Americans Experiencing Greater Access-to-Care Barriers

The number of people forgoing or delaying health care jumped dramatically between 2003 and 2007, signifying a fundamental reduction in Americans' overall access to health care, says a recently released tracking report from the Center for Studying Health System Change.

In 2007, about 59 million people, or one in five Americans, reported going without or delaying needed health care during the previous 12 months, compared with 39 million people, or one in seven people, who reported doing so in 2003, according to the report. The 2007 data, drawn from a nationally representative survey containing information on 18,000 people, reflect the biggest increase in people forgoing or delaying needed care since the study began in 1997, signaling a "sharp change in Americans' access to care, which was relatively stable between 1997 and 2003."

"This report validates what our 94,000 members across the country have been telling us for the past several years, and that is that the health care system is not working well," said AAFP Board Chair Rick Kellerman, M.D., of Wichita, Kan., during a June 26 press conference here announcing the report's findings.

The proportion of Americans reporting an unmet medical need increased by 2.8 percent, or by about 9.5 million people, between 2003 and 2007, the report found. At the same time, the proportion of Americans delaying needed care increased by 3.9 percentage points to 12.3 percent, or about 13.5 million more people. The 59 million people who reported an access problem in 2007 cited cost as the most frequent and growing obstacle to care, but the report found that the problems of cost and access were inextricably linked.

"Without cost containment, expanded government support for insurance coverage will have to keep pace with the trend in medical care spending to maintain affordability for individuals and families," the report said. "Such increases in health care costs will be difficult for governments to sustain, especially during periods of slow or negative economic growth. To the extent that cost increases are passed on to individuals, continued declines in access to care are inevitable."

For example, the report found that, among insured people, the number of people citing a health plan-related reason for going without or delaying health care increased by 8.5 percent between 2003 and 2007, climbing to 39 percent. Study participants also reported they had problems getting their health plan to pay for treatment or their physician or hospital had refused to accept their insurance.

Uninsured people continued to face far greater access problems than their insured counterparts and were nearly three times as likely to report going without care as insured people. However, insured people experienced a greater percentage increase in unmet medical needs compared with uninsured people -- a 62 percent increase for insured participants versus a 33 percent increase among the uninsured. "Rising out-of-pocket costs in the form of higher deductibles, coinsurance and copayments likely account for much of the increased unmet need among insured people," said the report.

"We can no longer say this is just a problem of the uninsured," Kellerman said. "It is affecting everybody, and I think it is proof that we have a health care system that is unraveling."

In addition, increasing numbers of people reported more problems getting timely appointments or not being able to get to the physician's office or a clinic when it was open.

"Increased provider capacity constraints may have contributed to the rise in health system barriers," the report said. "A shortage of some types of doctors in different markets, particularly primary care physicians, could affect people's ability to get a timely appointment."

"Family physicians across the country realize we don't have enough family physicians," Kellerman said, citing an AAFP study that indicates the United States will need 140,000 family physicians by 2020, a 40 percent increase from current workforce levels.

Problems with the health care workforce are only going to get worse, said Kellerman. "Last year, we had 16,000 medical school graduates from American medical schools and a little more than 1,000 went into family medicine. At the same time, we will soon see between 1,500 and 2,500 family physicians retire each and every year. We cannot keep up with the workforce needs. We have the health care needs of our country going one way and our medical schools, student choice and health care system going another way."

The report also found that