Delayed and foregone care among low-income insured adults: Does the magnitude of perceived problems create barriers to accessing healthcare?

INTRODUCTION: In a group of low-income, ethnically diverse adults enrolled in public healthcare programs, we examine reports of provider discrimination and perceived barriers to care. We further examine the effect of the frequency of discrimination and the magnitude of perceived barriers on needed healthcare being delayed or foregone in the past year. We hypothesized that those who report frequent discrimination compared to no discrimination or big problems accessing healthcare compared to no problems will have substantially higher odds of delayed or unmet medical needs within the last year. METHODS: We used data from a statewide survey of Minnesota Healthcare Program enrollees (n = 4,626) designed to assess racial and ethnic disparities in the utilization of healthcare services. Outcomes are self-reported delayed care or foregone care in the past year. Independent variables are levels of perceived discrimination (frequent, some, none) and levels of perceived barriers to care (big, small, no problems). Barriers domains included: 1) Coverage; 2) Financial; 3) Access; 4) Family and work responsibilities; 5) Provider-related issues. We used six multivariable logistic regression models to examine the impact of discrimination and each of five barrier domains on both outcomes, adjusting for race/ethnicity and additional covariates. Models were weighted for unequal probability of selection and accounted for the stratified sample design. RESULTS: Reports of any discrimination (frequent or some) compared with no discrimination or any problems (big or small) compared with no problems significantly increased the odds of delayed care in the past year. Additionally, frequent discrimination and big problems significantly increased the odds of foregoing needed healthcare in the past year compared with those who report no discrimination or problems, respectively. The effects for those who report some discrimination or small problems are mixed. Those who report some problems with coverage barriers, access barriers, and provider-related barriers have significantly increased odds of foregone care in the past year compared to no problems, while those who report some problems with financial barriers, family/work barriers, or some experiences of discrimination are not significantly different. DISCUSSION: Insured adults who experience any provider discrimination and problems of all types when accessing healthcare have significantly increased odds of delaying needed healthcare. In three of six barrier domains, only frequent discrimination and big problems have a consistent significant effect on foregoing needed healthcare. Expanding coverage without reducing other barriers to care is unlikely to eliminate disparities in access to services.