Related Experiment Video
Updated: Aug 13, 2026
A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting
Published on: January 12, 2018
Administrative Burden and Vaccination Uptake Disparities: Evidence from Medicaid Participation Among Low-Income
1Author Affiliation: Department of Marketing, Global Business, and Economics, Kean University, Union, New Jersey (Kochersperger).
Context:
During the early COVID-19 vaccine rollout, large disparities in uptake emerged across income and insurance groups, despite the vaccine being made available at no cost to recipients. Medicaid, as the largest public insurance program for low-income adults, was positioned to play a key role in supporting equitable COVID-19 vaccination uptake. However, administrative burden (AB) and fragmented enrolment processes may have inhibited participation.
Objective:
To estimate the relationship between Medicaid coverage and COVID-19 vaccine uptake among low-income adults, and assess whether differences in access or engagement underlie observed disparities.
Design:
Cross-sectional analysis of individual-level survey data using entropy balancing and robustness checks including instrumental variables.
Setting And Participants:
Adults aged 18-64 with household income below 200% of the federal poverty level, drawn from the US Census Household Pulse Survey (January-September 2021).
Main Outcome Measures:
Self-reported receipt of at least 1 COVID-19 vaccine dose or reported intention to vaccinate.
Results:
After balancing observed covariates across insurance groups, Medicaid coverage was associated with a 3.4 percentage point increase in vaccine uptake compared with being uninsured, but a 6.9 percentage point gap remained relative to private insurance. Additional analyses suggest unobserved barriers may further depress vaccine uptake among those insured through Medicaid. These disparities seem driven in part by administrative burden (AB): Medicaid recipients facing more complex enrolment systems were less likely to use available vaccination services, underscoring how program design can shape downstream health behaviors even postenrolment.
Conclusions:
AB and access fragmentation likely contributed to lower COVID-19 vaccination rates among Medicaid enrollees, even when vaccines were free and insurance was nominally available. Addressing these policy-mediated barriers may improve equity in vaccination uptake among low-income adults in future public health interventions.
Related Concept Videos
01:51Vaccinations
01:18Introduction To Health Care Delivery System
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
01:21Health Literacy
01:30Preventive Healthcare Services
01:21Barriers to Effective Communication II
Cultural barriers:
Differences in values, beliefs, religion, knowledge, and tradition can significantly impact communication. Awareness of nonverbal cues is critical, especially when conversing with a patient from a different culture. What appears appropriate in one culture may be inappropriate in another.
Semantic barriers:
As a result of their tendency to use...
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...