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Despite insurance gains, more people in the U.S.A can't afford doctors

Despite insurance gains, more people in the U.S.A can't afford doctors

Despite insurance gains, more people in the U.S.A can't afford doctors

(Reuters Health)- A growing number of Americans find it too expensive to see doctors even though more people have health insurance, a U.S. study suggests.
Over the past two decades, the proportion of adults without insurancedropped to 14.8% from 16.9%, the study found. But during this same period, the proportion of adults unable to afford doctor visits climbed from 11.4% to 15.7%.
Out-of-pocket costs made doctors too expensive for the uninsured, but costs also kept people with coverage from seeing physicians even when they had chronic medical conditions requiring regular checkups.
“The quality of private health insurance is getting worse, and the cost of healthcare is rising significantly,” said lead study author Dr. Laura Hawks of the Cambridge Health Alliance and Harvard Medical School in Boston.
“We know that private health insurance plans increasingly rely on high premiums, high-deductible health plans . . . high copays and other forms of cost-sharing,” Hawks said by email. “All these create financial barriers.”
For the study, researchers examined survey data collected from 1998 to 2017 by the Centers for Disease Control and Prevention. They wanted to see how access to care changed after the Affordable Care Act (ACA) was implemented 2014.
The proportion of adults ages 18 to 64 who couldn’t afford to see the doctor climbed slowly from 1998 to 2009, then rose more rapidly for several years before improving with the passage of the ACA, researchers report in JAMA Internal Medicine. But even after the ACA took effect, the proportion of adults able to afford checkups never returned to 1998 levels.
Affordability worsened across all racial and ethnic groups, and nearly all income groups, the study found.
Among the uninsured, the proportion of adults unable to afford a physician visits climbed from 32.9% to 39.6% during the two-decade study period.
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For people with health benefits, the proportion unable to pay for doctor visits rose from 7.1% to 11.5%.
The inability to see a doctor because of costs rose for people with many common chronic health problems including heart disease, high cholesterol and alcohol use disorders.
The study didn’t look at whether or how shifts in affordability of physician checkups affected health outcomes.
One limitation of the analysis is that researchers lacked data on the affordability of prescription medications, which can also impact health as well as how often people need to see doctors.
“We knew that uninsured adults are much more likely than insured adults to avoid seeing a doctor due to cost, and uninsured adults with chronic conditions such as diabetes or heart disease are much less likely to get regular check-ups,” said Dr. John Ayanian, director of the Institute for Healthcare Policy and Innovation at the University of Michigan in Ann Arbor, who wrote an editorial accompanying the study.
Still, the results underscore that the ACA hasn’t insured everyone who needs coverage or made care affordable for all Americans, Ayanian said by email.



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