Study Paints Sickly Picture of Insurance for Workers
A new UCLA study has found that American workers with health insurance, particularly minorities, have worse access to medical care than the elderly and are more likely to have major financial problems brought on by illness.
The study, to be published Thursday in the New England Journal of Medicine, raises serious questions about the health insurance coverage of working Americans at a time when the public focus has been on improving coverage for the elderly and uninsured.
“What it suggests is there are fundamental problems with the way in which health care is financed and insurance distributed within the country,” said Dr. Martin F. Shapiro, an associate professor at UCLA School of Medicine and a co-author of the study.
The researchers trace the discrepancies in part to co-payments, deductibles and other restrictions on coverage that, while intended to control the rising costs of health care, may be deterring lower-income people from seeking help at all.
Medicaid Patients
Physicians may also be turning away patients insured through Medicaid, a government health insurance program for the poor known as Medi-Cal in California, because reimbursement levels are low. And transportation problems, scarce medical facilities and cultural and institutional barriers may keep people from getting care, the researchers say.
“It is not enough to provide all poor people with some kind of medical insurance or to have an adequate supply of doctors,” stated the study, which included both people with private insurance and people covered by Medicaid. “Medical insurance for the poor must cover all needed health services adequately and be honored by most, if not all, health care providers.”
The study, based on telephone interviews with 7,633 adults, made the following findings:
* Insured working-age adults were 3.5 times as likely as the elderly to have needed help and not received it. They were more than three times as likely to have had major financial difficulties because of illness or to report a financial barrier to regular care.
* Among insured working-age adults, blacks were nearly twice as likely as whites to have needed help and not gotten it. Hispanics with a medical problem were more than twice as likely as non-Latino whites not to have seen a physician within the last year.
* Among insured working-age adults, those who fall below the federal poverty level were 4.4 times as likely as those who are not poor to have needed services and not to have received them. They were 5.2 times as likely to have had major financial problems because of illness.
* Even middle-income working adults were often worse off than the elderly.
“The magnitude of the findings were quite surprising,” Dr. Rodney A. Hayward, who headed the study, said in an interview. “We assumed that the working-age adults had better insurance coverage than it appears that they do.
“In general, we found their insurance coverage was adequate for minor problems,” Hayward said. “But when they developed major medical problems, their insurance coverage tended not to be as good as that of the elderly.”
Understanding of Limitations
Hayward said it is unclear whether people understand the limitations in their coverage. Some may have decided not to purchase additional medical coverage; others may be unaware of limitations built into their plans, he said.
“We know from other studies that people often have a very incomplete understanding of their medical coverage,” Hayward said. “If you ask them, they will think they are covered for things they are not. That’s part of the problem.”
Ironically, the UCLA study is being published while Congress is in the midst of passing the largest expansion of the Medicare program, the government-managed health insurance program that provides coverage for Americans over age 65.
Hayward, Shapiro and others said they supported the efforts by policy-makers and others to expand coverage for the elderly and uninsured. But they said little attention has been paid to deficiencies in access to health care among the insured.
“I think (the new study) really documents a problem that we’ve known about and haven’t been willing to pay attention to,” said Dr. Nicole Lurie, an assistant professor of medicine and public health at the University of Minnesota. “It makes us confront the inadequacies and inequities in the way our society cares for people.”
