Barriers to health care access among US adults with chronic conditions and co-occurring serious psychological distress between 2011-2015

Main Article Content

Priscilla Joy Novak Jie Chen Mir Ali


Importance: Nearly 34 million adults – 17 percent of all American adults – have co-occurring mental and physical health conditions. However, the extent to which increased health insurance coverage has facilitated access to needed health care services among this population remains unclear.

Objective: Prior research suggests that people with serious psychological distress (SPD) and cancer, heart disease, diabetes, asthma, or hypertension report worse access to care than people with the same physical conditions but no SPD. While the recent expansion in health insurance coverage was expected to improve access to care for people with SPD, access barriers that people with SPD report remain underexplored.

 Setting: Using the cross-sectional data from the National Health Interview Survey 2011-2015, we examined self-reported health care access barriers among adults (between ages 18 to 64) with SPD and co-occurring physical health conditions.

Results: Our sample included 45,294 individuals with chronic conditions (heart disease, high blood pressure, diabetes, cancer, or asthma).  Among them, 3,639 also had SPD. After controlling for  demographic and socioeconomic factors, results of multivariate logistic regressions showed that individuals with co-occurring SPD and a physical health condition were significantly more likely to report that they had worse health insurance coverage compared to the prior year (OR=1.32, p<0.01), that doctor's office informed that they were not accepting new patients (OR=2.09, p<0.001), that the doctor's office stated they did not accept the particular health insurance they have (OR=1.98, p<0.001), that they couldn't get an appointment soon enough (OR=2.42, p<0.001), they had no transportation to get to the doctor (OR=3.23, p<0.001), and that overall they had trouble finding a doctor/provider (OR=2.12, p<0.001).

Conclusions: Our results suggest that despite an increase in health insurance coverage between 2011 and 2015, barriers to access remain a significant concern for individuals with co-occurring SPD and physical health conditions.

Article Details

How to Cite
NOVAK, Priscilla Joy; CHEN, Jie; ALI, Mir. Barriers to health care access among US adults with chronic conditions and co-occurring serious psychological distress between 2011-2015. Medical Research Archives, [S.l.], v. 7, n. 7, july 2019. ISSN 2375-1924. Available at: <>. Date accessed: 18 aug. 2019. doi:
Research Articles


1. Sommers BD, Gunja MZ, Finegold K, Musco T. Changes in Self-reported Insurance Coverage, Access to Care, and Health Under the Affordable Care Act. Jama. Jul 28 2015;314(4):366-374.
2. McMorrow S, Polsky D. Insurance Coverage and Access to Care Under the Affordable Care Act. LDI issue brief. Dec 2016;21(2):1-8.
3. Horgan CM, Hodgkin D, Stewart MT, et al. Health Plans' Early Response to Federal Parity Legislation for Mental Health and Addiction Services. Psychiatric services. Feb 2016;67(2):162-168.
4. Golberstein E, Busch SH. Mental Health Insurance Parity and Provider Wages. The journal of mental health policy and economics. Jun 01 2017;20(2):75-82.
5. Busch SH. Implications of the Mental Health Parity and Addiction Equity Act. The American journal of psychiatry. Jan 2012;169(1):1-3.
6. Cooper P, Davis K, Miller GE. Trends in Enrollment, Offers, Eligibility and Take-Up for Employer-Sponsored Insurance: Private Sector, by State Medicaid Expansion Status, 2008-2015. Statistical Brief (Medical Expenditure Panel Survey (US)). Rockville (MD)2001.
7. Baker J, Travers JL, Buschman P, Merrill JA. An Efficient Nurse Practitioner-Led Community-Based Service Model for Delivering Coordinated Care to Persons With Serious Mental Illness at Risk for Homelessness [Formula: see text]. Journal of the American Psychiatric Nurses Association. Apr 01 2017:1078390317704044.
8. Sklar M, Aarons GA, O'Connell M, Davidson L, Groessl EJ. Mental Health Recovery in the Patient-Centered Medical Home. American journal of public health. Sep 2015;105(9):1926-1934.
9. Jolles MP, Haynes-Maslow L, Roberts MC, Dusetzina SB. Mental health service use for adult patients with co-occurring depression and physical chronic health care needs, 2007-2010. Medical care. Aug 2015;53(8):708-712.
10. Tepper MC, Cohen AM, Progovac AM, et al. Mind the Gap: Developing an Integrated Behavioral Health Home to Address Health Disparities in Serious Mental Illness. Psychiatric services. Aug 01 2017:appips201700063.
11. Weissman J, Russell D, Jay M, Beasley JM, Malaspina D, Pegus C. Disparities in Health Care Utilization and Functional Limitations Among Adults With Serious Psychological Distress, 2006-2014. Psychiatric services. Jul 01 2017;68(7):653-659.
12. Olfson M, Marcus SC. National trends in outpatient psychotherapy. The American journal of psychiatry. Dec 2010;167(12):1456-1463.
13. Gronfein W. Incentives and intentions in mental health policy: a comparison of the Medicaid and community mental health programs. Journal of health and social behavior. Sep 1985;26(3):192-206.
14. Santiago CD, Kaltman S, Miranda J. Poverty and mental health: how do low-income adults and children fare in psychotherapy? Journal of clinical psychology. Feb 2013;69(2):115-126.
15. Hsueh J, Yoshikawa H. Working nonstandard schedules and variable shifts in low-income families: associations with parental psychological well-being, family functioning, and child well-being. Developmental psychology. May 2007;43(3):620-632.
16. Ell K, Sanchez K, Vourlekis B, et al. Depression, correlates of depression, and receipt of depression care among low-income women with breast or gynecologic cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. May 01 2005;23(13):3052-3060.
17. Davis RG, Ressler KJ, Schwartz AC, Stephens KJ, Bradley RG. Treatment barriers for low-income, urban African Americans with undiagnosed posttraumatic stress disorder. Journal of traumatic stress. Apr 2008;21(2):218-222.
18. Donker T, Petrie K, Proudfoot J, Clarke J, Birch MR, Christensen H. Smartphones for smarter delivery of mental health programs: a systematic review. Journal of medical Internet research. Nov 15 2013;15(11):e247.
19. Friedman SA, Thalmayer AG, Azocar F, et al. The Mental Health Parity and Addiction Equity Act Evaluation Study: Impact on Mental Health Financial Requirements among Commercial "Carve-In" Plans. Health services research. Dec 12 2016.
20. Mechanic D. Seizing opportunities under the Affordable Care Act for transforming the mental and behavioral health system. Health affairs. Feb 2012;31(2):376-382.
21. Kessler RC, Barker PR, Colpe LJ, et al. Screening for serious mental illness in the general population. Archives of general psychiatry. Feb 2003;60(2):184-189.
22. Min JW, Lee SH. Validation of the K6/K10 Scales of Psychological Distress and Their Optimal Cutoff Scores for Older Koreans. International journal of aging & human development. Mar 2015;80(3):264-282.
23. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? Journal of health and social behavior. Mar 1995;36(1):1-10.
24. Gooptu A, Moriya AS, Simon KI, Sommers BD. Medicaid Expansion Did Not Result In Significant Employment Changes Or Job Reductions In 2014. Health affairs. Jan 2016;35(1):111-118.
25. Chen J, Vargas-Bustamante A, Mortensen K, Ortega AN. Racial and Ethnic Disparities in Health Care Access and Utilization Under the Affordable Care Act. Medical care. Feb 2016;54(2):140-146.
26. Loeb DF, Bayliss EA, Candrian C, deGruy FV, Binswanger IA. Primary care providers' experiences caring for complex patients in primary care: a qualitative study. BMC family practice. Mar 22 2016;17:34.
27. Beacham AO, Van Sickle KS, Khatri P, et al. Meeting evolving workforce needs: Preparing psychologists for leadership in the patient-centered medical home. The American psychologist. Jan 2017;72(1):42-54.
28. Dickinson WP, Miller BF. Comprehensiveness and continuity of care and the inseparability of mental and behavioral health from the patient-centered medical home. Families, systems & health : the journal of collaborative family healthcare. Dec 2010;28(4):348-355.
29. Krupski A, West, II, Scharf DM, et al. Integrating Primary Care Into Community Mental Health Centers: Impact on Utilization and Costs of Health Care. Psychiatric services. Nov 01 2016;67(11):1233-1239.
30. Denham SA. Moving to a culture of health. Journal of professional nursing : official journal of the American Association of Colleges of Nursing. Sep - Oct 2017;33(5):356-362.
31. Rodgers M, Dalton J, Harden M, Street A, Parker G, Eastwood A. Integrated care to address the physical health needs of people with severe mental illness: a rapid review. Southampton (UK)2016.
32. Trape TL, Campos RO. The mental health care model in Brazil: analyses of the funding, governance processes, and mechanisms of assessment. Rev Saude Publica. Mar 23 2017;51(0):19.
33. Panda B, Thakur HP. Decentralization and health system performance - a focused review of dimensions, difficulties, and derivatives in India. BMC Health Serv Res. Oct 31 2016;16(Suppl 6):561.
34. Ma J, Lu M, Quan H. From a national, centrally planned health system to a system based on the market: lessons from China. Health affairs. Jul-Aug 2008;27(4):937-948.
35. Ali MM, Teich JL, Mutter R. The role of perceived need and health insurance in substance use treatment: implications for the Affordable Care Act. Journal of substance abuse treatment. Jul 2015;54:14-20.

Most read articles by the same author(s)

Obs.: This plugin requires at least one statistics/report plugin to be enabled. If your statistics plugins provide more than one metric then please also select a main metric on the admin's site settings page and/or on the journal manager's settings pages.