The study author Dr. Joseph S. Ross, a primary care internist in the Robert Wood Johnson Clinical Scholars Program at Yale University, explained that lacking in health insurance was associated with reduced care at each income level. He said that even though rates of use increase as income increases, uninsured adults are not using their pocket funds to narrow the gap in use between themselves and insured adults.
The findings, which came as a surprise to the study authors, also call into question the suitability of recent policy initiatives. Stating that if the aim is to get people into preventive care and to increase the percentage of people being screened, then the need to examine the issue of cost sharing for these services must be really looked into, said Mark Rukavina, executive director of the Access Project, a Boston-based consumer advocacy group focused on the uninsured. He said that the idea of putting the burden of costs on people will somehow increase the number of people being screened was very impractical.
Statistics show that currently, more than 45 million Americans, representing almost one-fifth of the non-Medicare population are without health insurance. The study also shows that the number of Americans without health insurance has increased by more than 6 million between 2000 and 2004, this could be largely due to decline in the employer sponsored coverage. The study stated, that one-third of that increase occurred among adults with incomes totalling more than 200 percent of the federal poverty level.
And according to a report released last week, the analysts found that the number of middle-income Americans without health insurance is on the rise: 41 percent of working-age Americans with annual incomes between $20,000 and $40,000 were uninsured for at least part of the past year, up from 28 percent in 2001.
This study, which appears in the May 3 issue of the Journal of the American Medical Association, Ross and his team analysed data on almost 200,000 men and women aged 18 to 64 polled in 2002 on their medical history, health behaviours and use of health-care services. The incomes were divided into six categories: below $15,000, $15,000 to $25,000 to $35,000, $35,000 to $50,000, $50,000 to $75,000 and greater than $75,000.
They found that the use of different healthcare services varied tremendously. For instance, use of cancer-prevention services ranged from 51 percent for colorectal cancer screening to 88 percent for cervical cancer screening. Use of cardiovascular risk reduction services ranged from 38 percent for weight-loss counselling to 81 percent for aspirin use. Diabetes management services ranged from 33 percent for the pneumococcal vaccine to 88 percent for haemoglobin measurement. They noted that the gap between uninsured and insured was roughly the same regardless of the income category. Stating that for none of the groups did income affect use, Dr Ross said that all of their results were consistent across income.
Although the researchers were not looking for reasons specifically for the phenomenon, Dr Ross pointed to a number of possible explanations. He said that one factor they were most concerned about was that people simply don't believe that these services are sufficiently beneficial, or at least outweigh the costs.
Rukavina said that they people seem to be afraid of what they might find. He felt it like the fear of opening the Pandora's box. This is a problem both at that point in time when they discover there may be a problem that they have no insurance for and future costs, if their insurance will not cover it because it'd been identified, he said. The major question he felt is who should assume more of the costs.
Dr Ross and his team are of the opinion that any type of health-care reform that increases out-of-pocket burden with higher co-payments or higher deductibles or reforms that rely on patients to make decisions to purchase care like health savings accounts that people are not going to purchase care at the level we would hope to see.
They also felt that the patient education might also help. People need to understand why doctors are recommending these procedures Dr Ross stated. He also said that if people don't feel it's worth it then Medicare at the very least should be invested in making sure people get this low-cost prevention and chronic care treatments early on.