Insured experience a larger relative increase in access problems
Falling Behind: Americans’ Access to Medical Care Deteriorates, 2003-2007
By Peter J. Cunningham and Laurie E. Felland
Center for Studying Health System Change (HSC)
June 2008
The number and proportion of Americans reporting going without or delaying needed medical care increased sharply between 2003 and 2007, according to findings from the Center for Studying Health System Change’s (HSC) nationally representative 2007 Health Tracking Household Survey. One in five Americans — 59 million people — reported not getting or delaying needed medical care in 2007, up from one in seven — 36 million people — in 2003.
While access deteriorated for both insured and uninsured people, insured people experienced a larger relative increase in access problems compared with uninsured people. Moreover, access declined more for people in fair or poor health than for healthier people. In addition, unmet medical needs increased for low-income children, reversing earlier trends and widening the access gap with higher-income children. People reporting access problems increasingly cited cost as an obstacle to needed care, along with rising rates of health plan and health system barriers.
While cost continued to be the overwhelming concern among uninsured people (more than 90% of uninsured people reported cost as a barrier across all three surveys), the increase in cost barriers occurred mostly among insured people. Higher patient cost sharing — people facing higher deductibles and other increased out-of-pocket expenses for medical services — likely is driving growing cost concerns among insured people.
The health plan-related barriers that people increasingly cited were that their health plan would not pay for treatment (9.2 percentage point increase), followed by the doctor or hospital would not accept their insurance (4.5 percentage point increase). The return of health plan prior-authorization requirements for certain services may be a contributing factor. Also, rising insurance deductibles or coinsurance that cause people to be responsible for much or all of a medical bill may contribute to some people reporting that their health plan would not pay for the treatment. The increase in people reporting that their doctor would not accept their insurance may mean more doctors are opting out of private insurance networks or not accepting new Medicare or Medicaid patients.
http://www.hschange.org/CONTENT/993/
And…
Increasing Number of U.S. Residents Delay, Forgo Needed Health Care Because of Cost Concerns, According to (HSC) Report
Kaiser Daily Health Policy Report
June 26, 2008
Karen Ignagni, CEO of America’s Health Insurance Plans, said that lawmakers must address a number of issues — such as differences in quality of care across the nation and the high costs of surgeries, medical imaging services and specialty medications — to make medical care more affordable (Rubenstein, Wall Street Journal, 6/26).
http://www.kaisernetwork.org/Daily_reports/rep_hpolicy.cfm#52980
Comment:
By Don McCanne, MD
Access to health care in the United States is bad and getting worse. Particularly shocking are some of the factors that are associated with impaired access: increasing rates of uninsurance, deterioration in the financial protection afforded those who are insured, rising rates of health plan barriers, children being in families with low incomes (reversing prior gains), excessive increases in health care costs, and, most shocking of all, actually having a need for health care, insured or not.
Other contributors to impaired access include the growing shortage of primary care professionals, evolving entrepreneurial trends with a decline in the provision of charity services, and the increasing constraints in the capacities of community health centers and other safety-net institutions.
The fastest growing cause of impaired access is the increase in health plan-related barriers. So what is the response of the insurance industry? “Lawmakers must address” the issues. If the insurance industry is making things worse, and they want to turn the problems over to lawmakers, then we should accept their suggestion. Why continue to pay them hundreds of billions of dollars when their insurance product innovations are no longer ensuring affordable access for those of us with significant health care needs?
In an HSC press release, Gail Shearer, director of health policy analysis at Consumers Union, stated, “This study is yet another wake-up call to policymakers that our health care system is failing to meet the needs of even insured consumers in America. Health care reform is not just about decreasing the numbers of uninsured people. It is about transforming the system into one that consistently provides appropriate quality care without unfair financial burdens.”
Single payer, anyone?