Lack of confidence in understanding of health insurance may influence whether Black and Hispanic adults use covered ambulatory care services

An article in the April/June 2022 issue of the Journal of Ambulatory Care Management looked at why Black and Hispanic non-elderly people with care-sensitive conditions like diabetes and hypertension underutilize health insurance. Authors Dean et al. noted research showing that many Black and Hispanic Americans have health insurance but have challenges accessing ambulatory care services. In addition, “no known studies have examined factors that influence this population’s insurance use.” To explore two likely factors, Dean et al. turned to data collected in the Health Reform Monitoring Survey, distributed at ICPSR via the Health & Medical Care Archive. Launched in 2013 by the Urban Institute, the HRMS provides timely information on implementation issues under the Affordable Care Act (ACA) and changes in health insurance coverage and related health outcomes. It also provides data on access to and use of health care, health care affordability, and self-reported health status. First fielded quarterly, then semiannually, each HRMS survey draws from a panel of 55,000 non-elderly adults in the US. Dean et al. analyzed the responses from 10,792 respondents surveyed between the years 2013 and 2016, who self-reported that they had an ambulatory care-sensitive condition (ACSC). Dean et al. then generated two scores based on respondents’ answers to key questions in order to measure 1) their satisfaction with their health insurance and 2) their confidence in their understanding of health insurance. Dean et al. found that “Black and Hispanic participants with ACSCs had a significantly lower standardized confidence score than their White counterparts,” which may “provide insight into their lowered use of ambulatory care services in this country.” On the other hand, Dean et al. found no significant relationship between satisfaction with insurance and race/ethnicity, which they surmised may be attributable to the subsidies provided to lower-income families and Medicaid expansion under the ACA. Click here to see more publications that use HRMS data.