Insured Yet Insecure: Navigating the Complexities of Healthcare Insurance

By: Jaylin Hsu and Stella Wang

Think back to your most recent hospital visit. Whether it was for a routine check-up or a more serious medical complication, before you could even see the doctor, you had to present your insurance card. Without hesitation, you handed it over to the receptionist. While this routine procedure occurs millions of times everyday across the country, not everyone possesses medical healthcare insurance, which results in an abundance of adverse health outcomes that plague the United States healthcare system.

Currently, in the United States, more than 90 percent of people have some form of healthcare insurance. While this number has improved throughout the past several years, unfortunately, this still leaves more than 28 million people without health insurance. Uninsured adults have decreased access to care and receive poorer quality of care.

Insurance can be obtained through a wide variety of avenues, including employers, private purchase, Medicare, Medicaid, and Veteran Affairs. Those with coverage experience a multitude of benefits, including access to better prescription drugs for their existing issues as well as early diagnosis and treatment of illnesses. Insured individuals experience decreased mortality rates; when the state of Massachusetts implemented insurance coverage expansion, death rates dropped. Evidently, health insurance is of the utmost importance as it allows for increased access to care, positive health outcomes, and reduced financial strain.

However, among those who do have health insurance plans, they do not all receive the same standardized quality or comprehensiveness of care- adults with Medicaid are five times more likely to have regular care and four times more likely to have preventative care compared to those insured. The same applies for children too, as Medicaid children are four times more likely to have regular care and two to three times more likely to have preventative care. A survey study by Wray et al. published in 2021 reported that participants who were privately insured under an employer-sponsored plan, which constituted 63.9 percent of the study pool, experienced decreased access to care due to high costs and reported lower satisfaction with the care received, in comparison to the 36.1 percent of participants who were publicly insured. This finding is quite peculiar, as it is an intuitive notion that higher costs should correlate with higher quality–in this case, higher quality of medical services. However, when it comes to health insurance, the relationship between cost and quality is not linear due to unseen factors such as administrative expenses and higher negotiating power of public insurance companies. In fact, utilizing public insurance appears to be critical in increasing equitable access to healthcare.

In terms of patient-provider relationships, a 2006 study conducted by Meyers et al. found that 88 percent of participating physicians in the study reported making at least one change from their typical form of care management due to a patient’s insurance status. For example, after discussing insurance issues with the patient, physicians reported making changes in preventative services, diagnostic evaluations, and therapeutic treatments. Additionally, these changes were more likely to occur when the patient was uninsured, and changes were less likely to occur when the patient had private insurance. Although it cannot be concluded that each change was detrimental, participating physicians recognized that some of these changes increased inconvenience for the patient or had a direct negative effect on devising their treatment plan.

Findings from Meyers et al. underscore several underlying issues within the healthcare system. For one, although the direct conclusion could not be made from the article, it is important to consider that insurance-induced changes made by physicians have the potential to negatively impact patient outcomes. Especially for long-term treatment plans, such as for chronic illnesses or severe conditions in need of more recovery time, the alteration of treatment plans and methods based on what is most cost-efficient presents a barrier for the patient to receive care that is of the highest possible quality. In addition, making decisions about patient treatments based on insurance statuses in itself presents a prevalent ethical dilemma for physicians to grapple with. Physicians undergo extensive training to provide the best possible care for their patients, yet once they become practicing providers, they are faced with the reality of insurance constraints and compromising their own values to comply with policies or meet quotas.

The discussions surrounding the topic of health insurance illuminate a concerning rising trend: health insurance has altered the traditional physician-patient landscape such that patients are regarded as sources of profit, rather than vulnerable people in need of high-quality, comprehensive medical advice from a compassionate care provider. This shift is not reflective of the capabilities of the physicians themselves, but rather an inevitable response to the systemic pressures exerted by the insurance framework in the United States. They are forced to make difficult decisions that must balance quality medical care with considering limitations posed by insurance plans. It is necessary to advocate for reforms within the healthcare system which prioritize patient wellbeing, prevent physician burnout, and construct a physician-provider relationship built on a foundation of compassion and trust.

Jaylin and Stella are both third year Molecular, Cell, and Developmental Biology majors and current THINQ fellows.

Works Cited

Abigail, Barker AR;Li R, and Linda Li. “The Cumulative Impact of Health Insurance on Health Status.” Health Services Research, U.S. National Library of Medicine, Oct. 2020, pubmed.ncbi.nlm.nih.gov/32700375/.

McWilliams, J Michael. “Health Consequences of Uninsurance among Adults in the United States: Recent Evidence and Implications.” The Milbank Quarterly, U.S. National Library of Medicine, June 2009, www.ncbi.nlm.nih.gov/pmc/articles/PMC2881446/.

Meyers, David S, et al. “Primary Care Physicians’ Perceptions of the Effect of Insurance Status on Clinical Decision Making.” Annals of Family Medicine, U.S. National Library of Medicine, Sept. 2006, www.ncbi.nlm.nih.gov/pmc/articles/PMC1578641/#:~:text=RESULTS%20Eighty%2Deight%20percent%20of,409%20patient%20encounters%20(24.2%25).

“Report: The Importance of Health Coverage.” American Hospital Association, www.aha.org/guidesreports/report-importance-health-coverage. Accessed 21 Apr. 2024.

Wray, Charlie M, et al. “Access to Care, Cost of Care, and Satisfaction with Care among Adults with Private and Public Health Insurance in the US.” JAMA Network Open, U.S. National Library of Medicine, June 2021, pubmed.ncbi.nlm.nih.gov/34061204/.