Introduction: Homeless individuals bear a disproportionately high burden of disease. Lack of health insurance amongst homeless populations is a significant barrier to healthcare access.
Methods: This study explored barriers and facilitators to health insurance via a survey-format that focused predominantly on attitudes towards health insurance and enrollment assistance.
Results: Majority of respondents endorse a facilitator to guide the enrollment process at their location of healthcare. While 43.8% of participants reported they knew where to go for enrollment assistance, 43.7% did not. 100% of participants agreed that health insurance is important, while only 43.1% were insured.
Conclusion: Distrust regarding facilitation in the previous literature is overstated. Confusion during enrollment process is a merited concern. Data from this study showed that the population prioritizes health insurance. Financial barriers remain significant. This population has overall positive attitude towards health insurance enrollment and facilitation. Low-level outreach is warranted

Brown, Christopher

English

VCU Scholars Compass

Virginia Commonwealth UniversityVCU Scholars CompassMedical Education Symposium School of Medicine2017Assessing Attitudinal Barriers to Health InsuranceEnrollment and Facilitation in VulnerablePopulationsChristopher BrownVCUFollow this and additional works at: https://scholarscompass.vcu.edu/med_eduPart of the Medicine and Health Sciences Commons© The Author(s)This Poster is brought to you for free and open access by the School of Medicine at VCU Scholars Compass. It has been accepted for inclusion inMedical Education Symposium by an authorized administrator of VCU Scholars Compass. For more information, please contact libcompass@vcu.edu.Downloaded fromhttps://scholarscompass.vcu.edu/med_edu/5Introduction• Nearly 550,000 individuals experience homelessnesseach night in the United States [1].• Homeless individuals bear a disproportionately highburden of disease from acute and chronic medicalconditions in addition to a mortality rate that is morethan four times that of the general population [2].• Single greatest obstacle to healthcare access amongstthe homeless population is lack of health insurance[3].• Lack of awareness of available coverage options andconfusion regarding enrollment procedures mayrepresent a primary barrier to enrollment amongstthis population [4].• Distrust and disengagement, language and literacybarriers, and absence of stable contact informationmay further impede the process of achieving healthinsurance coverage [5].• In this study we surveyed guests at an urbanhomeless shelter to explore barriers and facilitatorsto health insurance in this population.• We focused predominantly on attitudes towardshealth insurance and enrollment assistance that mayinform future enrollment efforts.Results• 52 shelter guests, 81.3% of whom reported chronic homelessness, participated in the study.• Forty-six respondents (90.2%) stated they had received healthcare in the past year; 11 (21.6%) report visits for preventive care.• Compared to currently insured respondents, uninsured individuals with eligibility indicators were less likely to have completed high school(86.4% vs 56.3%, P = 0.037).• Trends were noted towards increased coverage with increased educational attainment, dependent children, military service, and monthlyincome.• Sixteen of the currently uninsured individuals (55.2%) reported at least one indicator of program eligibility.• The most common barriers identified by participants included expense, difficulty negotiating the enrollment process, inability to accesscommunity resourcesConclusions• Distrust regarding facilitation in the previousliterature is overstated• Regarding placement of resources to assist inenrollment, respondents most commonly reported thatthey would want facilitators in primary care offices andfree clinics (84.4% and 87.5%, respectively) followedby the CSB (78.1%), the homeless shelter (75%) and theED (68.8%).• Confusion about the process is a warranted concern• Responses regarding the enrollment process were moredivided. While 43.8% of participants believed theyknew where to go for enrollment assistance, 43.7%disagreed. Alternatively, only 28.1% of respondentsbelieved that the enrollment process was toocomplicated, whereas 59.4% disagreed. Only 20% ofthose with prior military service reported that they werenot aware of the benefits offered by the VA; however,40% reported that accessing these resources wasdifficult, and the remainders were neutral.• Data showed that population prioritized insurance• Likert responses were not dissimilar from the populationas a whole: 100% agreed that health insurance isimportant.• Agree that financial barrier is significant• Interestingly, all 3 participants endorsing expense as abarrier to enrollment had multiple indicators foreligibility in public insurance schemes.• Population has overall positive attitude towardshealth insurance enrollment and facilitation• Low level outreach is warranted; relationship and trustbuilding within the community through insuranceenrollment is efficacious.Methods• Study approved by Eastern Virginia Medical SchoolInstitutional Review Board under exemption fromfull review and waiver of formal consent.• Structured interviews were conducted with guests ofan overnight shelter for homeless adults organizedthrough the Norfolk Emergency Shelter Team(NEST) over a one-week period in March, 2016.• All interviews were administered by trainedpersonnel following scripted verbal consent.• A combination of free-response, yes/no, multiplechoice questions and Likert-style questions wereused to assess demographics, health status and healthresource utilization, characteristics related tohomelessness, insurance status, and attitudes.Innovation• Health insurance acquisition among vulnerablepopulations has been shown to double primary careresource utilization, increase use of ambulatory careservices, reduce ED visits, and improve medicationadherence. [6-8]• Previous literature has shown that vulnerablepopulations can be effectively engaged in primary andother clinical care services through low-level tailoredoutreach efforts. [9]• Implementation of low-level outreach to connectvulnerable populations with health insurance facilitatorscan identify individuals with markers of healthcareinsurance eligibility.• This approach addresses perceived barriers to obtaininghealth insurance such as negative attitudes and difficultynegotiating the enrollment process. [5]• With 90.2% of respondents having accessed healthcarein the past year, the vast majority of individuals withinthis and similar vulnerable populations will have contactwith resources.• There is a need for further research to determine theeffectiveness of tailored outreach efforts for thefacilitation of insurance enrollment.References1. Meghan Henry RW, Lily Rosenthal, and Azim Shivji, Abt Associates. The 2016 Annual Homeless Assessment Report (AHAR) to Congress. The U.S. Department of2. Morrison DS. Homelessness as an independent risk factor for mortality: results from a retrospective cohort study. Int J Epidemiol. 2009;38(3):877-883. 3. Jezewski MA. Staying connected: the core of facilitating health care for homeless persons. Public Health Nurs. 1995;12(3):203-210.4. Fryling LR, Mazanec P, Rodriguez RM. Barriers to Homeless Persons Acquiring Health Insurance Through the Affordable Care Act. J Emerg Med. 2015;49(5):755-762.e752.5. DiPietro B KS, Ertiga D, et al. Medicaid Coverage and Care for the Homeless Population: Key Lessons to Consider for the 2014 Medicaid Expansion. W A S H I N G T O N , D C: The Henry J. Kaiser Family Foundation; September 2012.6. Kushel MB, Vittinghoff E, Haas JS. Factors associated with the health care utilization of homeless persons. JAMA. 2001;285(2):200-206. 7. Riley ED, Moore KL, Haber S, Neilands TB, Cohen J, Kral AH. Population-level effects of uninterrupted health insurance on services use among HIV-positive unstably housed adults. AIDS Care. 2011;23(7):822-830. 8. Baicker K, Taubman SL, Allen HL, et al. The Oregon experiment--effects of Medicaid on clinical outcomes. N Engl J Med. 2013;368(18):1713-1722. 9. O'Toole TP, Johnson EE, Borgia ML, Rose J. Tailoring Outreach Efforts to Increase Primary Care Use Among Homeless Veterans: Results of a Randomized Controlled Trial. J Gen Intern Med. 2015;30(7):886-898.10. Courtemanche C, Marton J, Ukert B, Yelowitz A, Zapata D. Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States. 2016. doi:10.3386/w22182.11. Tsai J, Rosenheck RA, Culhane DP, Artiga S. Medicaid expansion: chronically homeless adults will need targeted enrollment and access to a broad range of services. Health Aff (Millwood). 2013;32(9):1552-1559. 12. Chwastiak L, Tsai J, Rosenheck R. Impact of health insurance status and a diagnosis of serious mental illness on whether chronically homeless individuals engage in primary care. Am J Public Health. 2012;102(12):e83-89.Assessing Attitudinal Barriers to Health Insurance Enrollment and Facilitation in Vulnerable Populations Brown CK[1], Reinhart CH[1], Shah A, Martin BC, Aravich PF, Etheridge JCInstitute of Healthcare Improvement, Eastern Virginia Medial School, Norfolk, VAVariableInsured(n = 22)Uninsured(n = 29) PAge 44.3 ± 15.7 49.2 ± 9.9 .183Male 17 (77.3%) 26 (89.7%) .228Race/Ethnicity .549African-American 14 (63.6%) 20 (69%)Caucasian 7 (31.8%) 6 (20.7%)Mixed/Other 1 (4.5%) 3 (10.3%)FLNE/LEP 1 (4.5%) 2 (6.9%) .724Education .142HSDG/GED or Higher 19 (86.4%) 18 (62.1%)Less than HSDG/GED 3 (13.6%) 11 (37.9%)Chronic Illness 14 (82.4%) 15 (75%) .588Currently Employed 16 (72.7%) 19 (67.9%) .709Monthly Income .02Less than $792 10 (47.6%) 19 (70.4%)$792 - $1068 6 (28.6%) 4 (14.8%)$1068 - $1366 3 (14.3%) 0 (0%)$1366 - $1842 2 (9.5%) 0 (0%)More than $1842 0 (0%) 4 (14.8%)Chronic Homelessness 16 (8.9%) 7 (24.1%) .684Over Age 65 4 (18.2%) 0 (0%) .017Disability 11 (55%) 5 (17.2%) .006Dependent Children 8 (36.4%) 5 (17.2%) .121Military Service 1 (4.5%) 5 (17.2%) .163Currently Insured43%Previously Insured39%Never Insured8%Pursued Enrollment10%Insurance StatusMedicaid29%Other25%Private17%VA/Tricar…Medicare24%Type of Insurance0%10%20%30%40%50%60%70%80%90%100%26. I knowwhere to goif I need helpsigning upfor insurance.29. Gettinghealthinsurance istoocomplicatedfor me.28. I do notneed healthinsurancebecause I amnot sick.30. I do notneed healthinsurancebecause I canget good carewithout it.31. It isimportant tome that Ihave healthinsurance.37. I knowwhat kind ofbenefits theVA can giveme.38. Gettinghelp from theVA is:*Agree(Hard*)NeutralDisagree(Easy*)0%10%20%30%40%50%60%70%80%90%100%32. I would wantthe people at mydoctor's office tohelp me sign upfor healthinsurance.33. I would wantthe people at thefree clinic to helpme sign up forhealth insurance.34. I would wantthe people in theER to help mesign up for healthinsurance.35. I would wantthe people at theCommunityServices Board tohelp me sign upfor healthinsurance.36. I would wantthe people at myshelter to helpme sign up forhealth insurance.AgreeNeutralDisagree

Assessing Attitudinal Barriers to Health Insurance Enrollment and Facilitation in Vulnerable Populations

https://scholarscompass.vcu.edu/cgi/viewcontent.cgi?article=1001&context=med_edu

Assessing Attitudinal Barriers to Health Insurance Enrollment and Facilitation in Vulnerable Populations

Abstract

Similar works

Full text

Available Versions

VCU Scholars Compass

VCU Scholars Compass