Need for Reform: Availability of Care

A central principle of an effective health care system is that patients have care available to them:

• at the right time, with timely and convenient access
• at the right place, through providers who offer the necessary levels of medical expertise
• at a cost perceived by patients and their families as affordable

Patients throughout the United States encounter daily problems and monumental barriers due to lack of available care:

Rising Costs for Insurance and Medical Care

Average Premium Cost of Family Coverage

Enlarge

Per Capita Health Expenditures chart

Enlarge

During the past 30 years, insurance and medical care costs have risen dramatically. The rising costs have created problems and barriers at all levels:

• At the individual level, many perceive health care as no longer affordable and are choosing to drop their insurance or delay necessary medical care.

• Within the private and public sectors, organizations struggle with the burden of rising health care costs. Health benefits are now the central driving factor for businesses' strategic decisions, for unions' contract negotiations, and for government officials' budgeting and taxing decisions.

• At the national level, the rising cost of health care is a drag on the economy and a constant source of political conflict. More critical, the cost of health care has created nationwide social and racial disparities.

Personal and Financial Burdens

Problems with high health care costs create significant personal and financial burdens for individuals, employers and providers:

For Individuals
Patients struck by catastrophic medical problems (and their families), whether they have health insurance coverage or not, face the additional strain of financial problems from medical bills and, in many cases, loss of wages. Individuals must rely on financial support provided through family and social networks, media coverage and the philanthropic community. One study found that half of the personal bankruptcies in the United States in 2001 were caused by illness and medical bills.

For Employers
Organizations in the private and public sector are faced with untenable choices. They must invest significant time and money to manage employee health benefits. Increasingly, businesses are forced to raise benefit costs for their employees, and reduce or eliminate medical coverage.

For Providers
Hospitals and clinics face an increasing burden of charity care, medical care provided to patients who lack the ability to pay.

For individual providers, the problem of rising health care costs creates multiple problems in managing patient care, including:

• Dilemmas in offering treatment options for patients based more on cost than on desired clinical outcomes
• Pressures to reduce time spent with patients and increase the volume of patients, at the risk of lowering the quality of care

Access Barriers

For people who are uninsured or underinsured, numerous studies have demonstrated that people without the means to pay will forgo early-stage medical treatment. The results are:

• Increased use of hospital emergency rooms for medical care, leading to expensive, inconsistent and poor quality of care, particularly for chronic illnesses
• Delays in seeking care which lead to more difficult treatment problems, even death

Patients also experience barriers accessing needed medical expertise, including:

• Lack of geographic access to certain types of medical specialists
• Inadequate numbers of specialists experienced in treating certain medical conditions
• Patients uninformed about processes to seek treatment from medical experts

Sources

U.S. Agency for Healthcare Research and Quality
www.ahrq.gov

U.S. Department of Health & Human Services
Centers for Medicare & Medicaid Services
www.cms.hhs.gov

American Medical Association
www.ama-assn.org

The Commonwealth Fund
www.cmwf.org

The Kaiser Family Foundation
www.kff.org

Health Affairs
The Policy Journal of the Health Sphere
www.healthaffairs.org

Further Reading

Why Health Care Costs Too Much
Cato Institute

Health Insurance Costs
The National Coalition on Health Care

Rising Out-of-Pocket Spending for Medical Care: A Growing Strain on Family Budgets
The Commonwealth Fund

Consequences of Uninsurance
Institute of Medicine

Health Coverage and the Uninsured
Kaiser Family Foundation

Hidden Costs, Value Lost: Uninsurance in America
The National Academies