Barriers to health care access among US adults with chronic conditions and co-occurring serious psychological distress between 2011-2015

Importance: Nearly 34 million adults – 17 percent of all American adults – have co-occurring mental and physical health conditions. However, the extent to which increased health insurance coverage has facilitated access to needed health care services among this population remains unclear.

Objective: Prior research suggests that people with serious psychological distress (SPD) and cancer, heart disease, diabetes, asthma, or hypertension report worse access to care than people with the same physical conditions but no SPD. While the recent expansion in health insurance coverage was expected to improve access to care for people with SPD, access barriers that people with SPD report remain underexplored.

Setting: Using the cross-sectional data from the National Health Interview Survey 2011-2015, we examined self-reported health care access barriers among adults (between ages 18 to 64) with SPD and co-occurring physical health conditions.

Results: Our sample included 45,294 individuals with chronic conditions (heart disease, high blood pressure, diabetes, cancer, or asthma). Among them, 3,639 also had SPD. After controlling for demographic and socioeconomic factors, results of multivariate logistic regressions showed that individuals with co-occurring SPD and a physical health condition were significantly more likely to report that they had worse health insurance coverage compared to the prior year (OR=1.32, p<0.01), that doctor's office informed that they were not accepting new patients (OR=2.09, p<0.001), that the doctor's office stated they did not accept the particular health insurance they have (OR=1.98, p<0.001), that they couldn't get an appointment soon enough (OR=2.42, p<0.001), they had no transportation to get to the doctor (OR=3.23, p<0.001), and that overall they had trouble finding a doctor/provider (OR=2.12, p<0.001).

Conclusions: Our results suggest that despite an increase in health insurance coverage between 2011 and 2015, barriers to access remain a significant concern for individuals with co-occurring SPD and physical health conditions.