Health insurance status and primary care experiences among non-institutionalized under-65 population in the United States: 1996 vs. 2021–2022

Introduction A previous study using 1996 Medical Expenditure Panel Survey (MEPS) data identified disparities in primary care experiences by health insurance status. This study examined changes in these disparities following substantial expansions in health insurance coverage. Methods We conducted survey-weighted logistic regression analyses using 2021–2022 MEPS data among noninstitutionalized U.S. residents younger than 65 years and compared the findings with those of a previous study using 1996 data. Five primary care attributes were examined, including having a usual source of care (USC), USC location, waiting time, telephone accessibility, and evening or weekend office hours. Results The uninsured proportion decreased from 19% in 1996 to 8% in 2021–2022, while public insurance coverage increased from 12% to 23%. The proportion of individuals with a USC declined from 93% to 71%. Insured individuals had significantly higher odds of having a USC than uninsured individuals in both 1996 (OR 3.40, 95% CI 2.91–3.97) and 2021–2022 (OR 3.92, 95% CI 2.74–5.62). Among privately versus publicly insured individuals, the odds ratio for being seen within 30 minutes decreased from 1.77 (95% CI 1.51–2.06) to 1.02 (95% CI 0.51–2.03), and the odds ratio for evening or weekend office hours decreased from 1.68 (95% CI 1.48–1.91) to 0.98 (95% CI 0.59–1.63). Discussion Despite improvements in insurance coverage, disparities in primary care experiences persisted, particularly between insured and uninsured individuals. Some findings suggested reduced disparities between privately and publicly insured individuals, especially in waiting times and evening or weekend office hours. Further targeted efforts to improve equitable access to primary care are warranted.