One in Seven Americans Faces Problems Getting Needed Medical Care

National Tracking Study Details Americans' Access to Care; Nearly Two-Thirds Cite Cost as Barrier

News Release
March 21, 2002

Alwyn Cassil: (202) 264-3484

ASHINGTON, D.C.—More than 41 million Americans reported problems getting needed medical care in 2001, and nearly two-thirds cited cost as the reason, according to a new national tracking study issued today by HSC.

Despite a strong economy, fewer uninsured people and record low unemployment, overall rates of people foregoing or delaying needed care failed to improve between 1997 and 2001, according to results from HSC’s Community Tracking Study Household Survey, a nationally representative survey involving about 60,000 people in 33,000 families.

"This failure to improve people’s access to health care during such good economic times is a bad omen," said Paul B. Ginsburg, Ph.D, an economist and president of HSC, a nonpartisan policy research organization funded by The Robert Wood Johnson Foundation.

"Access problems and consumer concerns about costs are likely to increase in light of the weaker economy and the rapidly rising health care costs that are driving double-digit health insurance premium increases," Ginsburg said.

The percentage of Americans reporting they went without needed care at some point in the previous year increased slightly, from 5.2 percent in 1997 to 5.8 percent in 2001, which translates into almost 16 million Americans. Another 26 million people, or 9.8 percent of the population, delayed needed care in the previous 12 months—about the same level as in 1997.

The study findings are detailed in a new HSC Tracking Report—Treading Water: Americans’ Access to Needed Medical Care, 1997-2001—available by clicking here.

Cost remained the most frequently cited barrier to getting needed care. Among people reporting an unmet need or who delayed care, about 62 percent said cost was the reason in both 1997 and 2001.

"Worries about the cost of care remained the primary reason that people went without care or delayed care," said Peter J. Cunningham, Ph.D., an HSC senior health researcher and co-author of the study.

Contrary to the findings for the general population, children’s ability to get care improved between 1997 and 2001, with the percentage having either an unmet need or delayed care decreasing from 6.3 percent in 1997 to 5.1 percent in 2001. Despite the improved access, which may have been helped by the State Children’s Health Insurance Program, almost 2 million children could not get needed care in 2001, while another 1.7 million children delayed needed care.

The study also found other reasons for concern. For example, people are increasingly facing problems getting timely physician and clinic appointments, having medical providers accept their health insurance and getting their health insurer to pay for services.

Other survey data suggest more Americans are having trouble scheduling appointments, with the percentage of people waiting more than seven days for an appointment for a doctor’s treatment of an illness or injury increasing from 22.2 percent in 1997 to 28 percent in 2001.

Other key findings of the study, which examines access to care by insurance and health status and income, include:

  • Insurance Counts: The access gap between insured and uninsured people persisted between 1997 and 2001, and uninsured people were still about three times as likely not to get needed care as insured people. In 2001, 4.4 percent of insured people reported an unmet need compared with 15 percent of uninsured people. More than nine out of 10 uninsured people cited cost as the reason they either went without care or delayed care.

  • Income Matters: People with income below 200 percent of poverty, or about $35,000 a year for a family of four in 2001, remained almost twice as likely to have an unmet need than higher-income people-8.1 percent vs. 4.7 percent in 2001.

  • Health Status: People who reported fair or poor health remained almost three times as likely to have an unmet need as healthier people-13 percent vs. 4.6 percent in 2001.

  • Insurance Troubles Increase: For insured people who reported an unmet need or delayed care, the percentage reporting problems with their insurance increased from 28.5 percent in 1997 to 33.4 percent in 2001. The most common problems cited were that health plans would not pay for a service and medical providers would not accept their insurance.
  • Stakeholder Comments on the HSC Study

    Ron Pollack, executive director, Families USA,
    "It is disconcerting that despite the strong economy we experienced in the last five years, access to health care did not improve. In the year 2001, more than 2.2 million people lost their health insurance due to increased unemployment. With this increase, the number of people without health coverage has reached such epidemic proportions that there are more uninsured people than the cumulative population of 23 states plus the District of Columbia. Now is the time to make access to quality, affordable health care a national priority."

    Karen Ignagni, president and CEO, American Association of Health Plans,
    "Americans are clearly concerned about maintaining their access to health care and being able to afford services. It’s time for Washington and the nation to address the growing cost crisis and to focus on solutions that will work to eliminate cost as a barrier to needed care."

    William Hall, M.D., F.A.C.P., president, American College of Physicians-American Society of Internal Medicine,
    "The available research into the health effects of being uninsured points to one simple reality: people without health insurance tend to live sicker and die younger than people with insurance. This problem could be greatly allayed by expanding existing government programs-such as Medicaid and SCHIPs-and establishing measures such as tax credits for the purchase of health insurance. If the nation does not address the problem now, it will pay for it later in the form of unnecessary hospitalizations and expensive treatments for diseases and conditions that could have been easily treated or prevented if detected early enough."

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    The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded by The Robert Wood Johnson Foundation and affiliated with Mathematica Policy Research, Inc.