Some health care providers may be closing their doors to some insurance groups: An assessment using CTS and NHIS survey data

Context:

The published literature is now unambiguous on the importance of always considering the multi-dimensional nature of “access to medical care”. Regrettably many attempts to measure access to medical care services have not done that. They have analyzed data on whole populations not insurance and population sub-groups. Many have ignored cost, affordability, and access to auxiliary medical services like prescription medications as access factors. This study aims at assessing the consequences of these omissions, by carrying out the more comprehensive analysis.

Objective:

Use nationally representative data to determine whether some health care providers were closing their doors to some insurance groups. Determine if there is a declining trend in access to medical services over the recent past.

Methods:

We analyzed data from 2001-2006 NHIS and 2003 Household survey of CTS, created two measures of access from the data from 9 survey questions, and analyzed data on 7 insurance groups. We compared access for various insurance groups, to access for the privately insured in similar age groups as control. We identified predictors of highest risk of various insurance groups facing access difficulties in 2006 using logistic regression techniques.

Results

From NHIS data, 16.2%-21.9% disabled Medicare beneficiaries, 17.2%-20.1% Medicaid beneficiaries reported barriers to getting needed care, compared to 8.8%-16.5% privately insured elderly (55-64 years old). 39.1% disabled Medicare beneficiaries, and 21.9% Medicaid beneficiaries also report they could not afford needed auxiliary medical care services like prescription medication, compared to 7.4% privately insured elderly. Similarly 9.9% aged Medicare beneficiaries report having cost and affordability problems.

From CTS data, 31.4% disabled Medicare beneficiaries and 22% with military insurance did not get needed medical care. 45.3% disabled Medicare beneficiaries and 28.3% Medicaid beneficiaries had a problem paying their medical bills or could not afford prescription medication.

Trends in the proportions lacking access seem to be worsening (2001-2006) for most insurance sub-groups. The odds of facing access barriers increase almost two fold for the poor compared to those not poor, and more than two and half fold for those in poor health compared to those in excellent health.

Conclusions:

Even though past studies apparently found no access problems for Medicare beneficiaries, our more comprehensive analysis unearthed significant barriers for the more vulnerable insurance sub-groups.