Access barriers for low-income families
Insurance + Access (does not equal) Health Care: Typology of Barriers to Health Care Access for Low-Income Families
By Jennifer E. DeVoe, MD, DPhil, Alia Baez, BA, Heather Angier, BA, Lisa Krois, MPH, Christine Edlund, MSc and Patricia A. Carney, PhD
Annals of Family Medicine
November/December 2007
This study was designed to identify barriers faced by low-income parents when accessing health care for their children and how insurance status affects their reporting of these barriers.
Families reported 3 major barriers: lack of insurance coverage, poor access to services, and unaffordable costs.
In summary, obtaining and maintaining insurance was the most important theme among all families. Comparing families in all insurance groups, insurance coverage issues were more often reported by families with uninsured parents or uninsured children. Access concerns were mentioned most often among those with public health insurance, whereas privately insured families more commonly mentioned unaffordable medical costs.
http://www.annfammed.org/cgi/content/full/5/6/511
Comment:
By Don McCanne, MD
This is yet another study of coverage, access and costs for low-income families. The findings are intuitive, not to mention having been supported by many other studies.
- For families with no coverage, obtaining insurance was their greatest concern.
- For families with public insurance such as Medicaid, access to care was their greatest concern.
- For families with private insurance, unaffordable medical costs were their greatest concern.
What does this mean?
For the uninsured, the consequences are obvious. In the event of medical need, being uninsured threatens both health security and financial security.
For those covered by public insurance targeted to low-income families, chronic underfunding remains a problem because of the lack of adequate political support for welfare programs. This results in a lack of willing providers, especially for specialized services. Thus access is a problem simply because the care is not available. Community Health Centers, if accessible, provide some basic needs, but cannot ensure access to more expensive, high-tech services.
For those with private insurance, health care costs remain a barrier to care. As this report states, “there is a growing number of low- and middle-income families with private health insurance who gain access to most services, but the high deductibles and co-pays prevent them from getting necessary care.”
The last statement above should concern us all. The financial barriers erected by private plans impact not only low-income families but also middle-income families as well. Yet most of the leading proposals for reform are based on a market of these private insurance plans. Lack of affordability is already a major concern, and it will only grow worse under these proposals.
The fact that this study indicated that public insurance causes access problems should not concern us since it represents a peculiarity of an underfunded welfare program - Medicaid. Our other public insurance program - Medicare - is funded at a level that assures an adequate number of willing providers, primarily because of continuing political advocacy for a popular program that eventually serves us all.
Medicare does have one problem that Medicaid does not, and that is excessive out-of-pocket cost sharing that creates affordability problems for some beneficiaries. But a new and improved Medicare for All, a single-payer national health program, would rectify that problem. Cost sharing that creates financial barriers to care would be removed.
We can have it all: health care that is universal, accessible and affordable.