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Affordable Care for All?

Faculty associate Jerome Dugan investigates the relationship between socioeconomic status, health insurance coverage, and affordable quality care

Dr. Jerome Dugan is currently working on a research project that aims to improve understanding of how health insurance coverage decisions may be used to resolve racial and gender disparities in health outcomes among patients with chronic disease. His work focuses on three main questions:

  • Does underinsurance drive racial and gender disparities in physician and resource utilization?
  • How does payment source for healthcare services impact the quality and quantity of care received?
  • How does the financial pressure generated by changes in the distribution of patients covered by managed care plans impact provider efficiency and efficacy?

The Patient Protection and Affordable Care Act represents an important public policy goal of expanding healthcare coverage and improving the quality of healthcare to previously underserved groups by requiring nearly every American to have health insurance by 2014. But simply having insurance may not be enough to ensure adequate care for low-income people with chronic health conditions. Depending on the type of insurance plan, these individuals may still find their care regimens too expensive to maintain.

Low-income people tend to be dependent on health insurance with less generous cost sharing provisions than more affluent people and are less likely to obtain supplemental insurance coverage to make up for the limitations in their primary plan. As a result, socioeconomically disadvantaged people tend to utilize non-emergency care less often, even when they have access to insurance. This can be a particular problem for those with chronic conditions like diabetes, heart disease, and COPD, which require regular routine care. Even with insurance, the co-pays for frequent follow-up visits can quickly become unmanageable for individuals with little financial margin who may find it necessary to cut back on necessary medical care in order to pay other bills.

Many Americans are expected to fulfill the ACA’s requirement to purchase insurance by enrolling in managed care plans. Since managed care organizations incentivize providers to limit the supply and use of expensive healthcare technologies, Dr. Dugan hypothesizes that persons with managed care insurance will receive less resource-intensive care, which may have negative impacts on their health.

Dr. Dugan believes it is critical to understand how changes in health insurance coverage will impact inequalities in healthcare, particularly in light of the changes anticipated as a result of the Affordable Care Act. His work will increase understanding of how the type of insurance a person enrolls in affects the amount and quality of care that they receive, and will investigate the potential shortcomings of individual insurance plans and their aggregate on provider performance.

Read Dr. Dugan's bio