Insurance Status Affects Care Given and Sought by Patients in Puerto Rico, Study Finds

Insurance Status Affects Care Given and Sought by Patients in Puerto Rico, Study Finds

Health care disparities linked to public or private insurance reflect differences in socioeconomic status, and can affect the use of health care services and clinical outcomes in women with endometriosis, a database study from Puerto Rico reports.

Its findings, “Disparities in healthcare services in women with endometriosis with public vs. private health insurance,” were published in the American Journal of Obstetrics and Gynecology.

“In the case of endometriosis, few studies have been conducted to assess differences in access to care within a geographic region based on socioeconomic status,” the investigators wrote.

Researchers at Ponce Health Sciences University in Puerto Rico, working with others on that U.S. territory and elsewhere in the U.S.,  set out to study if women with endometriosis in Puerto Rico are affected by health care disparities, like the frequency and severity of their disease, based on socioeconomic factors such as access to care.

They analyzed and compared the use of health care services and the prevalence of disease comorbidities among women on public (government-based) and private (self- or employer-based) health insurance coverage from 2004 through 2006.

The retrospective study of a claims database involved 342 endometriosis patients, 14–50 years old, who were all with a health insurance company that provides both public and private insurance coverage. Exactly half of the women analyzed had public health insurance, and half had private coverage.

Results showed the utilization of health care services (i.e., hospitalization, laboratory tests, pathology analyses, and radiology exams) for reasons related to endometriosis were about three times lower among women on public health insurance compared to those with private insurance.

For instance, women on public insurance were half as likely to visit a doctor’s office — 201 visits in the public group over the three years and 429 visits among private coverage holders — and specialty services like a gynecologist  2.4 times less likely among public insurance holders as well.

Women with public health insurance coverage were also about 3.5 times less likely to undergo a laparoscopy. That surgical procedure, used to check for abnormalities in a woman’s reproductive system, is also considered the golden standard for an endometriosis diagnosis.

“Another worrisome finding was that the proportion of hysterectomies was two times higher in the public sector,” the researchers said.

Women in the public group were also 2.7 times more likely to receive prescriptions for opioids and narcotics (pain medications), after adjustment for region and age.

“Narcotics are not recommended for the treatment of chronic pelvic pain [CPP] since they cause substantial morbidity and mortality,” the study said. “Experts have raised  concern about the prevalent use of opioid treatment for CPP and are calling for additional training for medical doctors as a measure to also prevent opioid use disorders.”

Surgery and hormonal treatment are typically recommended to alleviate chronic pelvic pain.

Likewise, less than one-third (29.5%) of women on public health insurance filed claims related to an obstetrician/gynecologist visits, while the vast majority (70.5%) of those with private coverage reported to do so on a regular basis. Data also showed that only women with public insurance used a hospital’s emergency room for claims related to gynecological problems.

“[W]e conclude that there are endometriosis-associated health disparities in Puerto Rico. We speculate that uninsured or underinsured women with endometriosis will be 1) more likely to have poor health status, 2) less likely to receive medical care, 3) more likely to be diagnosed later, and 4) more likely to have a poor quality of life,” the researchers wrote.

“More studies are necessary to assess whether the observed disparities result in the detriment of the health and wellbeing of those who do not receive appropriate care based on their socioeconomic status,” they added.

Endometriosis,  a chronic inflammatory disease caused by the abnormal growth of womb cells outside the uterus, is  estimated to affect about 10% of all women of reproductive age.

Joana is currently completing her PhD in Biomedicine and Clinical Research at Universidade de Lisboa. She also holds a BSc in Biology and an MSc in Evolutionary and Developmental Biology from Universidade de Lisboa. Her work has been focused on the impact of non-canonical Wnt signaling in the collective behavior of endothelial cells — cells that make up the lining of blood vessels — found in the umbilical cord of newborns.
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Joana is currently completing her PhD in Biomedicine and Clinical Research at Universidade de Lisboa. She also holds a BSc in Biology and an MSc in Evolutionary and Developmental Biology from Universidade de Lisboa. Her work has been focused on the impact of non-canonical Wnt signaling in the collective behavior of endothelial cells — cells that make up the lining of blood vessels — found in the umbilical cord of newborns.
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