Delayed Medical and Mental Health Care Disparities Among Adults: Evidence From the Integrated Health Interview Series, 2000 to 2011

Background and Purpose:  Previous research lends support to the view that late detection and late treatment of health conditions compromise overall prognosis.  Healthcare utilization has particular relevance in the national efforts presently occurring to improve health care delivery system in the United States.  To this end, understanding and ultimately eliminating barriers to health care is a major public health and social concern particularly for vulnerable groups such as the underinsured or uninsured.  The main objective of this study was to examine how insurance enrollment or uninsurance among US adults affect forgoing medical and mental health care visits due to cost.

Methods:  This cross-sectional study examined associations between health insurance status and delayed medical and mental health visits in adults 18 to 64 years of age.  The dependent determinants, delayed medical health visits was defined as forgoing medical health care in the past 12 months due to cost and delayed mental health care visits was defined as forgoing mental health care in the past 12 months due to cost.  The independent determinant, insurance coverage, was categorized as Medicaid, private, and no insurance.  Other covariates assessed include sociodemographic factors (age, race and ethnicity, marital status, education, poverty status and sex), and health factors (self-rated health and regular place of care), and insurance coverage was categorized as Medicaid, private, and no insurance. Data from the Integrated Health Interview Series 2000 to 2011 were analyzed (n= 649,143; size = 70,107,444) using logistic regressions. 

Results: The results show 10.3 % and 3.1% of adults reported forgoing medical care and mental care, respectively.  Significant associations were found between health insurance and delayed medical and mental health visits.  After adjustments, respondents without health insurance coverage were 6.7 times (95% CI 6.29-7.21, p<0.000) more likely to forgo medical visits than those with Medicaid and those with private insurance were 1.2 times (95% CI 1.11-1.27, p<0.000) more likely to forgo medical visits than those with Medicaid.  Respondents without health insurance coverage were 3.1 times (95% CI 2.74-3.47, p<0.000) more likely to forgo mental care visits than those with Medicaid.  Results indicated an inversed relationship among respondents with private health insurance coverage.  These individuals were 0.7 times (95% CI 0.62-0.82, p<0.000) more likely or (1.43 times as unlikely) to forgo medical visits than those with Medicaid.  Significant covariates for both types of relationship included race and ethnicity, sex, age, education, marital status, self-rated health and whether or not a respondent had a usual place of healthcare. Among the covariates assessed, only poverty was not significant in the insurance coverage-delayed medical visits, relationship.

Conclusion & Implications: These findings suggests underlying sociodemographic and health factors contribution to differences in delayed medical and mental health care visits are important in the context of healthcare utilization among adults in the U.S with different insurance statuses.  Future social work research might investigate whether results are similar in other insurance coverage populations.