Rationing by waiting is having its greatest effect on those at the bottom of the income ladder. As I wrote at the Health Affairs blog:“Think metaphorically of waiting in line for care. The lowest-income families are at the end of that line. The longer the line, the longer they will have to wait. If you do something to shorten the line, you will be mainly benefiting higher-income people who are at the front.”There is another study gated with abstract that suggests that even low-income patients are more deterred by non-price barriers than by money prices.
An Estimated $84.9 Billion In Uncompensated Care Was Provided In 2013; ACA Payment Cuts Could Challenge ProvidersMay 5, 2014
Millions of uninsured people use health care services every year. We estimated providers’ uncompensated care costs in 2013 to be between $74.9 billion and $84.9 billion. We calculated that in the aggregate, at least 65 percent of providers’ uncompensated care costs were offset by government payments designed to cover the costs. Medicaid and Medicare were the largest sources of such government payments, providing $13.5 billion and $8.0 billion, respectively. Anticipating fewer uninsured people and lower levels of uncompensated care, the Affordable Care Act reduces certain Medicare and Medicaid payments. Such cuts in government funding of uncompensated care could pose challenges to some providers, particularly in states that have not adopted the Medicaid expansion or where implementation of health care reform is proceeding slowly.
This article presents estimates of personal health care spending by age and gender in selected years during the period 2002–10 and an analysis of the variation in spending among children, working-age adults, and the elderly. Our research found that in this period, aggregate spending on children’s health care increased at the slowest rate. However, per capita spending for children grew more rapidly than that for working-age adults and the elderly. Per capita spending for the elderly remained about five times higher than spending for children. Overall, females spent more per capita than males, but the gap had decreased by 2010. The implementation of Medicare Part D, the effects of the recent recession, and the aging of the baby boomers affected the spending trends and distributions during the period of this study.
For Kids’ Sake: State-Level Trends in Children’s Health Insurance A State-by-State Analysis. SHADAC, April 2014.
County Health Rankings Show People Living in Least Healthy Counties Twice as Likely to Have Shorter Lives than People Living in Healthiest Counties – Robert Wood Johnson FoundationMarch 28, 2014
The fifth edition of the County Health Rankings released today continues to show us that where we live matters to our health. Large gaps remain between the least healthy counties and healthiest counties. For instance, the least healthy counties have twice the death rates and twice as many children living in poverty and teen births as the nation’s healthiest counties.
A collaboration between the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute (UWPHI), the County Health Rankings allow each state to see how its counties compare on 29 factors that impact health, including smoking, high school graduation rates, unemployment, physical inactivity, and access to healthy foods. The Rankings are available at http://www.countyhealthrankings.org.
This undersupply of physicians has long caused medical experts to fret that rural patients receive too little medical care. As a team of researchers pointed out in a recent article in Health Affairs, Medicare has responded by providing a financial incentive to rural healthcare providers, boosting their payment to encourage physicians to locate in such areas: “In the aggregate, Medicare pays rural providers $3 billion more each year in special payments than those providers would receive under traditional payment rates.”
These researchers are skeptical that such payments are working as intended. They analyzed healthcare use across the U.S. to see whether, all else equal, rural patients receive fewer Medicare services than their urban peers. Their results raise serious questions about the idea that such patients are underserved
America’s Underinsured: A State-by-State Look at Health Insurance Affordability Prior to the New Coverage Expansions – The Commonwealth FundMarch 25, 2014
The Affordable Care Act insurance reforms seek to expand coverage and to improve the affordability of care and premiums. Before the implementation of the major reforms, data from U.S. census surveys indicated nearly 32 million insured people under age 65 were in households spending a high share of their income on medical care. Adding these “underinsured” people to the estimated 47.3 million uninsured, the state share of the population at risk for not being able to afford care ranged from 14 percent in Massachusetts to 36 percent to 38 percent in Idaho, Florida, Nevada, New Mexico, and Texas. Nationally, more than half of people with low incomes and 20 percent of those with middle incomes were either underinsured or uninsured in 2012. The report provides state baselines to assess changes in coverage and affordability and compare states as insurance expansions and market reforms are implemented.
Last week, the Census Bureau released some nice charts about the young and uninsured — that is, the folks that insurance companies are now falling over themselves to sign up because young people are cheap (and can be charged premiums higher than are actuarially fair in order to subsidize older people).
Thus, while the US spends more than twice as much on health care than the mean of other OECD countries, its greater GDP and higher prices explain most of it, and income inequality offers an explanation for the rest.
Jeff Young tweeted these Census Bureau maps showing where Americas low-income uninsured live, using the cutoffs for Medicaid expansion eligibility and for Obamacare exchange subsidy eligibility.