Annals of Family Medicine
September/October 2003
On Being New to an Insurance Plan: Health Care Use Associated With the First Years in a Health Insurance Plan
By Peter Franks, MD, Colin Cameron, PhD and Klea D. Bertakis, MD
Results:
After multivariate adjustment, the first year of insurance was associated with a higher risk of not getting a mammogram, a higher risk of avoidable hospitalization, greater likelihood of visiting a physician, and higher expenditures, especially for testing.
Conclusions:
The findings suggest there might be adverse clinical and financial implications associated with changing insurance.
From the Discussion:
The 20% annual turnover in insurance observed in this study represents a considerable proportion of those insured and is consistent with previous national data.
… this study represents a step toward examining possible costs of changing
insurance status. Depending on the measure examined, we observed adverse
effects (less prevention, higher costs, more avoidable hospitalizations)
that lasted up to 3 years from enrollment in the health plan. These findings are consistent with the observations of Hjortdahl that it took 1 to 5 years for the primary care physician’s sense of medical responsibility for and knowledge about their patients to reach adequate levels also reflected in resource use. Together with studies showing decreased patient
satisfaction with forced health plan switches, the findings suggest that there are likely pervasive adverse consequences of the frequent rebidding of insurance contracts by employers.
http://www.annfammed.org/cgi/content/full/1/3/156
Comment: Changing insurance plans, a very common occurrence in our current
fragmented system of funding care, results in adverse clinical and financial
outcomes. Life long coverage through a single universal insurance system
would eliminate this cause of impaired continuity of care.
(The current issue of Annals of Family Medicine contains several other
articles and editorials on continuity of care which you may find of
interest: http://www.annfammed.org/current.shtml)