(12) Patient Perspectives on Employer-Based Health Insurance: Experiences of Employees with Chronic Diseases

Background: : Discussions around insurance design policy, including employer-based coverage, usually center around ‘average’ or healthy patients with acute conditions. However, people with chronic diseases are often more vulnerable to the burdens of cost exposure, access, and affordability. Without understanding the unique challenges employees with chronic disease face with health insurance, employers may be unknowingly missing or misunderstanding employee experiences.

Objective: : Explore overall chronic disease patient experience with employer-based insurance coverage, including how it does or does not accommodate chronic disease needs.

Methods: : Qualitative analysis of five virtual 120-minute focus group sessions (September 2024) with 27 participants (US residents with chronic disease and employer health insurance) recruited from Johnson & Johnson Innovative Medicine’s Patient Engagement Research Councils (PERC), a diverse group of disease-aware participants living with chronic health conditions who provide their insights and feedback around specific, structured series of research activities. Key themes were identified from focus group transcripts and direct observations (Data managed by MAXQDA software).

Results: : Participants report that employer-based insurance often fails to meet the needs of patients with complex chronic conditions and is most often designed for healthy employees to cover occasional costs. There is a lack of communication and support from employers, especially around enrollment. Participants also describe the impact of insurance challenges on patient-employer relationships, including concerns around discrimination and feeling “tethered” to employment, and suggest improvements such as better awareness of chronic diseases, improved communication, and transparency around costs.

Conclusions: : Employees with chronic diseases have unique needs, experiences, and outcomes regarding health insurance. Employers should focus more specifically on the chronic-disease employee population to learn more about their experiences and consider more targeted communications and engagement strategies to ensure health insurance and supporting communication meets the needs of these employees.

Sponsorship:: Johnson & Johnson Innovative Medicine