9.1 million adults with health insurance reported interruptions in benefits in 2018

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Disclosure: Yabroff does not report any relevant financial information. Please refer to the study for all relevant financial information from the other authors.


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The latest data shows that in 2018, around 9.1 million adults with health insurance reported interruptions in benefits in the previous year.

Adults who had an interruption in private or public insurance coverage received fewer preventive health services and were more likely to say they forego needed care and medication for cost reasons compared to those with continuous insurance coverage, the researchers said.

“Decades of research have shown that in the United States, health coverage is strongly linked to better access to standard health care, receiving recommended preventive services, treating acute and chronic illnesses, and survival.” K. Robin Yabroff, PhD, MBA, the American Cancer Society’s scientific vice president of health research, told Healio Primary Care. “However, less research has looked at the relationship between insurance interruptions (i.e., periods of uninsured) with access to care and affordability.”

Yabroff and colleagues used the National Health Interview Survey from 2011 to 2018 to assess whether disruptions of care or non-insurance affected access, maintenance, and affordability of care for adults under 65. Of the study population, 124,746 had private health insurance, 30,932 statutory health insurance and 31,802 were not.

In 2018, 5% of the privately insured and 10.7% of the publicly insured reported an interruption in coverage in the previous year, which corresponds to an estimated 6.8 million and 2.3 million adults, respectively. Interruptions in insurance cover were less preventive for both private (adjusted OR = 0.42; 95% CI 0.37-0.46) and public (aOR = 0.48; 95% CI, 0.4 –0.58) compared to those with continuous insurance coverage. The costs during the interruption of insurance cover were also with the waiver of the necessary care for patients with private (aOR = 4.79; 95% CI 4.44-5.17) and public (aOR = 4.28; 95% -KI, 3.86-4.75), which were not complied with (private: aOR = 3.55; 95% CI 3.13-4.03; public: aOR = 4.09; 95% CI 3.43-4.88) compared to those with continuous coverage.

According to the researchers, longer interruption times were “significantly associated with poorer access, maintenance and affordability of care and dose-response patterns.”

Although interruptions in health insurance coverage were assessed during the 2018 study period, the researchers found that the results have an impact on the COVID-19 pandemic. The rising unemployment rates in the first few months of the pandemic were later lowered in part due to the “recovery”, but part of that recovery occurred in “industries where their employees are less likely to be insured, such as retail and hospitality”. They added that the permanent health effects of infection “may affect the ability to work” in the 14.5 million US residents diagnosed with COVID-19 as of December 2020.

“The COVID-19 pandemic resulted in widespread unemployment and the potential loss of employer-based health coverage, which is the most common type of coverage for adults aged 18 to 64 in the United States,” said Yabroff.

The next steps in research will be to “assess the impact of the COVID-19 pandemic on health insurance coverage, disruptions in insurance coverage and access to care once this data becomes available” and “the relationships between the COVID-19 pandemic and disruptions in the Health insurance coverage and the stage of cancer diagnosis, obtaining cancer care and related health outcomes, ”said Yabroff.

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