The researchers found that privately insured residents in communities with high uninsurance rates reported difficulty getting needed care and were less satisfied with that care. They also were more likely to have unmet medical needs than residents of communities where the percentage of uninsured residents was lower.
The findings extended to seniors with Medicare coverage: those living in areas with a high rate of uninsured were more than likely than their counterparts in areas with a low uninsured rate to report problems getting needed care and prescription drugs.
It would be easier to shrug off this study if the focus was rural medicine. Of course patients in a rural area might not have access to certain specialties, and their physicians might not be well versed in the latest technologies. But this study looks at patients in major healthcare centers like New York City, Philadelphia, Los Angeles, San Diego, and Akron, OH.
The bottom line is that access to care is limited in communities with a lot of uninsured people, explains Carole Roan Gresenz, PhD, a senior economist at the RAND Corporation and co-author of the study.
The link between the insured and uninsured can work in a couple of ways. Specialist services might not be available, or physicians might be rushed. According to the report, which appears in the latest issue of Medical Care, physicians who practice in areas with a large number of uninsured may find it difficult to "provide different levels of care to their insured and uninsured patients, and instead may tend to provide a similar level of care to all patients." That is, a lower level of care to all patients, says Gresenz.
Say you're insured and you see your doctor for a condition that could be quickly resolved with an expensive surgery…but a less expensive medication exists that might slowly resolve the problem. The doctor's recommendation for your insured care could be influenced by the number of uninsured patients in his or her practice and in the community. Instead of that quick, expensive surgery, you could be on a slower road to recovery.
We all have some "skin in the game" when it comes to providing for the uninsured. The crowded ER is more than an inconvenience; the problem of uninsurance reaches to the very soul of medical care — access and quality for everyone.