Study on the privately insured still uncovers racial disparities

Opioid overdose patients with private insurance are rarely connected to addiction treatment after visiting the emergency department, a new national study from the University of Pennsylvania has found.

And the problem is particularly severe among black and Hispanic patients, more evidence of deep racial disparities in health care generally and addiction treatment in particular.

Private insurance — which most Americans get through employers — is a marker of relative affluence. So this study finds, as others have, that race and not poverty can spell the difference in getting needed care.

The study, released last week, examined a large private insurer’s records for more than 6,500 opioid overdose patients who were treated at an emergency department between 2011 and 2016.

In the three months after their overdoses, less than 17% received follow-up treatment, defined as a pharmacy claim for medication-assisted therapy or a medical claim for a visit to outpatient or inpatient treatment. Less than half of all patients who got follow-up treatment received anti-addiction medication, considered the gold standard of care.

“This study shows that even people with insurance may still have barriers to treatment,” said Austin Kilaru, the study’s lead author, an attending physician at Penn Presbyterian Medical Center and a fellow in the National Clinician Scholars Program at Penn. “Just the fact of having insurance may not empower you to make the leap (to treatment).”

Black patients were half as likely as white patients to receive such treatment. Hispanic patients were also less likely than white patients to get treatment.

Kilaru called those data “the most important finding of this paper.”

He said he and his coauthors wanted to study privately insured Americans, as opposed to people on Medicaid, because they wanted to see whether private insurance might level out racial disparities in access to health care.

“We think of patients with Medicaid generally having worse access to care because of their insurance, especially around substance use treatment,” he said. “There are more minorities in the Medicaid population, and we were wondering whether you could correct those disparities if you gave patients an even playing field with the kind of insurance they had. That wasn’t the case.”

It’s difficult to tell what is driving the racial disparities found in the study, Ki