Healing Connections

Call them stoic, call them cost-conscious, call them under- or uninsured…but almost 20 percent of the U.S. population either went without or delayed needed medical care at sometime during 2007. That figure is up from 14 percent in 2003, and if you are counting, is an additional 9.5 million Americans who didn’t get the medical care they needed in 2007.

People had numerous reasons why they had postponed or had completely forgone medical care for themselves during the year. Chief among them was out-of-pocket medical costs and deductibles they couldn’t afford to pay, followed by a list that included things like a lack of acceptable clinic hours of operation, difficulty getting to clinics during working hours, problems with doctors being overbooked that resulted in difficulty getting timely appointments, and doctors and hospitals not accepting their insurance plans.

It wasn’t just people without medical insurance that were avoiding medical visits, but both people with and without insurance that were either delaying or forgoing medical care, according to a random national phone survey. The survey was conducted by the Center for Studying Health System Change, a nonpartisan policy group, who called 18,000 people, with a 43 percent response rate.

The study’s lead author, Peter Cunningham, noted that as health care costs increase, a larger share of cost, often in the form of higher deductibles, is being shifted to people and families, requiring them to pay more out of their own pockets. “To the extent that cost increases are passed on to individuals, continued declines in access to care are inevitable,” wrote the co-authors of the study.

Karen Ignagni, chief executive of America’s Health Insurance Plans, an insurance-industry trade group, feels that a variety of issues need to be addressed by policy makers to make surgery, medical imaging, and specialty drugs more affordable to the general public, and to standardize quality of care among providers. The cost of drugs and services has risen at a rate at least twice that of inflation for several years, making it more difficult for even those with health insurance to pay for medical care.

Another area that needs to be addressed is the decline in the number of medical students going into family practice, in part because it pays less than specialties. This is making it harder for people to get even initial appointments. In 2007 only about 1,000 out of 16,000 medical students chose to practice family medicine noted Rick Kellerman, chairman of the board of the American Academy of Family Physicians.

A 2007 survey by the Commonwealth Fund found that 30 percent of Americans over age 18 spent more than $1,000 a year on out of the pocket medical expenses. By contrast, only 4 percent of people in the United Kingdom, 12 percent of people in Canada, and 10 percent of people in Germany paid that much for out of pocket medical expenses in a year.

The U.S. Census Bureau reports that about 47 million Americans have no health insurance. Among the uninsured, 38 percent stated they didn’t get medical care because of cost concerns in 2007; only 29 percent had made that comment in the 2003 survey. The uninsured also had problems finding a doctor and getting an appointment, the 2007 study found.

As things stand now, insured Americans are finding that for one reason or another, the level of care they thought they were guaranteed by their health insurance plans has declined.