Fewer Access Problems, More Uninsured

by Clive Riddle, August 26, 2011

That is the title to the opening section of a new study released from the Center for Studying Health System Change:  Mixed Signals: Trends in Americans' Access to Medical Care, 2007-2010, Tracking Report No. 25, August 2011 by Ellyn R. Boukus and Peter J. Cunningham.

In a statement, the Center commented on this paradox by noting “about 9 million fewer people had health insurance in 2010 compared with 2007, and logically such a large increase in the uninsured population would be accompanied by an increase in access problems. However, approximately 17 percent of the U.S. population in 2010—about one in six people—reported not getting or delaying needed medical in the previous 12 months, down from 20 percent—one in five—in 2007, the study found.”

So how can that be? The statement goes on to answer this question: “the decline in access problems was driven primarily by fewer problems for insured people, likely reflecting recession-related decreases in the demand for medical care and subsequent easing of health system capacity constraints.”

The study authors also say that access for the insured improved much more than for the uninsured.  Ellyn R. Boukus, M.A., health research analyst with the Center, and coauthor of the study tells us “while overall access problems declined, the access gap between insured and uninsured people widened in 2010, especially for lower-income people and those with health problems.”

Here’s some key findings from the study:

• The proportion of insured people reporting an unmet medical need declined from 6.2% to 4.5% between 2007 and 2010.
• 17.5% of the uninsured reported an unmet need in 2010 compared to 16.6% in 2007
• 75.2% of the 52 million people reporting access problems identified cost as an obstacle to needed care in 2010 compared with 69.0% percent in 2007.
• 95.3% of the uninsured cite cost as a barrier compared to 65.9% of the insured in 2010
• In 2010, 9.3% of people with incomes below 200 percent of poverty ($44,100 for a family of four) reported an unmet need compared to 3.0% for those with incomes at or above 400 percent of poverty
• This 2010 ratio of 3.1 (9.3%/3.0%) for low incomes peoples unmet needs/higher income unmet needs compares to a ration of 2.2 in 2007
• 16.9% of those in fair or poor health reported forgoing needed medical care in 2010 compared with 4.6% of those in good, very good or excellent health (16.9% vs. 4.6%)
• 30% of uninsured people in poor or fair health reported they went without needed care in 2010
• Among all people citing a health-system obstacle, the biggest declines were associated with the following reasons: inability to get an appointment soon enough (10.2 percentage point decrease); takes too long to get to the provider (6 percentage point decrease); inability to get to provider when the office was open (5.7 percentage point decrease); and inability to get through on the telephone (5.5 percentage point decrease)