The proportion of Americans reporting unmet needs declines by 1.3-percentage points between 2007 and 2010…Accounting for the increase in population, this means that about 4-million fewer people went without needed care in2010 than would be the case if there has been no change in the rate of unmet need.[1]
A reality faced by healthcare leaders, providers, and health plans is that the healthcare purchaser in 2012 – employer, individual consumer, family, is making decisions based on their personal economics, realization of the actual cost of care delivery versus historically subsidized and hidden costs obscured by employer-sponsored health plans, and a deeper understanding of personal economic limitations when faced with co-payments out-of-plan expenses.
2010 Health Tracking Household Survey results from the Center for Studying Health System Change(HSC) found the number of uninsured has increased; but, the number of Americans reporting they had gone without or delayed accessing health care had decreased slightly between 2007 and 2010. Industry-wide, one in six Americans have delayed accessing healthcare services are gone without services they perceive as necessary.
Analysis of economic cycles and their impact on healthcare indicates this recession is not that different from other economic upheavals experienced in the United States. Issues related to accessing health care decrease as demand for healthcare decreases. Scheduling an appointment, a diagnostic test or a procedure is somewhat easier when overall use of industry services decreases.
Improved access has come with a price. The gap between insured and insured has increased since 2007. Increased out of pocket expenses, decling employer sponsored health plans, and expanding co-payments. Demand for safety-net healthcare services – community health centers, has also surged.
The uninsured seek out the care of physicians and physician extenders less than Americans who are insured. The evidence uncovered in the HSC study was that between 2007 and 2010, there was a significant decline in care delivery utilization for the uninsured and no relevant change among the insured.
The other day, I was at a social gathering and asked what I did. As I was explaining about research tools for healthcare analytics, the individual looked at me and said, “Oh, you help them make more money.” The statement was presented with a smirk and hesitation that belied the real meaning of his statement. In some respects, his impression was that this work was equivalent to the role of money lenders in the Middle Ages – a fate that no man would want to have. My new friend was in real estate. I attempted to provide more explanation – the value of healthcare analytics, ability to forecast demand and develop more efficient care delivery systems, understand the market and meet its demands in a more focused and targeted manner. The smirk never left his face.
My next statement ended the conversation abruptly: “So you have properties for lease – houses, apartments, business sites. I am looking for a new office space and one of your properties if perfect. I can only spend $10.sf..” I was informed that the cost was $25.00/sf. “So what,” in a defiant retort, “That’s all I want to spend so lease me the space. Are you in the business of matching tenants with properties or making money?”
The logic of this discourse is age-old and somewhat meaningless. Our current healthcare industry has continued to grow total spending at a pace faster than our patient’s incomes have increased. Coupled with increased cost-sharing with employers and health plans, cost is at the top of the concern list for Americans seeking healthcare.
Current and upcoming healthcare reform promises to focus attention on access barriers, increased coverage options for low and no income, and expanded options for securing healthcare coverage. The continuing financial crises, and state’s ability to fund state-wide access programs, is likely to diminish some aspects of proposed reform. In the interim, it is essential to keep attention on safety-net programs and expanding accessibility with physician extenders.
[1] http://www.hschange.org/CONTENT/1233/#ib8
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