THE PRICE OF HEALTH

Despite recent health insurance expansion, many patients continue to face financial barriers to accessing critical specialty care, like dermatology consults and psychiatric services.  

One group facing significant obstacles to obtaining care include patients using Medicaid as their health insurance. According to a survey of physicians serving children, 84% of primary care providers experience difficulty referring Medicaid patients to specialists compared to 24% experiencing difficulty when referring privately insured patients. The proportion of healthcare providers in US cities that accept Medicaid can be as low as 23%, as illustrated in the graphic below. Due to low Medicaid acceptance rates, low-income patients are forced to wait weeks to months for specialty appointments or forgo care all together.

Privately insured patients with high-deductibles also experience challenges in obtaining specialty care. Under the Affordable Care Act’s exchanges, health plans require patients to pay a significant amount before insurance will, leading patients to forgo expensive specialty appointments and procedures as they cannot afford to pay out of pocket. In a 2013 study, economists observed the effect of a company's shift of 75,000 employees and their dependents from a no-deductible health plan to one with a $3,750 deductible. According to the study's results, while employees did receive less "potentially wasteful care" on the high-deductible plan, they also received less "potentially valuable care" like preventative services. In addition, the sickest workers were the most likely to reduce their use of care before reaching their deductible, even though they are the group in need of the most healthcare services.

In addition to direct costs, patients must also account for transportation, childcare and time spent from work to attend specialty appointments. Delayed care can result in adverse clinical outcomes, avoidable emergency room visits and unnecessary healthcare costs. Timely access to affordable specialty care is critical to achieving optimal health but this reality is still out of reach for many Americans.

Access to high-quality healthcare is critical to healthy and equitable communities. However, underserved and low-income patients commonly face barriers in accessing healthcare, especially specialty services like dermatology and psychiatry visits. Factors that can determine a patient's ability to obtain convenient specialty care include finances, insurance status, transportation and wait times for appointments. This inequity in access can lead to adverse health outcomes, as patients are forced to delay or forgo critical medical care. Read more