Number of factors affect people’s access to health care

Jennifer Saavedra
Graduate School of Journalism at CUNY

Reporting on people who are underinsured is tricky because "you never know who is truly underinsured until they're sick," according to Reed Abelson, a business health reporter for The New York Times.

Two doctors joined Abelson on the "Coming to grips with access to care" panel at the Urban Health Journalism Workshop on Oct. 18, at the CUNY Graduate School of Journalism in Manhattan. The panel spoke to a packed room of people about the roadblocks preventing people from obtaining health care.

"Fifty-seven million people are estimated to have some form of medical debt, and you say,‘Okay, that's probably the uninsured,' but in fact 43 million of those, they estimate, were insured," Abelson said. She spoke about the obstacles the middle class and underinsured face when accessing care.

She recommended looking at health plans and the benefits they cover to understand why the underinsured are having a difficult time getting the care they need or paying their bills. She also said the New America Foundation, particularly Len Nichols's work, provided good data on how affordability is affecting the middle class's access to care.

But Abelson cautioned that simply looking at access to care in general terms is not enough. "You should also be thinking about ‘Are there times when there is too much access?'"

Abelson said unnecessary care prevents people from obtaining the care they need.  "The idea that people should think twice before getting an MRI, should think twice about getting a back operation that would leave them better off, is a fair discussion and one that needs to be had."

Peter Selwyn, M.D., chairman of the department of family medicine and social medicine at Montefiore Medical Center and professor at the Albert Einstein College of Medicine, argued that a major issue affecting people's access to care is the lack of primary care physicians. He said the more primary care physicians there are in a neighborhood, the healthier the neighborhood becomes.

"You can calculate that adding one primary care physician per 10,000 population is associated with an average mortality reduction of 5.3 percent or 49 deaths per 100,000 population per year," Selwyn said.

He attributed the lack of primary care doctors to medical students entering specialized fields like ophthalmology and anesthesiology, because these specializations offer higher salaries.

Albert Knapp, M.D., president of the Independent Doctors of New York and professor of medicine at New York University School of Medicine, said that HMOs, group insurance plans that do not cover care provided outside a particular network, affect people's access to care.

Knapp said the rules HMOs impose, such as only referring people within the network, affect patients' access to care because the options are limited.  Independent Doctors of New York and organizations like it are freed from such restrictions because they do not accept health insurance, according to Knapp.

"What that means is that if a patient comes to us the patient will pay the fee up front, we then give them the bill and then the insurance will pay for it," Knapp said.

Knapp said that most of the patients seen by his group have point-of-service plans, which are insurance plans that allow patients to see doctors both in and out of a network, but these plans usually offer a financial disincentive for going out of network.

In addition, Knapp said, point-of-service plans usually reimburses the patient anywhere from 70 percent to 80 percent of the cost and within two to four weeks. He described the majority of his patients as middle class and said the fees set by the Independent Doctors of New York are comparable to in-network fees.