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Commonwealth Fund to Study Access to Healthcare

 |  By Margaret@example.com  
   February 08, 2012

The Commonwealth Fund has announced an ambitious effort to track a fixed group of low- and moderate-income adults over the next two years to see how this population fares in terms of medical care and health insurance as the Patient Protection and Affordable Care Act is implemented.

The idea is to look at how access to healthcare insurance influences a host of medical issues, from access to preventive services, to ER use and physician relationships.

This week the Commonwealth Fund released the first in what it hopes will be a series of surveys involving 2,100 adults ages 19 to 64. It plans breakout studies on 19 to 29 year olds as well as 50 to 70 year olds later this year.

My kneejerk reaction when I first heard about this effort was to yawn. I mean we're all pretty familiar with the data documenting the struggles of this socio-economic group to access and afford healthcare—especially when they are uninsured.

But here's an interesting nugget from the first survey: The insured in this group have some of the same struggles as the uninsured.

Access to Primary Care Physicians
Finding a physician is a challenge for both the low- and moderate-income insured and uninsured. Some 51% of the uninsured reported problems finding a primary care physician over the past three years. That is understandable.

But here's the kicker: For the low- and moderate-income population, being insured doesn't mean you'll be able to see a doctor either. According to the report, 25% to 50% of the insured report that a physician or clinic wouldn't even take their health insurance.

Use of the ER
Using the ER was another problem for both the insured and uninsured among the low to moderate income population. According to the report, people with low incomes—with or without insurance—reported going to the ER at higher rates that adults with higher incomes.

At that income level, the uninsured and insured turn to the ER for medical emergencies at about the same rate (88% vs. 89%), and for the same reasons—when other facilities are closed (55% vs. 54%) or when they are directed by a physician (37% vs. 32%). No real surprises there.

Now let's consider diagnostic testing and access to prescription drugs.  Persons with low- to moderate-incomes, whether they are insured or uninsured, visit the ER because they expect easier access to diagnostic testing there (50% vs. 48%). And both groups turn to the ER when they need prescription drugs, although there is more of spread there—50% vs. 35%.

These findings raise a lot of questions about the quality of health insurance coverage available to these families. The American Hospital Association is quite aware of health insurance shortcomings that continue to encourage using expensive ERs for medical basics.

In a comment letter about essential health benefits, AHA said it would like the Department of Health and Human Services to establish "a universal baseline of benefits, and prevent insurers from picking and choosing the benefits that are covered."

The Commonwealth Fund expects to dig into these issues more deeply as it tracks this survey group over the next couple of years. What it hopes to find in subsequent studies is that the ACA makes a difference in access to insurance, cost of care, and health improvement for the low to moderate income population.

I'm looking forward to seeing the results of this longitudinal study. I want to know if the ACA is accomplishing its goals or whether it's just another behemoth government program.

Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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