A new report released today from the Commonwealth Fund highlights how those who are earning less than 133 percent of the federal poverty level were uninsured for significant chunks of time in 2011.
While reports like this are helpful in understanding where many of the problems are in healthcare, they all continue to point out how desperately we are in need of substantial reform efforts.
And at the heart of these reform efforts, there appears to be the underlying common denominator of coverage and access.
Take for example a 2008 study in the Journal of the American Medical Association. The authors found that uninsured people nearing age 65 became ill at a faster rate than those in the same age group with insurance.
Now some of this can be written off to “as you age you have more health problems” however, there is a kicker here.
Once the uninsured group turned 65 and became eligible for Medicare coverage, their illness management improved with the increased access they had to care.
Heart attacks and heart failure rates dropped by 10 percent for the newly insured Medicare group between ages 65 to 72.
The authors’ concluded:
“In this study, acquisition of Medicare coverage was associated with improved trends in self-reported health for previously uninsured adults, particularly those with cardiovascular disease or diabetes.”
It appears that having coverage can make a difference in not only health outcomes, but also proper utilization. As the Commonwealth Fund report highlights, those improperly utilizing emergency department services (very expensive services) often cited non-emergency reasons for their visit. As these data show, most needed prescriptions filled, others did not have other “affordable options” and most interesting, 41% did not have a regular doctor.
And back we are again to the importance of having a point of contact in healthcare. Back we are again to the critical importance of primary care. From a previous OH post:
“There also needs to be a higher value placed on primary care. One cannot underestimate the value of continuity in healthcare, and this is especially true in primary care. Yet we have fewer and fewer primary care physicians entering the healthcare workforce, which will ultimately affect quality and the cost of medical care.”
So the issues here are twofold – in order to have access, people must have insurance or else they use expensive services (e.g., emergency department) to meet their basic healthcare needs (driving up overall cost); there must be affordable health insurance options for those who cannot afford to pay a great deal for coverage. Unfortunately, the population often in the most need for healthcare services are those with limited resources.
When over 46 million people in the United States live in poverty, we have our work cut out for us.
Dr. Miller has his doctorate in clinical psychology and is an Assistant Professor in the Department of Family Medicine at the University of Colorado Denver School of Medicine where he is the Director of the Office of Integrated Healthcare Research and Policy. His core task is to integrate mental health across all three of the department’s core mission areas: clinical, education, and research. Opinions expressed here are his own and not those of his employer.
