The issue of patients' access to quality healthcare moved toward the top of the industry agenda again last week after two Washington-based organizations released related national reports examining access to and disparities in care.
More than 41 million Americans reported problems obtaining medical care in 2001, primarily financial, according to a national study released by the Center for Studying Health System Change (HSC), a nonpartisan policy research organization funded by the Robert Wood Johnson Foundation. Earlier in the week, the Institute of Medicine released a report concluding that minorities receive lower-quality healthcare than whites.
Some of the same provider groups that last month banded together to draw attention to the issue of the uninsured found themselves once again calling for a more unified effort to address access and quality problems.
"We've seen many descriptions of the problem, and now everyone is looking to work together to identify solutions," said Susan Pisano, spokeswoman for the American Association of Health Plans.
The HSC study, which examined access to care by insurance, income and health status, found that despite a strong economy, fewer uninsured and record low unemployment, overall rates of people forgoing or delaying needed care failed to improve from 1997 to 2001.
Almost 16 million Americans, or 5.8% of the population, said they had gone without needed care in the previous year, and an additional 26 million people, or about 9.8% of the population, reported delaying care, according to the HSC report. The cost of care was the principal barrier for 62% of those reporting problems. By comparison, 5.2% of Americans in 1997 said they had gone without needed care during the previous 12 months, and about the same percentage as today, 9.8%, said they had delayed care.
Paul Ginsburg, president of the HSC, in a written statement called the failure to improve care in good economic times a "bad omen."
The study, like many previous reports, concluded that insurance and income status were directly related to the access gap in healthcare.
In 2001, 4.4% of America's roughly 40 million insured reported they were unable to get care, compared with 15% of uninsured people who said they could not get the care they needed. More than 90% of uninsured people cited cost as the barrier to receiving or delaying care, the study said.
Low-income people were almost twice as likely to report an unmet healthcare need in 2001 as higher-income people-8.1% vs. 4.7%. Additionally, the percentage of higher-income people reporting difficulty getting access to healthcare increased to 4.7% in 2001 from 3.9% in 1997.
But advocates, industry leaders and policymakers working to find solutions to the age-old issues of access and cost containment will have to take another set of findings into account while making their recommendations for reform.
According to the IOM report also released last week, racial and ethnic minorities are more likely to receive lower-quality healthcare than nonminorities, even when patients' insurance status, income, age and conditions are comparable.
The 562-page congressionally mandated study emphasized that "differences in treating heart disease, cancer and HIV infection partly contribute to higher death rates for minorities."
"The real challenge lies not in debating whether disparities exist . . . but in developing and implementing strategies to reduce and eliminate them," said Alan Nelson, a retired physician and former president of the American Medical Association, at an IOM briefing held in Washington.
Nelson, chairman of the 15-person IOM committee that issued the report, said healthcare providers need to focus on understanding bias, stereotyping, prejudice and clinical uncertainty about a patient's condition.
"At a minimum, we need to have a shared understanding of cultural and language differences," said Carmela Coyle, senior vice president of policy at the American Hospital Association. "Coverage is an important aspect, but it's not everything."
Coyle said the IOM report, in particular, underscores the importance of acting quickly to broaden the base of the healthcare workforce.