Health insurance is not an indicator of good health, study says

A new study suggests how a patient identifies along racial and ethnic lines may be a greater indicator of their health than their insurance status.

Health disparities and access issues exist among individuals who receive health insurance through their employer, despite arguments that access to commercial insurance acts as a great equalizer among patients, according to a study published Monday by NORC at the University of Chicago.

The report was sponsored by Morgan Health, an initiative of JPMorgan Chase & Co. aimed at reforming the employment-based health insurance market. The findings show that socioeconomic differences are not the only factor leading to disparate health outcomes among different racial and ethnic groups, said Caroline Pearson, the study’s author and a senior vice president of health care strategy at NORC, a research organization. social.

“When you do research and report results on race and ethnicity, inevitably someone says, ‘How much of this is accounted for by income differences?’ Pearson said. “One of the things that was really exciting about our study was that we were able to control for differences in age, gender, income, and by race and ethnic group. Health disparities persist even after these adjustments. This really suggests that health disparities are deeply rooted in our health care system.”

The researchers analyzed self-reported data from people enrolled in their employer’s health plan from 2017 to 2019. They reviewed information that 12,372 patients reported in the Federal National Health Interview Survey; 3,103 individuals were reported in the Federal Health and Nutrition Examination Survey; and 14,580 were reported in the federal National Survey on Drug Use and Health.

The research found that black, Asian, and Hispanic respondents with low-risk pregnancies were at least 3 percentage points more likely to undergo a C-section than their white counterparts. C-sections pose a greater risk of maternal morbidity and mortality than vaginal delivery for low-risk pregnancies and are associated with a greater risk of infection, longer hospital stays, and hospital readmissions, according to the American College of Obstetricians and Gynecologists. Gynecologists. Twenty percent of black respondents, 17.7 percent of Asian respondents, and 17 percent of Hispanic patients with low-risk deliveries had had cesarean sections, compared with 13.6 percent of black respondents. white.

“These are people who are connected to the health care system and they all have low-risk pregnancies,” Pearson said. “Why are we performing C-sections at much higher rates in people of color? We shouldn’t.”

Lesbian, gay and bisexual individuals reported higher levels of serious psychological distress, anxiety and depression than people who were heterosexual, the study said. More than 23% of LGBTQ individuals said they had experienced serious psychological distress, compared to 8.8% of heterosexual patients who reported that condition, according to the report.

According to the report, white respondents of all genders and sexual orientations were more likely than black, Hispanic and Asian respondents to experience serious psychological distress.

Across the population, 30% of individuals reported heavy alcohol use, 18.8% said they used illicit drugs such as cocaine, and 19.8% used tobacco products. White and Hispanic respondents reported the highest rates of heavy alcohol use, at 31.7% and 33.2%, respectively. Almost 21% of white patients reported using illicit drugs, compared with 16.4% of black individuals, 16.6% of Hispanic individuals and 8.9% of Asian individuals, according to the report.

Chronic disease rates also differed among black, Asian, Hispanic, and white patients.

Asian, Hispanic and black individuals were more likely to have diabetes than whites, the study found. Black people were also more likely to have higher and uncontrolled blood pressure than white individuals.

While nearly all respondents reported having a common source of care, the study showed differences in how often different racial, ethnic, and income groups used the emergency department. The study authors pointed to emergency department use as a proxy for reliable access to care.

Black patients were more likely and Asian individuals were less likely to visit an emergency room than white people, the researchers said. Individuals in the lowest income group earning less than $50,000 per year were 7.1 percentage points more likely to have visited an emergency department than people in the highest income group earning at least $150,000 dollars.

“The working poor in this country still face many challenges in food security and paying medical bills compared to other costs, etc.,” Pearson said. “This is hard data for employers to digest.”

The findings create a national benchmark that employers can use to understand how their workers’ health compares to the national average, Pearson said. From there, companies should reflect on how to design health and wellness benefits to address health disparities, she said.

“They need to think about what are the actual things that are driving the disparities in this study, as opposed to just paying for them,” Pearson said.

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