For sick, cost can impede care
Fourteen percent of sick adults in Massachusetts were unable to get health care they needed in the past year, according to a poll conducted by the Harvard School of Public Health and others.
More than 7 in 10 of those who said they could not get treatment cited financial reasons, saying they could not afford the out-of-pocket costs or their insurer refused to cover the test or treatment.
“In a state that prides itself on universal coverage, it’s a finding you wouldn’t expect to see,” said Robert J. Blendon, health policy professor and director of the Harvard Opinion Research Program.
The poll, released Monday and sponsored by WBUR, the Blue Cross Blue Shield of Massachusetts Foundation, and the Robert Wood Johnson Foundation, found that most participants were satisfied with the quality of health care in the state but that costs increasingly strained family budgets.
About 98 percent of Massachusetts residents have health insurance, since coverage was expanded under a 2006 law. House and Senate leaders are now considering competing plans for controlling the growth of health costs to bring it in line with or below the estimated rate of growth of the overall state economy.
The poll, taken in April and May, surveyed 500 people age18 or older who said they had been hospitalized or had a serious illness or injury requiring medical treatment in the previous 12 months. Seventy-eight percent of participants said health costs were at least a somewhat serious problem for the state, and 63 percent said the problem has grown worse over the past five years. Forty percent said they have struggled to pay out-of-pocket costs themselves.
With high-deductible plans becoming more popular and provider networks shrinking, consumers could increasingly find that cost is a barrier to getting care, said Dr. Paul Hattis, cochairman of the health policy task force for the consumer group Greater Boston Interfaith Organization.
“Even if you put an insurance card in everybody's pocket, don’t believe that that solved the access problem,” Hattis said.
Drug costs, insurers, and hospitals\, in that order, were most often cited by survey participants as major drivers of health costs. Less weight was given to factors that often play prominently in the state debate, including patients getting more treatment than they need, too little government regulation, malpractice issues, and a lack of transparency on costs.
Evidence suggests that drug costs have contributed little to overall increases in health costs in recent years. While insurers are a factor, about 90 percent of every premium dollar in Massachusetts is required by the state to go toward paying hospitals and doctors for medical care.
Consumers have a hard time distinguishing between the big economic drivers and what they are paying for out of pocket. “The two are not always the same thing,” said Hattis, whose group has been working to educate its member congregations about the complexities of health economics with a series of Web seminars.
Blendon said that may be a problem for politicians. The public typically is more receptive to a difficult policy change when it provides a solution to a problem as they see it.
Especially as people are being asked to pay more and take a bigger role in making choices about their health care, “we need to do a better job supporting consumer understanding on how it works,” said Sarah Iselin, president of the Blue Cross Blue Shield Foundation.
Fifty-two percent of participants in the poll said the quality of care in Massachusetts is not a problem, and 75 percent said quality has remained the same or improved over five years. See the poll results at bluecrossmafoundation.org.