Publicly Insured Individuals Report Higher Satisfaction, Lower Costs Than Privately Insured

People enrolled in private and employer-sponsored insurance programs were more likely to report poor access to and lower satisfaction with care, as well as higher costs, than people enrolled in public insurance options, a new JAMA Network Open study shows.

“In this survey study, individuals covered by private insurance appeared to experience less access to care, higher costs of care, and decreased satisfaction with care compared with individuals with Medicare or VHA or military coverage,” said researchers.

Researchers conducted a survey of 149,290 people across 17 states and the District of Columbia using data from the 2016 to 2018 Behavioral Risk Factor Surveillance System, accounting for underlying health conditions. The final cohort was representative of 61 million US adults.

Of the survey participants, 63.9% were covered by private insurance (of which 79% had employer-sponsored coverage), 23.8% by Medicare, 8.9% by Medicaid, and 3.4% by Veterans Health Administration or military coverage.

Survey question topics included access to care, costs of care, and patient-reported satisfaction of care. In comparison to those covered by Medicare, individuals with employer-sponsored insurance were:

• less likely to report having a personal physician (odds ratio [OR], 0.52; 95% CI, 0.48-0.57);
• more likely to report instability in insurance coverage (OR, 1.54; 95% CI, 1.30-1.83), difficulty seeing a physician because of costs (OR, 2.00; 95% CI, 1.77-2.27), not taking medication because of costs (OR, 1.44; 95% CI, 1.27-1.62), and having medical debt (OR, 2.92; 95% CI, 2.69-3.17); and
• less satisfied with their care (OR, 0.60; 95% CI, 0.56-0.64).

In comparison with Medicaid, individuals with employer-sponsored insurance were:

• more likely to report having medical debt (OR, 2.06; 95% CI, 1.83-2.32) and
• less likely to report difficulty seeing a physician because of costs (OR, 0.83; 95% CI, 0.73-0.95) and not taking medications because of costs (OR, 0.78; 95% CI, 0.66-0.92).

The survey found no difference in satisfaction between those with Medicaid and those with employer-sponsored insurance.

The ACA has resulted in the expansion of public insurance options to more than 20 million adults in the United States. Data from this survey population represented “the experiences of more than 61 million US adults,” researchers noted.

“As US policy makers continue to debate health insurance reform, efforts directed at increasing the number of individuals covered by Medicare or improving protections for individuals covered by private insurance against increasing out-of-pocket costs, high deductibles, and surprise billing may be associated with improved experience of and satisfaction with health care,” researchers wrote.

Reference:
Wray CM, Khare M, Keyhani S. Access to care, cost of care, and satisfaction with care among adults with private and public health insurance in the US. JAMA Netw Open. 2021;4(6):e2110275. doi:10.1001/jamanetworkopen.2021.10275