Aug. 25, 2011
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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.
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, according to the study.
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, according to findings from HSC’s 2010 Health Tracking Household Survey, a nationally representative survey with information on 17,000 people. Funded by RWJF, the survey for the first time included 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.
“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, M.A., HSC health research analyst, and coauthor of the study with HSC Senior Fellow Peter J. Cunningham, Ph.D.
Overall, 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% vs. 3%). This imbalance has grown since 2007, when low-income people were only 2.2 times as likely as higher earners to forgo care. Within each income group, uninsured people were roughly three times as likely as insured people to report going without needed care.
People who reported fair or poor health also were more likely to report forgoing needed medical care in 2010 compared with those in good, very good or excellent health (16.9% vs. 4.6%), the study found. This is in part because sicker people tend to use more health care 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 52 million people reporting access problems increasingly identified cost as an obstacle to needed care—75.2 percent cited cost as a barrier in 2010 compared with 69 percent in 2007. At the same time, fewer people encountered health system-related barriers, such as getting timely appointments with doctors, possibly reflecting freed-up health system capacity because of lower demand.
The study’s findings are detailed in a new HSC Tracking Report—Mixed Signals: Americans’ Access to Medical Care, 2007-2010—available online at www.hschange.org. Other key findings include:
The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nations changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is affiliated with Mathematica Policy Research.