Adults with public insurance report lower costs and greater satisfaction than those with private insurance.



Individuals with private insurance are more likely to report higher care costs, poor access to services and less satisfaction with their care than those using a publicly funded program, according to a study recently published in JAMA Open Network

A survey of nearly 150,000 adults in 17 US states and Washington, DC also found that medical debt is more common among those with private insurance.

However, trends in favor of public insurance were less consistent when comparing Medicaid versus privately insured, with the former group frequently reporting cost-related barriers to health care.

“This data is consistent with the findings of the previous study, provides an update on the experience of adults in the US with private and public insurance, and suggests that the experience of people with private insurance is less different from that of people with public plans,” wrote the researchers from University of California, San Francisco or related.

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For their analysis, the researchers analyzed data collected from the state’s annual telephone survey between 2016 and 2018. The surveys included six questions in which respondents were asked to describe their access to care, the cost of care, and satisfaction with the care.

Individuals included in the analysis disclosed whether they had coverage that was purchased by an individual or an employer (private), or offered through Medicare, Medicaid, or the Veterans Health Administration (VHA) / military program (government).

Of the 149,290 respondents included in the analysis, about 64% were covered by private insurance. These people tended to be younger, had a job, were married, and had a higher level of education than those on a government program.

Four out of five respondents with private insurance said they were insured through an employer-sponsored plan. About two-thirds of those with public insurance were covered by Medicare, and about a quarter were covered by Medicaid.

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Compared to other coverage options, those with Medicare were more likely to report having a provider and were more satisfied with their care. In the meantime, Medicaid recipients most often reported having difficulty seeing a doctor or taking medication because of the cost.

When measured directly against each measure of cost, access, and satisfaction, Medicaid coverage consistently outpaced private options. VHA / military lighting also performed well when compared to private lighting, although these people were more likely to say they did not have a personal doctor.

The researchers wrote that comparisons between those using private insurance and Medicaid were more mixed. While Medicaid covered individuals were more likely to report having a personal doctor, they were also more likely to report variability in coverage and various cost barriers to care than individuals with private coverage.

An exception is medical debt, which is more frequently reported by individuals with individually purchased or employer-sponsored private insurance than any government type of coverage.

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The researchers suggested that people’s satisfaction and other outcomes may be less dependent on the source of coverage than on the quality of the benefits each person’s plan offers.

Just like the researchers write, comparisons between Medicaid and privately insured recipients differ from state to state and may reflect the impact of cost sharing or other out-of-pocket spending across states.

“As US policymakers continue to debate health insurance reform, efforts to increase the number of people covered by Medicare or better protect those covered by private insurance from increased personal spending, high deductibles, and unexpected billing may be associated with improved experience and satisfaction. medical care, ”the researchers write.


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