Financial access to physicians decreased in last 20 years
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Although the prevalence of Americans with health insurance coverage grew from 1998 to 2017, the prevalence of people who reported being unable to visit a physician due to cost also increased, according to a study published in JAMA Internal Medicine.
Laura Hawks, MD, a research fellow in the department of medicine at Cambridge Health Alliance and Harvard Medical School, told Healio Primary Care that despite short-term improvements in access to care and coverage gains after the Affordable Care Act, “these findings suggest that the improvements of the ACA — as important as they were — simply couldn’t overcome other forces in the market — increasing cost of health care, increased reliance on high premiums, high deductibles and copays — to improve access to health care when you take into consideration the long-term trends.”
Hawks and colleagues analyzed data from the Behavioral Risk Factor Surveillance Survey, a nationwide survey that collects information on U.S. civilians’ health conditions, insurance coverage, access to care, preventive services usage, and other characteristics through telephone interviews administered by both the CDC and state health departments. Those included in the study were aged 18 to 64 years.
A total of 117,392 respondents in 1998 and 282,378 respondents from 2017 were assessed in the study. During the study period, the rate of uninsured people decreased by 2.1 percentage points — from 16.9% in 1998 to 14.8% in 2017.
However, the proportion of those who reported being unable to see a physician due to cost rose by 2.7 percentage points during the study period — from 11.4% to 15.7%.
The prevalence of those who reported being unable to see a physician due to cost increased among uninsured participants by 5.9 (95% CI, 4.1-7.8) percentage points, from 32.9% to 39.6%. There was an increase of 3.6 (95% CI, 3.2-4) percentage points among insured patients, from 7.1% to 11.5%.
For most medical conditions, the adjusted proportion of those with a chronic medical condition who were unable to see a physician due to cost increased during the study period. The prevalence increased by 5.9% (95% CI, 1.7-10.1) for those with cardiovascular diseases, 3.5% (95% CI, 2.5-4.5) for those with elevated cholesterol, and 3.1% (95% CI, 2.3-3.3) for those with binge drinking. Among patients with chronic conditions, the adjusted proportion of those who received checkups did not change.
Researchers found that the adjusted proportion of people who received guideline-recommended influenza vaccines and cholesterol tests increased, but the proportion of women who received mammograms decreased.
In commentary published alongside the study, John Z. Ayanian, MD, MPP, professor in the Institute for Healthcare Policy and Innovation and the division of general medicine at the University of Michigan, wrote that due to increasingly common high-deductible plans and high out-of-pocket costs, “policymakers, health insurers, and health care professionals now must focus on making health care more affordable for all U.S. individuals in the next 20 years.”
Hawks told Healio Primary Care that the study authors believe the health care system in the U.S. should work on minimizing cost-sharing, but noted that this would be in “direct conflict” with the private insurance industry, as its “business model operates around creating barriers to health care in order to reduce the business’s bottom line.”
“Thus, we think that a single-payer system, which eliminates private insurance, would be the only effective solution to the problem identified in this study,” she said. – by Erin Michael
Disclosures: Ayanian reports receiving personal fees from JAMA, The New England Journal of Medicine, and the Society of Thoracic Surgeons outside the submitted work. Hawks reports receiving grants from Health Resources and Services Administration during the conduct of the study. Please see study for all other authors’ relevant financial disclosures.