A Mixed-methods Assessment of the Impact of Insurance Issues on the Emotional and Physical Health of Patients With Inflammatory Bowel Disease

Alicia Philippou; Beselot Birhanu; Anthony Biello; Laurie Keefer; Ksenia Gorbenko

doi:10.1093/ibd/izac022

A Mixed-methods Assessment of the Impact of Insurance Issues on the Emotional and Physical Health of Patients With Inflammatory Bowel Disease

Inflamm Bowel Dis. 2022 Dec 1;28(12):1851-1858. doi: 10.1093/ibd/izac022.

Authors

Alicia Philippou¹, Beselot Birhanu², Anthony Biello³, Laurie Keefer³, Ksenia Gorbenko^{4

5}

Affiliations

¹ Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
² Icahn School of Medicine at Mount Sinai, New York, New York, USA.
³ The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁴ Institute for Health Care Delivery Science, Mount Sinai Health System, New York, New York, USA.
⁵ Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

PMID: 35191977
DOI: 10.1093/ibd/izac022

Abstract

Background: In patients with inflammatory bowel disease (IBD), failure to adhere to treatment regimens due to insurance issues can lead to disease complications. Our aim was to examine patients' perceptions of the impact of insurance issues on their health.

Methods: Twenty-nine patients with IBD at a large US academic center and an insurance issue participated in a mixed-methods study. Retrospective chart review and an online questionnaire were completed to collect demographic information, IBD characteristics, and validated resilience scores. Semistructured interviews were completed for insurance experiences, which were coded independently by 2 coders for themes.

Results: Twenty-nine patients completed the interview, and 24 completed the online survey. Sixteen had Crohn's disease, 13 had ulcerative colitis, and 66% were female. The most common insurance issue was lapsed insurance. Many experienced physical consequences, with 58% having flares, 14% undergoing surgery, and 14% developing antibodies. All emotional responses were negative, with the majority feeling stressed (38%). Providers were uninformed of insurance issues in 28% of cases. When asked about perceived resilience, 41% felt incapable of managing the situation, and 45% gave up trying to solve the problem. When asked how to improve going forward, 38% requested an easily accessible advocate to guide them.

Conclusions: A large proportion of our cohort chose not to inform their provider, felt incapable of managing on their own, and gave up on resolving their insurance issue. This highlights the need to consider restructuring the insurance system, to identify those at risk for insurance issues, and to make advocates available to avoid devastating consequences.

Keywords: IBD; flare; insurance issue; insurance lapse; mixed-methods; patient-advocate; qualitative; stress.

Plain language summary

Few studies have qualitatively examined the impact of insurance issues on the health of patients with IBD. We highlight the need to identify patients at risk of insurance issues and when they occur so as to make advocates available to avoid disease complications.

MeSH terms

Chronic Disease
Colitis, Ulcerative* / therapy
Emotions
Female
Humans
Inflammatory Bowel Diseases* / therapy
Insurance*
Male
Retrospective Studies