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.

John

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