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Medscape.com
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http://www.medscape.com/viewarticle/430474
One in Seven Americans Say They Can't Get Needed Healthcare
Introduction
WASHINGTON (Reuters Health) Mar 21 - 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 study results released on
Thursday.
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. The survey began
in late 1996, as
the economy began a record surge, with low unemployment and declining uninsured.
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, compared with 1997. In 1997, 5.2% said that 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, said the Center.
The number of those who delayed care, another 26 million, stayed steady over each of the survey years.
"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.
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 a quarter of those who were uninsured and in poor health said that they could not get needed care.
Of those who could not get care or delayed it, 62% cited cost as 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. One potential explanation: Employers began asking
workers to
share more of their premiums, said Susan Pisano, a spokeswoman for the American
Association of Health Plans.
Of the remainder, 13.2% said that 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. Pisano said that some
employers were offering less comprehensive benefits than in the
past,
so fewer services were covered.
Another 13% said that a doctor or hospital would not accept their insurance. Again, said Ginsburg, there is no clear explanation.
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, explained Pisano.
A whopping 32.6% said that 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."
Both Pisano and Ginsburg said that the appointment logjam might be
because people have more direct access to specialists now,
flooding
those practices.
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.
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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