It's well known that people with insurance pay more for health care through cost shifting. Doctors and hospitals charge insurers more to compensate for the uninsured, who often don't pay their full bill. That means higher insurance premiums and taxes for public insurance programs.
A new study finds that having high numbers of uninsured residents in a region also increases the odds that people with insurance will have trouble accessing treatment and will be less satisfied with the care they get.
"It doesn't seem intuitive, but having a lot of uninsured people not only affects the pocketbook, but also affects the care that you get," said José Escarce, a UCLA professor of medicine who conducted the research with Carole Roan Gresenz of Rand.
The study, published last month in the journal Medical Care, was funded by the Robert Wood Johnson Foundation. It builds on work led by Mark Pauly, a University of Pennsylvania health economist, but uses a broader database, Escarce said.
He and Gresenz found that privately insured, working-age people who lived in metro-
politan areas with lots of uninsured residents were less likely to have a usual provider of medical care or an office visit or medical expenditure in the past year. They were more likely to have had trouble getting care they needed and were less satisfied with their care.
Medicare patients who lived in areas with high rates of uninsurance were more likely to say they had trouble getting care or prescription drugs. They were less satisfied with the care they got.
In the Philadelphia area, 13.5 percent of residents were uninsured, about average.
Doctors congregate in richer areas, but Escarce, who got his medical degree and health economics Ph.D. at Penn, said the study controlled for the number of doctors.
He and Gresenz did not study why these "spillover" effects are occurring, but think doctors in unprofitable areas may be more likely to limit their hours, which would affect access. They may also find it impractical and unethical to provide different levels of care to patients with and without insurance.
Contact staff writer Stacey Burling at 215-854-4944 or sburling@phillynews.com
