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“They Treat you a Different Way:” Public Insurance, Stigma, and the Challenge to Quality Health Care

Abstract

Under the Affordable Care Act, Medicaid Expansion programs are extending Medicaid eligibility and increasing access to care. However, stigma associated with public insurance coverage may importantly affect the nature and content of the health care beneficiaries receive. In this paper, we examine the health care stigma experiences described by a group of low-income public insurance beneficiaries. They perceive stigma as manifest in poor quality care and negative interpersonal interactions in the health care setting. Using an intersectional approach, we found that the stigma of public insurance was compounded with other sources of stigma including socioeconomic status, race, gender, and illness status. Experiences of stigma had important implications for how subjects evaluated the quality of care, their decisions impacting continuity of care, and their reported ability to access health care. We argue that stigma challenges the quality of care provided under public insurance and is thus a public health issue that should be addressed in Medicaid policy.

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Notes

  1. We define “Public insurance” as Medicaid and other government funded healthcare plans, such as county funded health plans available to low-income individuals. Medicare, which is not means-tested, is not included in this definition.

  2. To protect anonymity, all proper names in this paper are pseudonyms.

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Funding

The Michigan Department of Community Health (MDCH) provided funding for this research project (Grant # 134355). The views in this paper are those of the authors, and should not be assumed to reflect those of MDCH.

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Correspondence to Linda M. Hunt.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in this study. All names have been changed to pseudonyms and identifying information has been removed.

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Martinez-Hume, A.C., Baker, A.M., Bell, H.S. et al. “They Treat you a Different Way:” Public Insurance, Stigma, and the Challenge to Quality Health Care. Cult Med Psychiatry 41, 161–180 (2017). https://doi.org/10.1007/s11013-016-9513-8

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  • DOI: https://doi.org/10.1007/s11013-016-9513-8

Keywords

  • Stigma
  • Insurance
  • Poverty
  • Healthcare
  • Medicaid
  • Intersectionality