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Americans' Access to Medical Care Deteriorates Between 2003 and 2007

1 in 5 Americans Faced Problems Getting Needed Medical Care in 2007, up from 1 in 7 in 2003

News Release
June 26, 2008

Alwyn Cassil (202) 264-3484 or

WASHINGTON, DC—More than 20 percent of the U.S. population in 2007—one in five people—reported not getting or delaying needed medical care in the previous 12 months, up significantly from 14 percent—one in seven people—in 2003, according to a national study released today by the Center for Studying Health System Change (HSC).

In 2007, more than 23 million people reported going without needed care and approximately 36 million people delayed care, for a total of about 59 million people reporting access problems, according to findings from HSC’s 2007 Health Tracking Household Survey, a nationally representative survey containing information on 18,000 people; the survey had a 43 percent response rate. HSC has conducted the survey five times since 1997 as part of the Community Tracking Study, and the 2007 survey shows the sharpest increase in access problems in a decade, particularly among insured Americans.

The proportion of Americans reporting an unmet medical need between 2003 and 2007 increased by 2.8 percentage points to 8 percent—the equivalent of about 9.5 million more people going without medical care, the study found. During the same period, the proportion of Americans delaying needed care increased by 3.9 percentage points to 12.3 percent, or about 13.5 million more people postponing care. The 59 million people reporting access problems increasingly cited cost as an obstacle to needed care, along with rising rates of health plan and health system barriers, the study found.

"This is the most up-to-date snapshot of the access problems Americans are facing when seeking medical care, and it’s not a pretty picture, especially for insured people, who increasingly are finding that the access to care once guaranteed by insurance is declining," said Peter J. Cunningham, Ph.D., an HSC senior fellow and coauthor of the study with HSC Health Researcher Laurie E. Felland, M.S. HSC is a nonpartisan health policy research organization funded in part by the Robert Wood Johnson Foundation, which funded the survey and the study.

Access problems increased more for people in poor or fair health than for healthier people, the study found. Likewise, low-income children encountered the greatest increase in unmet needs among all children, reversing the gains they experienced between 1997 and 2003. As a consequence, income differences in unmet need for children were eliminated by 2003, but these disparities returned by 2007.

Uninsured people continued to face far greater access problems and were almost three times as likely to report going without care as insured people—17.5 percent vs. 6.3 percent. However, insured people experienced a greater percentage increase in unmet medical needs compared with uninsured people—a 62 percent increase for the insured vs. a 33 percent increase for the uninsured. As a result, ironically, the access gap between insured and uninsured people narrowed slightly. In 2003, uninsured people were 3.4 times as likely to report going without care as insured people and 2.8 times as likely in 2007.

"The deteriorating access to care, particularly for vulnerable groups—the uninsured, people in the worst health and low-income children—are especially disturbing," said David C. Colby, Ph.D., vice president for research and evaluation at the Robert Wood Johnson Foundation.

"The findings send a clear message that we are heading down the wrong path. The American health care system is broken, and with each passing year more Americans are falling behind when it comes to getting the medical care they need," Colby said. "This is a national problem that demands national attention."

The study’s findings are detailed in a new HSC Tracking Report—Falling Behind: Americans’ Access to Medical Care Deteriorates, 2003-2007available here. Other key findings include:

  • Access to care deteriorated the most for insured people in poor or fair health—14.2 percent reported going without needed care in 2007, up from 9 percent in 2003. Overall, people in poor or fair health with an unmet need increased by 5.1 percentage points between 2003 and 2007 (11.9% vs. 17.0%), compared with an increase of 2.1 percentage points for people in good, very good or excellent health (4.1% vs. 6.2%).
  • Uninsured people in poor or fair health reported the greatest problems getting needed care in 2007, with one in four (25%) reporting they went without needed care.
  • For people reporting an access problem, cost was the most frequently cited—and a growing—obstacle to care. In 2007, 69 percent of people who went without or delayed needed care cited worries about cost, a 3.8 percentage point increase from 2003.
  • Between 2003 and 2007, the frequency with which insured people cited a health plan-related reason for going without or delaying care increased 8.5 percentage points to 39 percent in 2007. Most of the increase was attributable to people reporting more problems getting their health plan to pay for treatment or that their doctor or hospital would not accept their insurance.
  • Between 2003 and 2007, the frequency with which people reported a health system-related reason for going without or delaying care increased 8.6 percentage points to 58.2 percent. Most of the increase was attributable to people reporting more problems getting timely appointments or not being able to get to the doctor’s office or a clinic when it was open.

Stakeholder Comments on the HSC Study

Gail Shearer, director of health policy analysis, Consumers Union,

"This study is yet another wake-up call to policymakers that our health care system is failing to meet the needs of even insured consumers in America. Health care reform is not just about decreasing the numbers of uninsured people. It is about transforming the system into one that consistently provides appropriate quality care without unfair financial burdens."

Karen Ignagni, president and CEO, America’s Health Insurance Plans,

"Health care reform needs to be a top priority to ensure that nobody falls through the cracks. We have offered proposals to shore up the health care safety net, give working families a helping hand to afford health care coverage, and to address the cost-drivers that are making health care coverage unaffordable for many Americans."

Rick Kellerman, M.D., FAAFP, chair of the American Academy of Family Physicians Board of Directors,

"This study reflects the complexity of the problems facing America’s health care system. We must solve multiple problems: uninsured and underinsured Americans, the inadequate payment for primary care physicians’ medical expertise and time, the worsening primary care physician shortage, and the escalating costs of our system.

"We can move in that direction by re-emphasizing the foundation for all health care-primary care that helps prevent illness, manages chronic conditions, coordinates subspecialty care, and reduces fragmentation and duplication of services. Studies have shown that a primary care-based health system results in better outcomes, longer life spans, lower infant mortality, and less cost.

"A new emphasis on the value of primary care and a dramatic increase in the number of primary care physicians will improve access to health care services. Family physicians are working to implement the patient-centered medical home model that will further reduce systemic barriers and enhance access to care. Elements of the medical home include same-day appointments, expanded office hours, offering online services such as access to lab and test results or making appointments, and offering group visits for chronic conditions. If we can dramatically increase the number of primary care physicians and more fully implement the patient-centered medical home, systemic barriers to care will fall.

"All of this requires an understanding of the challenges and a willingness to work together to meet those challenges. The HSC Tracking Report-Falling Behind: Americans’ Access to Medical Care Deteriorates, 2003-2007-is an important contribution to that process."

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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 principally by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.


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The Center for Studying Health System Change Ceased operation on Dec. 31, 2013.