Access to health care improved modestly for insured Americans between 2007 and 2010, according to a recent national study, but cost is increasingly identified as a worry and an obstacle to obtaining needed care in the future.
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Approximately 17% of the U.S. population in 2010about 1 in 6 peoplereported not getting or delaying needed medical care in the previous 12 months, down from 20%1 in 5in 2007, according to a study out of the Center for Studying Health System Change (HSC). Findings from the study, which was funded by the Robert Wood Johnson Foundation, were based on phone interviews with 17,000 people.
Sound like good news?
It depends on where you sit, says HSCs Alwyn Cassil. If you were insured, it worked for you.
For the uninsured, whose numbers escalated between 2007 and 2010, obtaining health care is still a battle.
About nine million fewer people had health insurance in 2010 than in 2007, which could explain why those with insurance had easier access to care.
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System wide this is probably just a blip, says Cassil. We [HSC] havent experienced anything like this since weve been collecting data on access.
Its likely that the easing of capacity constraints for patients seeking care created by the larger number of uninsured Americans essentially freed up care, she says, as did the trend for people to go without or delay care.
The study also found the recession forced many Americans to become savvier and more cost-conscious health care consumers by cutting back on care, which has been observed by some providers. While this thrifty attitude could be a positive development to the extent that patients cut back on wasteful, duplicative or discretionary care, it could be a problem if patients also cut back on necessary care or tests.
We dont want people to stop taking their blood pressure medication, says Cassil, or refrain from undergoing tests like a colonoscopy which is an effective tool that can actually change mortality rates.
Sustained reductions in demand could put downward pressure on health-care costs and help to bend the cost curve, but ideally this reduced demand would be greater for services of limited value to health and health outcomes.
Access: problem declines, gap widens
While overall access problems declined, the access gap between insured and uninsured people widened in 2010, especially for lower-income people and those with health problems, says Ellyn Boukus, , HSC health research analyst and study coauthor.
The study shows that in 2010, people with incomes below 200% of poverty--$44,100 for a family of four--were 3.1 times as likely to report an unmet need as those with incomes at or above 400% of poverty, that is 9.3% compared with 3%.
This disparity has grown since 2007 when low-income people were only 2.2 times as likely as higher earners to forgo care. Within each income group, uninsured people were roughly three times as likely as insured people to report going without needed care.
Cost overwhelmingly the biggest obstacle
According to the study, in 2010 about 19.7 million people reported going without needed care and about 32.3 million people reported delaying needed carea total of roughly 52 million people reporting access problems. Of these 52 million people, 75.2% increasingly identified cost as a major deterrent, up from 69% in 2007.
Whats more, cost has become even more of a deterrent over time. In 2010, the study shows people who went without or delayed needed care and indicated they were worried about cost jumped six percentage points since 2007.
People who reported fair or poor health were more likely to report forgoing needed medical care in 2010 compared with those in good, very good or excellent health. HCS says this occurs in part because sicker people tend to use more health care and, therefore have more opportunities to encounter access barriers. Between 2007 and 2010, unmet needs declined 1.6 percentage points from 6.2% to 4.6% among the healthier group and remained steady for those in fair or poor health.
Uninsured people with access problems were much more likely to cite cost as a barrier, 95.3%, as compared to insured people, 65.9% in 2010.
As cost concerns became more prominent over time, health system-related concerns diminished in importance among both insured and uninsured people with access problems. More than half of insured people reported a health system barrier in 2010, a drop of 11 percentage points from 2007. Approximately one-quarter of uninsured people encountered a system-related barrier in 2010, down 16.2 percentage points from 2007.
Among all people citing a health-system obstacle, the biggest declines were associated with the inability to get an appointment soon enough, a 10.2 percentage point decrease; taking too long to get to the provider, a six percentage point decrease; the inability to get to the provider when the office was open, a 5.7 percentage point decrease; and the inability to get through on the telephone, a 5.5 percentage point decrease.
As both the economy recovers and we experience expansion in coverage, well see capacity problems reemerge, Cassil saysa view shared by other experts.
Demand for care will increase. And, as the Patient Protection and Affordable Care Act (PPACA) coverage expansions are implemented in 2014 and many gain health coverage, system-related access problems may increase as pent-up demand from newly insured persons is unleashed, the study says.