February 1, 2000

Stigma

A Paper for Discussion

The origin of stigma related to government programs that provide health coverage appears to be linked to its negative association with the public welfare system. The stigma currently associated with Medicaid and SCHIP seems to break out into two components: the process and the product. The process end of stigma relates to the reportedly negative treatment of applicants by staff in welfare offices and the often intrusive nature of the personal information required upon application. On the product end, there is a prevailing perception that the delivery system does not provide the same level of care to holders of public coverage as it does to holders of private coverage. The stakes are high. Any success achieved with outreach, simplification and coordination will be diminished if the stigma attached to these programs continues to prevent the enrollment of children into health coverage programs.

This document is presented in six sections in an attempt to facilitate a discussion on stigma as a barrier to participation in health coverage programs. The first section defines stigma as the literature has defined it. The second section lists what the literature suggests are some causes of stigma. The third section provides information on how recipients internalize and manage the stigma felt from participating in public programs. The fourth section lists symbols that have been described as stigmatizing. The fifth section discusses research and policy projects that are identifying causes of stigma and eliciting suggestions for reducing it. Finally the last section provides examples that are being used in the field to address the stigma associated with government-sponsored health coverage programs.

Source: Southern Institute on Children and Families

Citation: Barr, Barbara Matacera. Stigma: A Paper for Discussion. Columbia SC: Covering Kids National Program Office, Southern Institute on Children and Families, February 2000.

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