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Health insurance gaps reduce the availability of health services provided, which can result in a lower quality of life and insufficient health care (Bethell et al., 2011; Doty & L Holmgren, 2006; Halterman, Montes, Shone, & Szilagyi, 2008; Short, Graefe, Swartz, & Uberoi, 2012; O. World Health Organization, and International Bank for Reconstruction and Development/The World Bank, 2018), especially among low income population (Cathy Schoen, 2010). The costs of health care services are increasing worldwide (Dieleman et al., 2017). Hence, affecting people’s quality of life, and it pushes them into the poverty line (O. World Health Organization, and International Bank for Reconstruction and Development/The World Bank, 2018). The gap in the health insurance system affects people especially the lower income and uninsured population due to inability to pay for the medical services. The lack of insurance prevents people from receiving the intended care and to meet their basic needs. As a result, they forgo or postpone medical care. The issue of accessing a high-quality of health care services remains, regardless of the innovation and huge growth in the medical field, patients reported that there is a lack in the quality of health care services provided by the public sector which indicates that the “out-of-pocket” payment method might provide the required quality of care. (MICHIELSEN, j. et al., 2011). People who live in low- and middle-income countries are accountable for significant part of their health care expenditures as direct out-of-pocket payment (Arenliu Qosaj, Froeschl, Berisha, Bellaqa, & Holle, 2018; O'Donnell et al., 2008; Spaan et al., 2012; O. World Health Organization, and International Bank for Reconstruction and Development/The World Bank, 2018), this can result in poverty and becoming a barrier to health care (Arenliu Qosaj et al., 2018; O'Donnell et al., 2008; Spaan et al., 2012; World Health Organization, 2019).
Understanding that one size insurance coverage cannot fit all, as there are variations in income, frequency in peoples’ illness and the quality of services by provider (Dror, 2007). Health insurance availability impacts the quality of health care services (Flores et al., 2017), and there is a correlation between health insurance and the quality of health care services (Talib, Azam, & Rahman, 2015). The World Health Organization defines quality of care as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (O. World Health Organization, and International Bank for Reconstruction and Development/The World Bank, 2018). In many specific conditions, the uninsured had higher financial burden, and the lack of coverage is associated with lower use of required services, and higher mortality (Abuosi, Domfeh, Abor, & Nketiah-Amponsah, 2016; Flores et al., 2017; UNICEF, 2016).
Studies have varying results on the impact of insurance and quality of health care. On one hand, patients who pay-out of their pocket might receive higher levels of cooperation and facilities provided (Duku, Nketiah-Amponsah, Janssens, & Pradhan, 2018). On the other hand, other studies demonstrated that being insured or uninsured has nothing to do with the quality of services and the overall care process received, yet it depends on how patients perceive the quality which indicates that being insured does not guarantee receiving higher-quality of care (Abuosi et al., 2016). According to JAMA’s research, most of the time the availability of health insurance in the United States does not guarantee high-quality health care services. Access to health insurance and the choice of plans and companies can affect the services that are provided to patients across the country. (JAMA, 2000)
Fore instance, in Ireland for example, it was reported that health care systems provided higher-quality of care to those who have access to private insurance, “This was the first time in Irish history, when a government committed to end the two-tier system of access to health care, which gives preferential access to hospital care to those who have private health insurance.” (Sara Ann Burke et al., 2017)