The proportion of Americans who reported going without or delaying needed healthcare declined modestly between 2007 and 2010, according to a national report released today by the Center for Studying Health System Change.
Funded by the Robert Wood Johnson Foundation, the HSC’s 2010 Health Tracking Household Survey results are detailed in the new report, “Mixed Signals: Americans’ Access to Medical Care, 2007-2010.”
The survey found that approximately 17 percent of the U.S. population in 2010 reported not getting or delaying needed medical care in the previous 12 months, down from 20 percent in 2007. This is despite the fact that about 9 million fewer people had health insurance in 2010 compared with 2007.
The decline in access problems was driven primarily by fewer barriers for insured people, likely reflecting recession-related decreases in the demand for medical care and subsequent easing of health system capacity constraints, according to the study.
“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,” said Ellyn R. Boukus, HSC health research analyst and coauthor of the study.
“It is very likely that the modest decline in access problems since 2007 will be temporary,” added Boukus. “As the economy improves and as coverage expands under healthcare reform, system capacity may become strained under increased demand. Therefore, it is important for providers and policy makers to be vigilant about system bottlenecks down the line to ensure patients' needs are met.”
The nationally representative survey of 17,000 people included for the first time a cell phone sample to account for the growing number of households without a landline phone. Response rates were 45 percent for the landline sample and 29 percent for the cell phone sample, for a combined response rate of 35 percent.
Key study findings include:
• In 2010, about 19.7 million people reported going without needed care and about 32.3 million people reported delaying needed care, for a total of roughly 52 million people reporting access problems.
• In 2010, people with incomes below 200 percent of poverty ($44,100 for a family of four) were 3.1 times as likely to report an unmet need as those with incomes at or above 400 percent of poverty (9.3 percent versus 3 percent). This imbalance has grown since 2007, when low-income people were only 2.2 times as likely as higher earners to forgo care.
• People who reported fair or poor health were more likely to report forgoing needed medical care in 2010 compared with those in good, very good or excellent health (16.9 percent versus 4.6 percent). This is in part because sicker people tend to use more healthcare and, therefore, have more opportunities to encounter access barriers. Between 2007 and 2010, unmet needs declined 1.6 percentage points, from 6.2 percent to 4.6 percent, among the healthier group and remained steady for those in fair or poor health.
• The proportion of insured people reporting an unmet medical need declined by more than a quarter, from 6.2 percent to 4.5 percent. At the same time, the incidence of unmet need among the uninsured fell slightly from 17.5 percent to 16.6 percent, which is statistically significant.
• Uninsured people in poor or fair health faced the greatest problems getting needed care, with nearly one in three (30 percent) reporting they went without needed care in 2010.
• After a decline in access in the middle of the decade, children’s access improved slightly between 2007 and 2010. In 2010, roughly 3 percent of children did not get needed medical care and another 2 percent delayed care, the latter estimate almost half that for 2007.
• Uninsured people with access problems were much more likely to cite cost as a barrier compared to insured people, 95.3 percent versus 65.9 percent in 2010. But, cost concerns increased significantly among insured people who encountered access problems, rising to 65.9 percent in 2010 from 60.7 percent in 2007.
• 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).