Stigma can hinder access to health care for the poor

In a study of 574 low-income adults, many felt stigmatized when receiving medical care. This stigma was most often the result of interactions with clinicians that felt demeaning, rather than an internalized sense of shame related to receiving public insurance or charity care.

Experiencing stigma was associated with unmet health needs, poorer perceptions of quality of care, and worse self-reported health.

"Feeling judged by providers was associated with higher reports of unmet physical and mental health needs and declining health, even though people who reported stigma were on average using as much care as those who didn't share this experience," said Dr. Heidi Allen, lead author of the Milbank Quarterly study. "Medicaid or poverty-related stigma can be thought of as a barrier to accessing quality health care, dampening the effect of the resources invested in getting people insured through Medicaid expansions."