The Rest of the Story

Facts are such inconvenient things. What do you do when your own study produces answers that are the opposite of what you hoped for?  The Center for Studying Health System Change (CSHSC) has a solution: spin the results your way anyway. 

"More Americans Delay Health Care," blared a headline over a Wall Street Journal story.  "Cost Concerns Drive Even the Insured to Forgo Treatment," said the subhead.  Large deductibles and cost shifting to patients are the cause of the problem, said the lead author.  "Alarming," said The New York Times [link].

Imagine my surprise when I discovered what the study actually said.

First, some background.  The primary way we pay for health care in the United States is not with money.  It is with time.  We ration care the same way Canadians do (but since we spend more, rationing is far less severe).  Further, the out-of-pocket share of health care spending has been steadily declining for decades.  So if there is an increasing problem of access, odds are that more rationing by waiting is the culprit, rather than rising prices.

Readers of my health blog will not be surprised by the preceding paragraph, but these views appear almost nowhere else.  The standard view in Europe is that we ration care by price-that people don't get care because they can't afford it.  And for some strange reason the vast majority of American health policy wonks have adopted the European view of our health care system.

Anyway, back to the study:  It inconveniently shows that between 2003 and 2007 concerns about costs among the uninsured actually went down as a reason for delaying or forgoing needed care…. Went down?…. Yes, went down…. By 2.3 percentage points!  By contrast, "health system related" problems (gobbledygook for rationing by waiting) climbed a whopping 14 percentage points!

For all people (insured and uninsured), worries about costs as a reason for delaying or forgoing care rose only 3.8 percentage points.  By contrast, "the greatest increases occurred for the following reasons: inability to get to the provider when the office was open (10.2 percentage point increase); inability to get through on the telephone (6.2 percentage point increase); takes too long to get to the provider (5.8 percentage point increase); and inability to obtain an appointment soon enough (4.5 percentage point increase)."

Oh, you are probably wondering: Were there any bad health consequences of delaying or forgoing care?  In surveying 18,000 people by phone, CSHSC never bothered to ask that question.

What can I say.  We're not all equally curious.


Comments (5)

Trackback URL | Comments RSS Feed

  1. Alwyn Cassil says:

    Suggest you read the study yourself at:

    Regarding Mr. Goodman’s comment that the proportion of uninsured reporting cost as a barrier to care declined between 2003 and 2007, a little context is in order — more than 90 percent of the uninsured who reported delaying or not getting care cited cost concerns as a reason in HSC’s 1996-97, 2003 and 2007 household surveys — the change from 2003(93.6%) to 2007 (91.3%) was not statistically significant.

    For insured people who delayed or went without care, the proportion citing cost as a barrier did change significantly between 2003 and 2007 — 53.7% vs. 60.8%, respectively.

    Alwyn Cassil
    Director of Public Affairs
    Center for Studying Health System Change

  2. Regina Herzlinger says:

    That is why we are called “patients”

  3. David R. Henderson says:

    Hey, John. Nice piece today. You’re becoming my go-to guy for checking quickly on the policy debate on health care. A huge public good.

  4. Chris Ewin says:

    Thank goodness the marketplace is taking over as “direct practices” become more common offering access to board certified, trusted primary care physicians at a reasonable price. It is all about the patient and it’s time for policy leaders who have never run a primary care physicians’ office observe and understand the transitions taking place for our patients’ benefit.

    Chris Ewin, MD, FAAFP
    Immediate past president, SIMPD

  5. Pat King says:

    This reflects the growing shortage in primary care physicians, which is getting worse every year as more and more med students choose more lucrative specialty practice over primary care. Looking down the road, we’ll all have to become our own PCPs, using a combination of retail clinics, Emergency Department services and specialists. Hopefully the most technology-savvy among us will centralize our health info on Google Health or Microsoft HealthVault.

    Patricia King, J.D., M.B.A.
    Principal, Digital Age Healthcare LLC