Over the last few years, healthcare reform has somehow morphed into health insurance reform. There is no doubt that there were aspects of the health insurance system that needed attention. But I know I’m not the only one who has been a bit dismayed by the fact that the health insurance industry seems to have become the primary focus of the reform efforts, with much less attention given to other elements of the healthcare system, some of which are also badly in need of reform.
A new study published last week in Health Services Research finds that 19 percent of US adults have a financial barrier preventing them from accessing healthcare: they are either without health insurance, concerned that their health insurance won’t cover the condition in question, or are concerned about their ability to pay their portion of the bill, even if insurance picks up some of the cost.
There is no doubt that increasing access to health insurance will be helpful for some of those people, especially if the health insurance premiums are subsidized to make them more affordable. But even more people – 21 percent – reported having non-financial barriers with regards to access to healthcare. Non-financial barriers include things like not having time to get to the doctor, medical office hours that conflict with work schedules, lack of transportation, not being able to get an appointment soon enough, etc.
And there was a significant overlap between the two groups: Two thirds of the people who reported having financial barriers preventing them from receiving healthcare also had non-financial barriers. That makes sense, as some of the barriers that are technically non-financial (in that they aren’t directly related to the ability to pay for healthcare) are actually very much linked to financial struggles: people who are trying to make ends meet working three low-paying jobs (none of which offer health insurance) aren’t going to have as much flexibility in their schedule to get to a doctor’s office as someone who works a 9 – 5 that offers paid sick leave. And a person who is struggling financially and unable to afford health insurance might be less likely to have access to reliable transportation.
The implications of the study are pretty clear: Insuring the entire population isn’t going to solve all of our healthcare woes. For starters, even with health insurance, healthcare can still be unaffordable. And even if we were to make health insurance more comprehensive than it is now, with lower out-of-pocket costs (not likely, as the trend over the last decade has been towards higher out-of-pocket costs in order to keep premiums from increasing even faster than they already do), there would still be more than one in five people without realistic access to care – for reasons that aren’t directly related to paying for care.
Many of the reforms that have happened or are scheduled to happen with regards to health insurance will surely help to increase access to health insurance coverage. But we should keep in mind that having health insurance does not necessarily translate to realistic access to healthcare.