Affordability of health care under publicly subsidized insurance after Massachusetts health care reform: a qualitative study of safety net patients

International Journal for Equity in Health

Research

Danny McCormick¹  Rachel Nardin¹  Leah Zallman²  Monica Malowney³  Assaad Sayah⁴ 

[1] Department of Medicine, Cambridge Health Alliance, 02139, Cambridge, MA, USA;Harvard Medical School, Boston, MA, USA;Department of Medicine, Cambridge Health Alliance, 02139, Cambridge, MA, USA;Institute for Community Health, Malden, MA, USA;Harvard Medical School, Boston, MA, USA;Department of Population Health, Maimonides Medical Center, Bronx, NY, USA;Harvard Medical School, Boston, MA, USA;Cambridge Health Alliance, Cambridge, MA, USA;

关键词: Cost Sharing;    Federal Poverty Level;    Health Reform;    Insurance Type;    Medicaid Expansion;   

DOI  :  10.1186/s12939-015-0240-5

 received in 2015-06-18, accepted in 2015-10-08,  发布年份 2015

来源: Springer

【 摘 要 】

IntroductionThe Affordable Care Act (ACA) and the 2006 Massachusetts (MA) health reform law, on which the ACA was based, aimed to improve the affordability of care largely by expanding publicly sponsored insurances. Both laws also aimed to promote consumer understanding of how to acquire, maintain and use these public plans. A prior study found an association between the level of cost-sharing required in these plans and the affordability of care. Preparatory to a quantitative study we conducted this qualitative study that aimed to examine (1) whether cost sharing levels built into the public insurance types that formed the backbone of the MA health reform led to unaffordability of care and if so, (2) how insurances with higher cost sharing levels led to unaffordability of care in this context.MethodsWe interviewed 12 consumers obtaining the most commonly obtained insurances under MA health reform (Medicaid and Commonwealth Care) at a safety net hospital emergency department. We purposefully interviewed a stratified sample of higher and low cost sharing recipients. We used a combination of inductive and deductive codes to analyze the data according to degree of cost-sharing required by different insurance types.ResultsWe found that higher cost sharing plans led to unaffordability of care, as evidenced by unmet medical needs, difficulty affording basic non-medical needs due to expenditures on medical care, and reliance on non-insurance resources to pay for care. Participants described two principal mechanisms by which higher cost sharing led to unaffordability of care: (1) cost sharing above what their incomes allowed and (2) poor understanding of how to effectively acquire, maintain and utilize insurance new public plans.ConclusionsFurther efforts to investigate the relationship between perceived affordability of care and understanding of insurance for the insurance types obtained under MA health reform may be warranted. A potential focus for further work may be quantitative investigation of how the level of calibration of cost-sharing to income and understanding of insurances under the MA reform was associated with perceived affordability of care.

【 授权许可】

CC BY   
© Zallman et al. 2015