Universal health insurance will not ensure equal access to care because the healthcare system will be swamped with new patients, according to a new study of 1,000 Americans.
The PricewaterhouseCoopers LLP Health Research Institute survey and study, Jammed access: Widening the front door to healthcare, also found that alternative care access strategies, such as shared doctors appointments, online consultations, and worksite clinics as a way of alleviating the access bottleneck received varying but significant support.
The study found that, unless innovative care delivery models are used, the nation's healthcare system will be ill-equipped to handle the tens of millions of currently uninsured people who would suddenly be covered under a universal healthcare system.
For example, the study found that Americans in general—and not just the uninsured—are increasingly using costly hospital emergency departments as the health system's point of entry. The physician shortage, a lack of access to specialists, Medicaid reimbursement disincentives, high costs for the under-insured, and poor coordination among practitioners are cited as leading reasons for the jammed access points. As a result, per capita ED visits already are at an all-time high, which is reflected in overcrowding, ambulance diversions, and long waits.
"It's clear that access to insurance coverage does not translate into access to care," says David Chin, MD, leader of PwCHRI. "The quick fix is to build bigger emergency rooms, but increasing supply will only drive up healthcare costs. We must find solutions that expand access without adding costs, and we believe the answer lies in new flexible models of care that use the right technologies and incentives and behavior changes to unclog jammed access points."
The study found that:
- Patients covered by Medicaid use EDs at twice the rate as the uninsured; and 44% of Medicaid respondents visited an ED in the past year compared to 20% of uninsured respondents.
- More than half of people who went to an ED in the past year say they went for a reason other than an emergency, such as their doctor's office was closed or they couldn't get an appointment.
- EDs have become holding tanks for mental health patients because of a shortage of mental health providers and beds. The average length of stay in the ED for patients in need of mental health services is double that of other patients.
- One in four consumers and one-third of Medicaid patients say it takes more than a month to see a doctor. One in 10 respondents say they've waited three months or longer.
States with high uninsured populations generally have lower ED use than states with lower uninsured populations, the study found. Massachusetts, where only 3% of residents are uninsured, has one of the nation's highest per-capita ED utilization rates. The Bay State also has the highest number of physicians per capita, but has been plagued by a severe physician shortage since introducing near-universal coverage in 2006.
The survey accompanying the study was conducted in April and found that people are willing to try alternative ways to access care, including:
- Electronic interaction with providers and payers: 50% of respondents say they'd be willing to seek healthcare through the Internet or other computer technology as a substitute for a face-to-face, non-emergent visit. E-mail consultations were the preferred method of interaction (76%), followed by telehealth, question/answer fee-based consults, and an online forum/chat room monitored by a doctor. Nearly three-quarters of consumers say they would use biometric electronic remote monitoring services to track their condition and vital signs.
- Retail and worksite clinics for patients: 37% of respondents say they'd be likely to use a worksite clinic, and 36% would use a retail clinic. Ten percent of large employers surveyed in PwC's 2009 Annual Employer Barometer Survey say they're providing worksite clinics, up from 1% in 2008.
- Shared medical appointments: 28% of respondents say they'd support the concept, which typically involves a 60- to 90-minute session that includes a private or personal exam integrated with patient education and discussion with a group of 10 to 15 people.