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New data reinforces an unsettling reality: Insurance coverage isn’t the same as access to health care.

As reported in JAMA Internal Medicine, researchers examined 20 years of data to gauge trends in coverage and access to physicians.  Data from 1998 to 2017 revealed an interesting irony. While the percentage of uninsured Americans has decreased, the percentage of Americans who cannot access a physician because of costs has gone up.

Using survey data from the Centers for Disease Control and Prevention, researchers determined that:

  1. Americans without insurance coverage has decreased by two percentage points, from 16.9% to 14.8%.
  2. Americans who cannot see a physician because of cost has increased by nearly three percentage points.  

Most groups of patients with chronic conditions saw an increase in people who couldn’t afford a physician visit.  For preventive measures, the data were mixed. More people received flu vaccines and cholesterol tests as recommended by clinical guidelines.  Access to mammograms among female patients, however, decreased.

The results offer intriguing insights on how insurance coverage impacts patients.  Since The Affordable Care Act passed Congress in 2010, more than 20 million Americans have gained health coverage.  But, for some Americans, that may be coverage in name only.

“Despite coverage gains since 1998,” the study’s authors note, “most measures of unmet need for physician services have shown no improvement.”

The study’s findings may be a reflection of continued cost shifting by insurers.  Premiums have more than doubled since The Affordable Care Act, with insurers pushing the cost of coverage onto patients. To some, the added out-of-pocket cost of visiting a physician may be too much to bear.  In other cases, patients may have opted for high-deductible health plans with lower monthly premiums. But the higher upfront out-of-pocket cost for care may deter these patients from seeing a doctor, limiting the coverage’s practical value to patients.

The irony leads the study’s authors to contend that, “Covering the 29 million [people] who remain uninsured would ameliorate, but not resolve, the access to care problems….” 

As the study conveys, coverage is only one facet of access to care.  The insurers who provide that coverage must also do their part in making care for their beneficiaries financially feasible.

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