Introduction
Although the association between health insurance coverage and access to care is well
documented, it is unclear whether the deleterious effects of being uninsured are strictly
contemporaneous or whether previous disruptions in coverage have persistent effects.
This study addresses this issue using nationally representative data covering 2011–2019
to estimate the extent to which disruptions in health insurance coverage continued
to be associated with poor access even after coverage was regained.
Methods
Analysis was conducted in 2022. Using a nationally representative cohort of insured
adults aged 18–64 years (N=39,904) and multivariable logistic regression models, the
authors estimated the association between past disruptions in coverage (occurring
at least 1 year before) and the risks of lacking a usual source of care provider and
having unmet medical need.
Results
Among insured nonelderly adults, the risk of being without a usual source of care
provider was between 18% (risk ratio=1.18; 95% CI=1.00, 1.38) and 75% higher (risk
ratio=1.75; 95% CI=1.56, 1.93) than for those with continuous coverage; the risk of
having unmet medical needs was between 41% (risk ratio=1.41; 95% CI=1.00, 1.83) and
66% (risk ratio=1.66; 95% CI=1.26, 2.06) higher. Longer insurance disruptions were
associated with a higher risk of lacking a usual source of care provider.
Conclusions
Previous disruptions in health insurance coverage continued to be negatively associated
with access to care for more than a year after coverage was regained. Improving access
to care in the U.S. may require investing in policies and programs that help to strengthen
coverage continuity among individuals with insurance coverage rather than focusing
exclusively on helping uninsured individuals to gain coverage.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Preventive MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Receipt of diabetes preventive services differs by insurance status at visit.Am J Prev Med. 2015; 48: 229-233https://doi.org/10.1016/j.amepre.2014.08.035
- Coverage Matters: Insurance and Health Care.The National Academies Press, Washington, DC2001https://nap.nationalacademies.org/catalog/10188/coverage-matters-insurance-and-health-careDate accessed: December 16, 2022
- Care Without Coverage: Too Little, Too Late.The National Academies Press, Washington, DC2002https://nap.nationalacademies.org/catalog/10367/care-without-coverage-too-little-too-lateDate accessed: December 16, 2022
- Health Insurance Is a Family Matter.The National Academy Press, Washington, DC2002https://nap.nationalacademies.org/catalog/10503/health-insurance-is-a-family-matterDate accessed: December 16, 2022
- America’s Uninsured Crisis: Consequences for Health and Health Care.The National Academies Press, Washington, DC2009https://nap.nationalacademies.org/catalog/12511/americas-uninsured-crisis-consequences-for-health-and-health-careDate accessed: December 16, 2022
- Impact of health insurance status on vaccination coverage among adult populations.Am J Prev Med. 2015; 48: 647-661https://doi.org/10.1016/j.amepre.2014.12.008
- Health insurance status and clinical cancer screenings among U.S. adults.Am J Prev Med. 2018; 54: e11-e19https://doi.org/10.1016/j.amepre.2017.08.024
- Do disruptions in health insurance continue to affect access to care even after coverage is regained?.J Gen Intern Med. 2022; 37: 2579-2581https://doi.org/10.1007/s11606-021-07187-5
- Association of insurance gains and losses with access to prescription drugs.JAMA Intern Med. 2017; 177: 1531-1532https://doi.org/10.1001/jamainternmed.2017.4011
- Inadequate cancer screening: lack of provider continuity is a greater obstacle than medical mistrust.J Health Care Poor Underserved. 2017; 28: 362-377https://doi.org/10.1353/hpu.2017.0028
- Changes in health care use and outcomes after turnover in primary care.JAMA Intern Med. 2021; 181: 186-194https://doi.org/10.1001/jamainternmed.2020.6288
MEPS-HC panel design and collection process. Agency for Healthcare Research and Quality. https://meps.ahrq.gov/mepsweb/survey_comp/hc_data_collection.jsp. Accessed December 16, 2022.
- Documentation for MEPS full-year 2020 consolidated data file.Agency for Healthcare Research and Quality, Rockville, MD2022https://meps.ahrq.gov/data_stats/download_data/pufs/h224/h224doc.shtml#Person255Date accessed: September 1, 2022
- National Health Interview Survey: 2019 survey description.Division of Health Interview Statistics, National Center for Health Statistics, Hyattsville, MD2020https://nhis.ipums.org/nhis/resources/srvydesc2019.pdfDate accessed: December 16, 2022
- Screening for serious mental illness in the general population.Arch Gen Psychiatry. 2003; 60: 184-189https://doi.org/10.1001/archpsyc.60.2.184
- Detecting and monitoring depression with a two-item questionnaire (PHQ-2).J Psychosom Res. 2005; 58: 163-171https://doi.org/10.1016/j.jpsychores.2004.09.006
- Statistical software, release 16.StataCorp, LLC, College Station, TX2019https://www.stata.com/manuals/svy.pdfDate accessed: December 16, 2022
- Computing adjusted risk ratios and risk differences in Stata.Stata J. 2013; 13: 492-509https://doi.org/10.1177/1536867X1301300304
- Insurance churning rates for low-income adults under health reform: lower than expected but still harmful for many.Health Aff (Millwood). 2016; 35: 1816-1824https://doi.org/10.1377/hlthaff.2016.0455
Article info
Publication history
Published online: December 24, 2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
