Background: The importance of trust in healthcare, including trust in physicians and the healthcare system, has been widely studied and established. Disparities in trust are also shown to exist from racial/ethnic and other standpoints. However, little is known about trust in health insurance companies, a topic that is crucial for understanding the dynamics of healthcare access and utilization. This research aims to fill this gap and provide valuable insights into the factors that influence trust in health insurance providers. 

Objective: To illuminate the characteristics of groups who trust or mistrust their health insurance provider.

Methods: This study utilized secondary data from the First Quarter 2020 Health Reform Monitoring Survey (n=5,302). The data, including demographic information and healthcare utilization/barriers, were analyzed using STATA version 18.0. Bivariate analyses via 𝛸2 tests were conducted to identify variables for inclusion in a multivariate analysis via logistic regression.

Results: Age above 60 (OR=1.39, 95% CI: 1.11-1.74), female gender (OR=1.19, 95% CI: 1.05-1.35), Hispanic ethnicity (OR=1.36, 95% CI: 1.03-1.80), high school education (OR=1.24, 95% CI: 1.04-1.48), and a bachelor’s degree or higher (OR=0.86, 95% CI: 0.74-1.00) where demographic factors significantly associated with trust in insurance companies. Private insurance coverage (OR=0.68, 95% CI: 0.54-0.84), Medicare coverage (OR=1.61, 95% CI: 1.25-2.07), state insurance (OR=1.27, 95%: 1.02-1.60), needing to forego medical care (OR=0.56, 95% CI: 0.47-0.67), having no place to go when sick (OR=0.58, 95% CI: 0.49-0.70), having trouble finding a doctor/provider (OR=0.49, 95% CI: 0.38-0.62), insurance not being accepted (OR=0.77, 95% CI: 0.62-0.94) and having trouble paying medical bills (OR=0.74, 95% CI: 0.60-0.90) were other healthcare factors significantly associated with trust in insurance companies.

Conclusions: The type of insurance coverage significantly impacts trust in insurance companies, where privately insured populations have decreased odds of trust and publicly insured (Medicare and state) have higher odds of trust. Addressing barriers to access is an opportunity for positive change considering that statistically significant barriers indicate a 33-51% decrease in the odds of trust. Despite the modest effect of demographic factors on trust, age above 60, female gender, Hispanic ethnicity, and a high school education are associated with increases in the odds of trust while a bachelor’s degree or more is associated with a decrease in the odds of trust.

Dr. Echu Liu (echu.liu@slu.edu) was incredibly influential to the success of this project. Dr. Liu provided excellent mentorship throughout the course of the project and his wisdom was invaluable.