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

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...

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Bibliographic Details
Published in:Culture, medicine and psychiatry medicine and psychiatry, 2017-03, Vol.41 (1), p.161-180
Main Authors: Martinez-Hume, Anna C., Baker, Allison M., Bell, Hannah S., Montemayor, Isabel, Elwell, Kristan, Hunt, Linda M.
Format: Article
Language:English
Subjects:
Access
Adolescent
Adult
Anthropology
Clinical Psychology
Decisions
Female
Health care
Health care policy
Health insurance
Health services utilization
Healthcare Disparities - standards
Humans
Illnesses
Income
Intersectionality
Low income groups
Male
Medicaid
Medical Assistance - standards
Medical decision making
Middle Aged
Original Paper
Patient Protection & Affordable Care Act 2010-US
Psychiatry
Public Health
Qualitative Research
Quality of care
Quality of Health Care - standards
Race
Social Sciences
Social Stigma
Socioeconomic status
Sociology
Stigma
Welfare recipients
Young Adult
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Summary: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.
ISSN:0165-005X
1573-076X
DOI:10.1007/s11013-016-9513-8