A Widening Rift In Access And Quality: Growing Evidence Of Economic Disparities
By Robert E. Hurley, Hoangmai H. Pham, Gary Claxton
Health Affairs
December 6, 2005
Data from the Community Tracking Study provide a valuable perspective from which to observe how economic disparities–largely a function of different sources of coverage–influence access to medical care in the United States. Many recent investments and initiatives are focused on affluent communities and are accessible mainly to people with employer-based or Medicare coverage. For people with Medicaid or no coverage at all, access to basic care is worsening, as a result of stalled coverage expansions and service cutbacks. An improving economy could forestall further cuts and permit reversal of earlier ones, but progress in closing this rift does not appear imminent.
Coverage And The Hierarchy Of Access To High-Quality Care
A clear hierarchy of access to care is apparent in many communities, which closely corresponds to insurance coverage and its sponsorship. Long-standing anxiety about prospects for a “two-tier” health care system has, in fact, given way to a three-tier reality in the CTS markets:
* Employer-sponsored and Medicare coverage.
* Medicaid and other state and local programs.
* Unsponsored and unfortunate.
There is every reason to expect that Americans will demand and receive more and better health care, shifting more resources into the health care sector. However, not all will be able to afford this care, and there is growing evidence that U.S. society is prepared to tolerate trading off pursuing excellence for some, at the expense of deteriorating care for others.
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.566v1
Comment: It is a gross understatement to say that individuals who have dedicated their lives to health care reform will be dismayed by this report.
The lowest tier of the unfortunate provides perhaps the greatest angst for us as we watch their problems grow ever greater. The middle tier compounds our angst as we recognize that this sector is shifting from having access to basic services to a lower level that could only be described as “unsatisfactory.” And the first tier? We are pouring resources into their affluent communities to provide them not the best, but the highest tech care available. Innumerable studies have shown that the overall quality of care for this first tier would actually improve if we would moderate the infusion of excessive high-tech resources into these communities.
We can get it right. This study confirms that the maldistribution of resources is directly related to the adequacy of coverage of the three tiers. Establishing a single, universal, equitable system of coverage would dramatically improve the allocation of our health care resources. It is not the only factor, but it is the most important one.
But will we get it right? We seem to be captivated by the high-tech glitz of the “greatest health care system on earth.” Those in the first tier seem to be unwilling to exchange some of the unnecessary glitz for greater equity in health care. Maybe we’ll have an awakening when the expansion of cost sharing moves many from the first tier to the second. Then those few remaining in the first tier may not be able to tolerate the cacophony of the masses. But even then, noise cancellation technology has become much more advanced.