Lack of Access to Care – The Wallet Biopsy

One of the most telling statistics comes from the 516 people who were sick enough to be hospitalized overnight but did not have insurance at some time during the year.  40% did not get the care they thought they needed compared to 10% for those with insurance.

  • The well insured:  Access is usually not a problem.  But, if the patient does not have an established place for care before an illness it may be difficult to get a timely appointment for evaluation or hospital follow up.  Some patients with Medicare will run into the “our practice is not taking any more Medicare patients at this time”.
  • The under-insured:  Major health issues are usually resolved.  But, not having the money for the expensive drugs prescribed at hospital discharge is a problem.  Not being able to find an outpatient healthcare provider when covered by Medicaid (title 19) is a huge problem if no provider was established prior to a hospitalization (your appointment might be in 6 months).  High dollar deductibles and lack of drug coverage can overwhelm someone on a tight budget.
  • The uninsured:  Serious issues are usually resolved at the hospital.  For example, some uninsured pregnant women show up at the hospital just hours before delivery.  The babies are delivered but with more complications since they did not get prenatal care.   Uninsured care generates a huge debt which is often not paid directly.  The debt is offset by cost shifting to insured programs.  (In political terms this is often called “the safety net”)  When a person is making an appointment and the scheduler asks “what insurance do you have?” the answer “none” will often not lead to an appointment.  Most health care providers and pharmacies have an astronomical fee for someone paying cash.  The high fees originated back in the old days of “usual and customary charge” paid by insurance companies.  Now the tables have turned — the insurance company dictates what they will pay, which is not what the hospital or doctor charges.  Unfortunately, the uninsured will be expected to  pay more than Medicare, more than insurance companies and more than Medicaid.

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