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Study: Insured Population Experiencing Health Care Access Problems

By Danielle Parnass, CQ Staff

June 26, 2008 -- The gap is narrowing between the insured and uninsured as more people with health insurance reported access barriers to health care in 2007, according to a study released Thursday.

The study by the Center for Studying Health System Change (HSC) found a 62 percent increase in the number of insured people with unmet medical needs from 2003 to 2007, compared with a 33 percent increase for the uninsured.

This reflects eight percent of the overall U.S. population without access to health care, up from 5.2 percent in 2003, the study found. Still, uninsured people were almost three times as likely to go without medical care—17.5 percent versus 6.3 percent of the insured.

"It's not a pretty picture, especially for insured people, who increasingly are finding that the access to care once guaranteed by insurance is declining," Peter Cunningham, co-author of the study and a HSC senior fellow, said in a release.

Health status also played a factor in people seeking access to medical care. While those without insurance in poor or fair health reported the most problems in getting needed care—25 percent in 2007—those with insurance and in poor or fair health saw the sharpest decrease in access to care—14.2 percent in 2007, up from nine percent in 2003. This is compared with 14.5 percent of the uninsured in good health accessing medical care and five percent of the insured in good health.

Of all those who had trouble with access, 69 percent cited cost as the main reason for delayed or unmet care, a 3.8 point increase from 2003. Other factors included problems with health plans and the health system in general, the report found. While cost was the number one concern for the uninsured at 91.3 percent, 64.7 percent of people with insurance cited problems with the health system and 60.8 percent cited costs.

Cost concerns can be attributed to out-of-pocket expenses that have been increasing with regard to family income, as well as a weakening economy, Cunningham said, and the report highlights the link between cost and access in medical care. "It's really two sides of the same coin," he said at a press conference Thursday.

Growing medical work force shortages in primary care are a major factor contributing to the rise in health system barriers, said Rick Kellerman, chairman of the board of the American Academy of Family Physicians (AAFP). "A robust and healthy primary care system works," he said, to provide the right care to the right patient at the right time.

He said a nearly 40 percent increase is necessary in family physicians by 2020 to deal with an aging population and more people with chronic disease. AAFP reports show that around 7 percent of American medical students who graduated in the past year will go into family medicine. Coupled with the baby boomer population that is expected to retire in the next three to five years, "we cannot keep up with workforce need," Kellerman said.

David Colby, vice president for research and evaluation for the Robert Wood Johnson Foundation, which funded the HSC study, said the report is a "warning about seismic change in our health care system." He said access surveys conducted by the foundation in the past 18 years indicated access neither improved nor deteriorated, whereas now it is declining for both the insured and the uninsured.

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