Variations in Patient Centered Care by Insurance Type

As the U.S. looks to improve health coverage for its citizens, it is important to identify potential gaps in quality of care in the current system. Patient-centered health care is a vital component of quality health care. This analysis examines variations in health care provider experiences, a key aspect of patient-centered care, by insurance type.

Our sample consisted of adults aged 18 years and older from the 2007 Medical Expenditure Panel Survey (N=14,600). All data were self-reported. Health insurance coverage was grouped as Medicaid, Medicare, or private health insurance. Respondents reported the frequency of the following health care provider (HCP) experiences: HCP listens carefully to you (LISTENS); HCP explains things so you understand (EXPLAINS); HCP respects what you have to say (RESPECTS), and HCP spends enough time with you (TIME). Response options were always, usually, sometimes or never. Suboptimal experience was defined as a response of never or sometimes. Logistic regression was used to model odds of suboptimal HCP experiences, comparing Medicaid to private and Medicare to private.

Compared to persons with Medicaid and Medicare, persons with private health insurance were significantly (p>.05) less likely to report the following suboptimal care experiences: LISTENS (16 % and 13 % versus 7%, respectively), EXPLAINS (15% and 15% versus 6%, respectively), RESPECTS (14 % and 13 % versus 7% respectively), and TIME (20%, 17% versus 14% respectively). In logistic regression models adjusted for age, sex, race/ethnicity, and education level, persons with Medicaid were more likely to report the following suboptimal care experiences compared to those with private insurance: LISTENS (AOR 1.9; 95%CI= 1.5-2.4); EXPLAINS (AOR 2.0; 95%CI=1.5-2.5); RESPECTS (AOR 2.2; 95%CI=1.7-2.9); and TIME (AOR 1.7; 95% CI=1.4-2.2). In logistic regression models adjusted for age, sex, race/ethnicity, and education level, persons with Medicare were more likely to report the following suboptimal care experiences compared to those with private insurance: EXPLAINS (AOR 1.4; 95%CI=1.0-2.0); and RESPECTS (AOR 1.6; 95%CI=1.1-2.1).

Our findings suggest that HCP experiences may be poorer among persons with Medicaid and Medicare compared to those with private insurance. Investigating and addressing reasons for suboptimal HCP experiences among persons with public insurance may improve the overall quality of health care in this group and may improve health equity between persons with public and private health insurance.