The Effects of Three Forms of Provider Discrimination on Access to Health Care and Mental Health.

Abstract

Background: Provider discrimination can diminish access to care and lead to poor health outcomes, especially in marginalized populations. We extend past research by exploring the combined or intersecting effects of 3 forms of provider discrimination and by looking beyond access to care to include the impact of provider discrimination on mental health.

Objectives: To examine reports of multiple forms of provider discrimination, including the prevalence, associated characteristics, and effects on health care access and mental health.

Research design: Secondary analysis of pooled 2021 and 2023 Minnesota Health Access survey data.

Subjects: Adults aged 18-64 who responded to the survey (unweighted sample size 11,908).

Measures: Reports of 3 forms of provider discrimination based on: (1) race, ethnicity, or nationality; (2) gender or sexual orientation; or (3) insurance type or lack of insurance.

Results: Nearly 1 in 5 adult Minnesotans reported at least one form of provider discrimination (19.6%), with some populations of adults reporting disproportionately higher rates. Experiencing insurance-based discrimination or gender or sexual orientation-based discrimination alone, together, and in combination with race-based discrimination was associated with foregone mental or behavioral health care, diminished confidence in getting needed care, and mental distress.

Conclusions: Provider discrimination comes in different forms, which intersect to impair access and mental health. Experiences of provider discrimination were concentrated among the most marginalized members of our communities based on their gender identity, sexual orientation, race, ethnicity, nationality, age, income, public insurance, and lack of insurance. We recommend several structural solutions.