Psoriasis Patients Without Insurance Are More Likely Unable to Obtain Care

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The relationship between insurance status and the degree to which patients with psoriasis delay receiving care was evaluated in a recent study.¹ It was found that those with public-only insurance were more likely to not receive timely care, compared to those with private insurance. Also, uninsured patients were more likely unable to obtain care, when compared to both private and public insurance-holders.

The population-based, cross-sectional study incorporated 20 years of data (2002-2021) from the Medical Expenditure Panel Survey (MEPS). This established a population total of 4,506,850 psoriasis patients 18 years of age and older in the United States. Out of these, 72.5% had private insurance, 23.6% had public-only insurance, and 3.9% had no insurance.

To assess, researchers utilized questions and variables from the Access to Care supplement of the Household Component of MEPS. Socioeconomic and sociodemographic characteristics such as applied medical services, health conditions and status, and prescribed medications were obtained. Other measured clinical demographics included age, sex, race, ethnicity, geographical region, and medical comorbidities. Descriptive statistics were calculated, and multivariable logistic regression analyses were performed.

Overall, 9.7% of all patients were delayed in seeking care while 4.7% were unable to receive care entirely. Among those who were delayed in receiving treatment, 7.7% had private insurance, 14.3% had public-only insurance, and 18.9% had no insurance. A further breakdown of those who were not treated at all showed that 4.4% had private insurance, 3.6% had public-only insurance, and 16.5% were uninsured.

Patients who had public–only insurance were 2.7 times more likely to delay receiving care (aOR, 2.72; 95% CI, 1.26–5.87; p = 0.012). This is consistent with what was found in previous population-based studies with melanoma patients receiving delayed surgical treatment.²

Compared to private insurance patients, uninsured patients were 3.4 times more likely to be unable to obtain care (aOR, 3.42; 95% CI, 1.31-8.92; p = 0.013). Compared to those with public-only insurance, uninsured patients were 3.7 times more likely to be unable to obtain care (aOR, 3.70; 95% CI, 1.32-10.38; p = 0.014). Although there was a numeric difference, there was no statistically significant difference between public-only insurance and uninsured psoriasis patients in the delay of receiving care.

Because data collection is self-reported, responses may be subject to recall bias and disease misclassification. MEPS also does not assess disease severity, so that could not be accounted for in the questionnaire results. These could all be potential limitations of the study.

The nontreatment and undertreatment among psoriasis patients could potentially link to increased disease morbidity and quality of life.³ Even with the passing of the Patient Protection and Affordable Care Act in 2010, publicly insured patients may struggle to get quick access to specialist care compared to those with private insurance.⁴ This is especially vital due to the routine screening and consistent follow-ups needed in psoriasis cases.⁵

Although this study was published before the assassination of UnitedHealthcare CEO, Brian Thompson, conversations surrounding the frustrations of American healthcare have grown in recent years. According to the investigators, increased healthcare access is necessary to ensure equitable, timely, and appropriate care for all psoriasis patients, no matter their insurance status. Future research should examine the influence of health insurance status and how it correlates to psoriasis disease severity.

“It is important to be aware of factors affecting psoriasis patients’ decision to seek care and their ability to receive care,” the authors wrote. “This information can help form policies that increase access to care, guide outreach initiatives that promote health-protective behaviors, and ultimately improve patient outcomes.”

References

1. Sadrolashrafi K, Hao A, Yamamoto RK, et al. The impact of insurance status on psoriasis patients' healthcare-seeking behavior: a population-based study in the United States. BMC Health Serv Res. 2024;24(1):1504. Published 2024 Nov 29. doi:10.1186/s12913-024-11992-z

2. Adamson AS, Zhou L, Baggett CD, Thomas NE, Meyer AM. Association of Delays in Surgery for Melanoma With Insurance Type. JAMA Dermatol. 2017;153(11):1106-1113. doi:10.1001/jamadermatol.2017.3338

3. Bhutani T, Wong JW, Bebo BF, Armstrong AW. Access to health care in patients with psoriasis and psoriatic arthritis: data from National Psoriasis Foundation survey panels. JAMA Dermatol. 2013;149(6):717-721. doi:10.1001/jamadermatol.2013.133

4. Miller S, Wherry LR. Health and Access to Care during the First 2 Years of the ACA Medicaid Expansions. N Engl J Med. 2017;376(10):947-956. doi:10.1056/NEJMsa1612890

5. Lebwohl MG, Kavanaugh A, Armstrong AW, Van Voorhees AS. US Perspectives in the Management of Psoriasis and Psoriatic Arthritis: Patient and Physician Results from the Population-Based Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) Survey. Am J Clin Dermatol. 2016;17(1):87-97. doi:10.1007/s40257-015-0169-x