Adults with public insurance report lower costs, greater satisfaction than those with private coverage

Individuals covered under private insurance more often report higher care costs, poor access to services and less satisfaction with their care than those under a publicly sponsored program, according to a survey study recently published in JAMA Network Open.

Conducted among nearly 150,000 adults living in 17 U.S. states and Washington, D.C., the poll also found medical debt to be more common among individuals with private insurance.

However, trends favoring public coverage were less consistent when comparing individuals with Medicaid coverage to those with private insurance, with the former group often reporting cost-related barriers to receiving care.

“These data are consistent with findings from prior research, provide an update on U.S. adults’ experiences with private and public coverage and suggest that the experiences of individuals covered by private insurance compare less favorably with the experiences of individuals covered by publicly sponsored plans,” researchers from or affiliated with the University of California, San Francisco wrote.

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For their analysis, researchers reviewed data collected from an annual state-based telephone survey between 2016 and 2018. The surveys included six questions asking respondents to describe their access to care, care costs and care satisfaction.

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

Among 149,290 respondents included in the analysis, about 64% were covered by private insurance. These individuals tended to be younger, employed, married and have higher educational attainment compared to those under public plans.

Four in five respondents with private insurance said they were covered under an employer-sponsored plan. About two-thirds of those with public insurance were covered under a Medicare plan, and about a quarter had Medicaid coverage.

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Compared to the other coverage options, those with Medicare more often reported having a healthcare provider and had higher satisfaction with their care. Medicaid beneficiaries, meanwhile, most often reported difficulty with seeing a physician or taking medications due to cost.

In head-to-head adjusted comparisons of each cost, access and satisfaction metric, Medicaid coverage consistently came out ahead of the private options. VHA/military coverage also fared well in relation to private coverage, although these individuals more often said they did not have a personal physician.

Comparisons between those with private insurance and Medicaid were more mixed, researchers wrote. While Medicaid-covered individuals more often reported having a personal physician, they were also more likely to report coverage instability and various care barriers related to cost than those with private coverage.

The exception came in the form of medical debt, which was more commonly reported among individuals with either individually purchased or employer-sponsored private insurance than among any public type of coverage.

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Researchers speculated individuals’ satisfaction and other findings may be less dependent on the source of insurance coverage than on the quality of benefits being offered by each individual’s plan.

Similarly, comparisons between Medicaid beneficiaries and those with private insurance varied from state to state, the researchers wrote, and could reflect the impact of cost-sharing or other out-of-pocket expenses implemented in different states.

“As U.S. policymakers continue to debate health insurance reform, efforts directed at increasing the number of individuals covered by Medicare or improving protections for individuals covered by private insurance against increasing out-of-pocket costs, high deductibles and surprise billing may be associated with improved experience of and satisfaction with health care,” the researchers wrote.