Health Care Costs and Financing

Losing health insurance coverage or changing plans often means patients will delay seeking needed care

Patients who are treated in a hospital emergency department (ED) are less likely to get recommended followup care if they have recently changed or lost health insurance than similar patients who have retained their same coverage. They also are more apt to delay seeking needed care, get prescriptions filled, and have a primary care doctor, according to a recent study supported by the Agency for Health Care Policy and Research (National Research Service Award fellowship F32 HS00062). These findings held even after controlling for other important factors influencing access to care such as income, education, and employment status.

Costly delays in seeking care prompted by health plan changes should be considered when calculating the advantages and disadvantages of selecting employer-sponsored insurance or Medicaid programs that force people to change plans, suggests Helen R. Burstin, M.D., M.P.H., of Brigham and Women's Hospital. Dr. Burstin and colleagues interviewed adult patients who were seen in five urban EDs in Boston in 1993 for problems ranging from abdominal and chest pain to head trauma. In addition, the patients were provided with self-administered questionnaires at the time of the ED visit, after 10 days, and 4 months later.

Results showed that 54 percent of patients who lost and 35 percent of those who changed insurance had no followup care with a regular doctor 4 months after emergency treatment compared with 30 percent of individuals who had no disruption in insurance. Also, 33 percent of patients who lost and 30 percent of those who changed insurance said they delayed seeking medical care for a problem or check-up in the prior 4 months compared with 18 percent of patients whose health coverage was not disrupted. Among patients who lost insurance coverage, 48 percent found it difficult to get health care when they needed it, and 32 percent had difficulty getting prescriptions filled compared with 13 percent and 9 percent of patients, respectively, who changed their insurance plan.

See "The effect of change of health insurance on access to care," by Dr. Burstin, Katherine Swartz, Ph.D., Anne C. O'Neil, M.P.H., and others, in Inquiry 35, pp. 389-397, 1998.

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