Work

Satisfaction and Cost-Related Access Barriers Among American Indian and Alaska Natives Adults by Insurance Type

Year: 2022

Type: article

Abstract: Using pooled data from 2016–2018 Behavior Risk Factor Surveillance (BRFSS), we identified all individuals who self-identified as AIAN among a random sample of adults in 17 states and DC. To assess coverage, we used the question, “What is the primary source of your health care coverage?” Of 2699 AIAN individuals who responded, we excluded 13 individuals who had reported no insurance coverage resulting in an analytic sample of 2686 AIAN adults representing about 700,000 AIAN adults. Survey details are available on the BRFSS website. We examined two domains among this sample: self-reported cost-related access barriers and satisfaction with care. Experience with cost-related access barriers was assessed by the following questions: (1) “Was there a time in the past 12 months when you needed to see a physician but could not because of cost?” (2) “In the past 12 months was there a time when you did not take your prescription medications due to cost?” (3) “Do you currently have any health care bills that are being paid over time?” Satisfaction was assessed with the question, “In general, how satisfied are you with the care you received?” We examined the baseline characteristics of the respondents and then performed multivariable analyses, controlling for age, gender, and baseline health, comparing AIAN adults with IHS to other forms of insurance coverage (Medicare, Medicaid, VA/Military, private employer/individual, other insurance). The analyses accounted for non-responses and the complex survey design. Among the 2686 AIAN adult respondents, 640 were covered by IHS and 2046 had other forms of insurance. Adults covered by IHS were younger (median age 37.7 (±2.3) versus 46.6 (±1.1) years) and reported better health compared to those with other coverage (Table 1 ). Table 1 demonstrates that AIAN adults who had coverage through the IHS less commonly reported not taking medications due to costs (5.1% vs. 13.4%, P <0.001). There was no significant difference in other outcomes. Multivariable analyses demonstrated that AIANs with IHS were less likely to report not taking medications due to costs in comparison to AIANs with other coverage (odds ratio (OR), 0.39; 95% CI, 0.20–0.75). No differences were found in difficulty seeing a physician because of cost (OR, 1.28; 95% CI, 0.72–2.27), medical debt (OR, 0.70; 95% CI, 0.39–1.25), or satisfaction with care (OR, 0.76; 95% CI, 0.51–1.15) between AIAN individuals with IHS and other coverages (Table 2 ).

Source: Journal of General Internal Medicine

DOI: 10.1007/s11606-022-07830-9

Authors: Tristan Moss-Vazquez, Charlie M. Wray, Lenny Lopez, Meena Khare, Salomeh Keyhani

Institutions: San Francisco VA Medical Center, Northern California Institute for Research and Education, University of California, San Francisco

Language: English

Topic: Healthcare Policy and Management

Subfield: Economics and Econometrics

Field: Economics, Econometrics and Finance

Domain: Social Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: hybrid

Estimated APC paid: $4,480