic women in California (Kropp, Montgomery, Hill, Ruiz, & Maldonado, 2005). Health insurance contributes to better health status and aids in reducing ethnic/racial health disparities.

This paper set out to identify the barriers to enrolling eligible individuals in public insurance, specifically Medicaid (called Medi-Cal in California) and the State Children's Health Insurance Program (SCHIP-called Healthy Families in California, Child Health Plus in New York, PeachCare in Georgia and CHIP in Ohio). Approximately 5.3 million adults nationwide are estimated to be eligible for Medicaid (Davidoff, Yemane, & Adams, 2003) based upon the 2002 National Survey of American Families. Most low-income uninsured adults who were eligible for public coverage were poor and many considered themselves to be in fair or poor health. Further, 6.2 million children are estimated to be eligible for Medicaid or SCHIP (Kaiser Commission on Medicaid and the Uninsured, 2005). A large segment of the 45 million uninsured individuals are eligible for public insurance programs: Identifying and eliminating the barriers is imperative if progress is to be made in improving access.

Using the evolving theoretical model proposed by Andersen (1995), illustrated in Figure 1, environmental factors, population characteristics, and health behaviors affect perceived and evaluated health status as well as consumer satisfaction. Environmental factors include the external environment such as the general economy and level of stress and health care system characteristics such as accessibility, availability, and acceptability of medical care services. …

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