Journal Article

The Role of Stigma in Access to Health Care for the Poor

HARDING, KRISTIN, WRIGHT, BILL J., ALLEN, HEIDI, BROFFMAN, LAUREN

2014

Overview

Context: The Affordable Care Act provides new Medicaid coverage to an estimated 12 million low-income adults. Barriers to access or quality could hamper the program's success. One of these barriers might be the stigma associated with Medicaid or poverty. Methods: Our mixed-methods study involved 574 low-income adults and included data from an in-person survey and follow-up interviews. Our analysis of the interviews showed that many participants who were on Medicaid or uninsured described a perception or fear of being treated poorly in the health care setting. We defined this experience as stigma and merged our qualitative interviews coded for stigma with our quantitative survey data to see whether stigma was related to other sociodemographic characteristics. We also examined whether stigma was associated with access to care, quality of care, and self-reported health. Findings: We were unable to identify other sociodemographic characteristics associated with stigma in this low-income sample. The qualitative interviews suggested that stigma was most often the result of a provider-patient interaction that felt demeaning, rather than an internalized sense of shame related to receiving public insurance or charity care. An experience of stigma was associated with unmet health needs, poorer perceptions of quality of care, and worse health across several self-reported measures. Conclusions: Because a stigmatizing experience in the health system might interfere with the delivery of high-quality care to new Medicaid enrollees, further research and policy interventions that target stigma are warranted.

• Publisher: Blackwell Publishing Ltd,THE MILBANK MEMORIAL FUND,BlackWell Publishing Ltd
• Subject: Access / Access to health care / Adult / Adults / Attitude to Health / Charity / Constraints / Data Collection / Delivery of Health Care - utilization / Doctor-patient relationship / Experience / Female / Focus Groups / Government programs / Health / Health care / Health care access / Health care quality / Health Care Services / Health insurance / Health needs / Health policy / Health services / Health Services Accessibility - economics / Hospitals / Humans / Income / Insurance coverage / Insurance providers / Internalization / Intervention / Interviews / Interviews as Topic / Legislation / Low Income Groups / Low income people / Male / Medicaid / Medicaid - utilization / Medicaid program / Medical service / Medical sociology / Mental health / Mental health insurance / Oregon / Original Investigation / Patient Protection & Affordable Care Act 2010-US / Polls & surveys / Poor / Poverty / Poverty - psychology / Quality of care / Quality of Health Care / Shame / Social disadvantage / Social inequality / Social interest / Social medicine / Social stigma / Sociodemographic aspects / Sociodemographic Characteristics / Sociodemographics / Stereotypes / Stereotyping / Stigma / Stigmatization / Success / Surveys / U.S.A / Uninsured people / United States / user's experiences