Cost prevents access to care, even for insured, JAMA study finds
The proportion unable to see a physician owing to cost increased by 2.7% overall; by 5.9% among the uninsured and 3.6% among the insured.
Despite gains in the number of people who have health insurance, medical needs are going unmet due to financial factors, according to research published in JAMA Internal Medicine.
The study shows that the enactment of the Affordable Care Act in 2014 improved coverage and access to care, but measures for unmet physician services has not improved.
WHY THIS MATTERS
The study comes out a time when the ACA is again facing elimination, this time by court challenge.
Last week, the Supreme Court declined a request by Democratic-led states and healthcare organizations to fast-track review of the ACA. The case is expected to go back to the District Court for the Northern District of Texas to decide whether the rest of the law can stand now that the individual mandate is gone.
The Texas court in 2018 ruled in favor of Republican states that brought a lawsuit claiming the ACA is unconstitutional since Congress did away with the individual mandate.
The ACA, enacted in 2014, allowed millions of Americans to gain health insurance who formerly went uninsured.
The results showed that among adults who responded to the Centers for Disease Control and Prevention Behavioral Risk Factors Surveillance System, between 1998 and 2017, uninsurance decreased by 2.1 percent, from 16.9% to 14.8%.
Yet the JAMA study said a focus on the ACA could distract attention from longer-term trends in unmet health needs, and the problems that persist.
RESULTS AND THE LARGER TREND
JAMA looked at the proportion of people ages 18 to 64, in both 1998 and in 2017, who were unable to see a physician when needed due to cost.
It also looked at those having no routine checkup within two years and those who did not have preventive services in the recommended time frame, both overall and among subgroups for chronic illness and self-reported health status.
The proportion unable to see a physician owing to cost increased by 2.7% overall; by 5.9% among the uninsured and 3.6% among the insured.
The proportion of persons with chronic medical conditions who were unable to see a physician because of cost also increased for most conditions. For example, an increase in the inability to see a physician because of cost for patients with cardiovascular disease was 5.9%, for patients with elevated cholesterol, 3.5%, and for patients with binge drinking, 3.1%.
The proportion of chronically ill adults receiving checkups did not change; the share of people receiving guideline-recommended cholesterol tests and flu shots increased; and the proportion of women receiving mammograms decreased.
JAMA concluded that despite coverage gains since 1998, most measures of unmet need for physician services have shown no improvement, and financial access to physician services has decreased.
Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com
