The always excellent Manoj Jain writes a piece on the uninsured in the Washington Post. It seems doctors, consciously or not, treat those without health insurance differently.

Sometimes it can be in helpful ways, like giving generic medications instead of expensive brand names.

Most of the time however, being uninsured is a stigma when seeking care:

A 2006 study of 25 primary care private practices in the Washington area showed that in nearly one in four encounters, physicians reported adjusting their clinical management based on a patient’s insurance status; nearly 90 percent of physicians admitted to making such adjustments. For patients with no insurance, alterations occurred 43 percent of the time; and for the privately insured, just 19 percent.

Some behavior is downright disturbing:

A heart surgeon told me he operates on uninsured patients but schedules them for the end of the day; if other cases take longer than expected, the uninsured get bumped. Some gastroenterologists are quick to perform endoscopies or colonoscopies on insured patients; not so for the uninsured.

With some states considering cutting already low Medicaid payment rates, those with this insurance are rapidly joining the uninsured by being treated with preferentially poor care.

Some doctors don’t look at a patient’s insurance status prior to an office visit, although it can be difficult with that information often prominently displayed on the chart.

Most simply choose to practice in affluent areas with a favorable (i.e. a low proportion of uninsured or Medicaid) payer mix, as Dr. Jain admits to doing:

I do not discriminate at an individual level, but many doctors, including myself, discriminate more broadly by moving our clinics to wealthier parts of the city, for example. To compensate for the cost of treating uninsured patients (about 10 percent of my practice), I inflate my charges for all patients, thus increasing my income from commercial insurance.