- WASHINGTON (Reuters Health)
- More than 41 million Americans--one in seven--had trouble getting medical
care or had to delay care in 2001, mostly because of cost, according to
a study issued Thursday.
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- The Washington, DC-based nonprofit Center for Studying
Health System Change surveyed a representative 60,000 Americans by telephone
about access to healthcare in each of the last several years. Results were
extrapolated to the US population.
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- The survey began in late 1996, as the economy began a
record surge, with low unemployment and declining uninsured.
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- Even so, the Center found that more people--whether they
had insurance or not--said in 2001 that they could not get care at all
or when they needed it, when compared with 1997.
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- In 1997, 5.2% said they had gone without needed care
in the past year; by 2001, it was 5.8%. That means 16 million people were
unable to get care when needed, the Center found.
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- The number of those who delayed care--another 26 million--stayed
steady over each of the survey years.
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- "This is a surprising and somewhat ominous result
given the context of the times," said Paul Ginsburg, an economist
and president of the Center, noting that he would have expected to see
an improvement in access, and fewer delays during the economic boom. And,
now, with the recession, "there's real concern that we could have
some significant declines in access," he told Reuters Health.
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- Getting care was most difficult for the uninsured, or
those with low incomes or in poor health. In 2001, the uninsured were three
times as likely to not get care. Slightly more than 15% of the uninsured
delayed care, compared with 8.6% of the insured. More than one quarter
of those who were uninsured and in poor health said they could not get
needed care.
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- Of those who could not get care or delayed it, 62% said
cost was the reason. It was the dominant worry for 90% or more of the uninsured,
and for half of those with insurance. They did not elaborate on what those
costs were.
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- One potential explanation is that employers began asking
workers to share more of their premiums, said Susan Pisano, a spokeswoman
for the American Association of Health Plans.
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- Of the remainder, 13.2% said they could not get care
or delayed it because their plan would not pay for a service. It is not
clear whether that was perception or reality, said Ginsburg.
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- Pisano said some employers were offering less comprehensive
benefits than in the past, so fewer services were covered.
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- Another 13% said a doctor or hospital would not accept
their insurance. Again, said Ginsburg, there is no clear explanation.
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- Some providers are contracting with fewer insurers, and
others are too overwhelmed to take new patients. Changes in employer-sponsored
plans also mean that a favorite doctor or hospital could be dropped from
the patient's network, Pisano noted.
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- A whopping 32.6% said they could not get an appointment
soon enough in 2001, compared with 22.9% in 1997. Ginsburg called that
a "shocking" increase, noting that it provides "evidence
that there is an imbalance between demand and supply of physician services."
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- Both Pisano and Ginsburg said the appointment logjam
might be because people have more direct access to specialists now, flooding
those practices.
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- In a bright spot, children's access increased over the
survey period, possibly due to extended coverage offered by the State Children's
Health Insurance Program, created in 1997.
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- The big picture, said Pisano, is that "very clearly,
access and affordability are the number-one issues right now." Those
issues "demand a response from policymakers," she said.
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