Access to Care, Cost of Care, and Satisfaction With Care Among Adults With Private and Public Health Insurance in the US, JAMA Network Open, June 1, 2021, by Charlie M. Wray, Meena Khare, Salomeh Keyhani
Introduction: In the past decade, health insurance expansion has been a major aspect of health care reform in the US, with the Patient Protection and Affordable Care Act (ACA) increasing coverage to more than 20 million US adults.
We used the Behavioral Risk Factor Surveillance System (BRFSS) to compare experiences related to access to care, costs of care, and satisfaction with care among the 5 major forms of health insurance coverage (private employerāsponsored insurance, private individually purchased insurance, Medicare, Medicaid, and Veterans Health Administration [VHA] or military coverage) after accounting for respondentsā underlying health.
Results: ā¦Compared with 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) and were 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). Compared with those covered by Medicare, individuals with employer-sponsored insurance were less satisfied with their care (OR, 0.60; 95% CI, 0.56-0.64)ā¦
Conclusions and Relevance: In this survey study, individuals with private insurance were more likely to report poor access to care, higher costs of care, and less satisfaction with care compared with individuals covered by publicly sponsored insurance programs. These findings suggest that public health insurance options may provide more cost-effective care than private options.
Comment:
By Don McCanne, M.D.
How many times do we have to say it? Public health insurance is designed to make health care accessible and affordable for the people. Private health insurance is designed to make a profit for the insurers. The policies used in the design of the various insurance products are selected on the basis of the desired results. Access to care, cost of care, and satisfaction with care are very important in the design of public insurance. In contrast, profits are of utmost importance in private insurance.
This study confirms that the private insurers will sacrifice access, cost, and satisfaction in order to increase profits. Patients have much higher access to care, financial protection, and satisfaction with public insurance. Shouldnāt we be demanding single payer Medicare for All so that we can all have what we want in health care, and so that we can free up the private insurers to engage in productive occupations that would be a greater benefit to society?
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