TYPE OF INSURANCE COVERAGE AND AFFORDABILITY BARRIERS IN MEDICAL, DENTAL, AND PRESCRIPTION SERVICES AMONG ADULTS IN THE UNITED STATES
Author(s)
Nazneen Fatima Shaikh, PhD1, MOHAMMAD IKRAM, PhD2.
1Real World Solutions, IQVIA, Inc., Jersey City, NJ, USA, 2Penn State University, Harrisburg, PA, USA.
1Real World Solutions, IQVIA, Inc., Jersey City, NJ, USA, 2Penn State University, Harrisburg, PA, USA.
OBJECTIVES: Affordability-related unmet need remains a major barrier to accessing health services in the US and may differ substantially by insurance coverage type. We examined insurance-based differences in the inability to afford (1) medical care, (2) dental care, and (3) prescription medicines among adults.
METHODS: Pooled data from the Medical Expenditure Panel Survey (MEPS) 2018-2023 were used to identify adults who responded to the question on the affordability of care. Outcomes were self-reported inability to afford medical care, dental care, and prescription medicines (yes/no). Insurance coverage was categorized as private, public, or uninsured. Chi-square tests and three separate multivariable logistic regressions analyzed the unadjusted and adjusted associations between insurance coverage type and affordability measures. All analyses accounted for the complex survey design of MEPS.
RESULTS: In the weighted population, 68.1% had private insurance, 24.7% public coverage, and 7.2% were uninsured. Overall, 4.4% reported inability to afford medical care, 9.7% dental care, and 3.0% prescription medicines. Affordability barriers differed significantly by insurance type (p<0.001), with the uninsured consistently reporting the highest prevalence, followed by publicly and privately insured adults. After adjustment, public coverage was associated with higher odds of unaffordable care compared with private coverage for medical (AOR 1.13 [95% CI 1.00-1.27]), dental (AOR 1.51 [1.33-1.70]), and prescription medicines (AOR 1.46 [1.24-1.72]). Uninsured adults experienced substantially higher odds across all outcomes: medical (AOR 3.34 [2.91-3.83]), dental (AOR 2.35 [1.95-2.83]), and prescription medicines (AOR 1.70 [1.24-2.32]) (all p<0.001).
CONCLUSIONS: Insurance coverage is strongly associated with affordability-related unmet need across medical, dental, and prescription services, with the uninsured experiencing the greatest barriers and publicly insured adults also facing elevated affordability challenges, especially for dental care and medications.
METHODS: Pooled data from the Medical Expenditure Panel Survey (MEPS) 2018-2023 were used to identify adults who responded to the question on the affordability of care. Outcomes were self-reported inability to afford medical care, dental care, and prescription medicines (yes/no). Insurance coverage was categorized as private, public, or uninsured. Chi-square tests and three separate multivariable logistic regressions analyzed the unadjusted and adjusted associations between insurance coverage type and affordability measures. All analyses accounted for the complex survey design of MEPS.
RESULTS: In the weighted population, 68.1% had private insurance, 24.7% public coverage, and 7.2% were uninsured. Overall, 4.4% reported inability to afford medical care, 9.7% dental care, and 3.0% prescription medicines. Affordability barriers differed significantly by insurance type (p<0.001), with the uninsured consistently reporting the highest prevalence, followed by publicly and privately insured adults. After adjustment, public coverage was associated with higher odds of unaffordable care compared with private coverage for medical (AOR 1.13 [95% CI 1.00-1.27]), dental (AOR 1.51 [1.33-1.70]), and prescription medicines (AOR 1.46 [1.24-1.72]). Uninsured adults experienced substantially higher odds across all outcomes: medical (AOR 3.34 [2.91-3.83]), dental (AOR 2.35 [1.95-2.83]), and prescription medicines (AOR 1.70 [1.24-2.32]) (all p<0.001).
CONCLUSIONS: Insurance coverage is strongly associated with affordability-related unmet need across medical, dental, and prescription services, with the uninsured experiencing the greatest barriers and publicly insured adults also facing elevated affordability challenges, especially for dental care and medications.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HPR98
Topic
Health Policy & Regulatory
Disease
No Additional Disease & Conditions/Specialized Treatment Areas