Health Care Access: Steadily Deteriorating Since 2003!

AMedNews calls itself "The Newspaper for America's Physicians." A trade publication for Health Care Providers, they tend to cover topics pertinent to this blog. Hardly shocking.

This time they bring us a bit of news that is shocking, or at least highly disturbing, especially in light of many topics we have covered here in the past. The article's subtitle is an excellent summation: "One report finds that millions more insured patients are delaying or not getting care, while another shows a spike in 'underinsured' Americans."

Doug Trapp brings us the findings and analysis:

One in five Americans -- 59 million people -- reported delaying or not getting needed health care in 2007, up from one in seven in 2003, found a June 26 Center for Studying Health System Change report. "We've been tracking access to care for 10 years, and this is by far the biggest change that we've seen in those 10 years," said Peter Cunningham, PhD, study co-author and senior fellow at the center. Of those reporting an access problem last year, 43.5 million had insurance, compared with 25.9 million in 2003.

In a similar vein, the number of underinsured -- steadily insured people who paid significant out-of-pocket costs for health care -- reached 25.2 million people in 2007, up from 15.6 million in 2003, according to an analysis by the Commonwealth Fund published online June 10 in the journal Health Affairs.

As always when examining the state of the current system, the hard numbers are disheartening. According to Mr. Trapp's reporting, a significant number of those uninsured are among those who earned 200% of the federally determined poverty level.

Access is an issue, now more than ever:

The center's report found growing access problems for children. Among all children, 3.9% had an unmet health care need in 2007, up from 2.2% in 2003 and 3.2% in 1996-97. Cunningham said children's access likely is being affected by the higher insurance costs their parents are facing.

Some people with access problems had trouble making or getting to medical appointments, the center reported. Fifty-eight percent of adults with access problems said the health system was a reason. Of those, 28.6% said they could not get to a doctor's office or clinic when it was open.

"This report is really a warning about seismic change in our health care system," said David Colby, PhD, vice president for research and evaluation at the Robert Wood Johnson Foundation, which funded the center's study. "With each passing year, more Americans are really falling behind when it comes to getting the medical care they need."

The reports he refers to show that cost of care, that consistent bugaboo, once again rears its ugly head as the culprit. Larger deductibles, tighter spending limits, and other factors being introduced on the insurance end of the equation are creating a prohibitive environment for health care access. This is something pointed towards by prior studies, but now is documented.
In addition, the Commonwealth Fund report noted a 62% jump in uninsured adults during the 2003-2007 period studied. I cannot help but wonder if those individuals are included in the oft-quoted number of 47 million uninsured Americans.

The article contains a wealth of information and documentation including a supplement at the end which presents the statistical data as a series of graphs and additional links to source data and online discussions.
SOURCE: "Health care access problems surge among insured Americans" 07/21/08
photo courtesy of FuzzCaminske, used under its Creative Commons license

Doctor's Visit? Can't Afford It

A new report by the Center for Studying Health System Change has just been released that sheds some light on American behavior patterns as the cost of care continues to escalate. Out-of-pocket expenditures are driving more and more people to opt out when it comes to the care that they need, and cost is the factor driving this trend.

Sarah Rubenstein of The Wall Street Journal reports:

About 20% of the respondents in a 2007 survey of 18,000 people said that they had put off or gone without needed medical treatment at some point in the year earlier, up from 14% in a 2003 survey. [...]

Of those who said in the 2007 survey they had scrimped, 69% cited concern about cost as a reason.

I'm sure that a moment's thought will bring to mind people that you, our reader, know on a personal level that have made decisions like this. I know I do. As a matter of fact, I have been one of those who has put off long overdue checkups and medical care simply due to the fact that even with insurance I cannot afford it. As Ms. Rubenstein notes in her article, I am not alone in this:

While the uninsured reported the highest rate -- 38% -- of delaying or going without care, the biggest rate of increase in such reports was among people who had health insurance. Seventeen percent of insured respondents said that they had scrimped, which was up from 11% in the 2003 poll.

Deductibles, co-pays, and high price tags seem to combine to make a very effective "patent repellent." And even for those of us who are acutely aware of how much more expensive a health issue can become after being neglected there is still the financial bottom line. Medical care can often put a dent on one's personal finances that is so large that it can quickly become a matter of paying the bills or paying for treatment.

To help illustrate the point here is a video that I came across on Current that will introduce you to a woman who did not forgo treatment, a decision which cost her greatly.


SOURCE: "More Americans Delay Health Care: Cost Concerns Drive Even the Insured To Forgo Treatment" 06/26/08
SOURCE: "Uninsured in America" 06/11/08