EXPLORING UNDERINSURANCE IN 2 SAFETY-NET CLINICS IN NEW MEXICO
Monica Swann, Gina Cardinali, Robert Rhyne, Andrew Sussman, Jennifer Bryant.
The University of New Mexico, Albuquerque, NM.
Since the inception of the Affordable Care Act (ACA), increased attention has shifted from the uninsured to the underinsured. Underinsurance (UI) is experientially defined to be when a person with health insurance experiences stressors due to the lack of access to medical care. The aim of this study was to investigate the prevalence of UI before the ACA, elicit patient and provider perceptions of UI, and explore the psychosocial and socioeconomic impact of UI. The study was implemented in New Mexico in 2 safety net clinics among the Vietnamese, Hispanic, and Anglo clinic population. Quantitative data were collected using surveys administered via telephone and in-person interviews and using REDCap electronic data collection software. Qualitative data were collected from patients and providers using interviews and focus groups and analyzed by reviewing transcripts thematically. The mixed-method approach allowed a deeper understanding of the experiences and decisional challenges encountered by patients and providers. Almost one-third of study participants were underinsured and 46% of them reported having poor health. Patients who were between 30 and 46 years old, Hispanic, low-income, and employed full-time were the most susceptible to being underinsured. Those with an income of < $25K were 8 times more likely to be underinsured. Qualitative data revealed 3 distinct themes: challenges UI patients encounter (inability to pay for necessary healthcare); strategies UI patients use (skipping or stretching medication); and patient and provider primary care specific problems (patients felt that personal relationships with doctors would improve care).