Health Affairs: Access To Care Declining, Study Says

The May issue of Health Affairs examines access to care issues, high-deductible health plans, the relationship between hospitals' size and costs, among other important topics.  

Kaiser Health News: Health Care Increasingly Out Of Reach For Millions Of Americans
Having trouble finding a doctor? You're not alone. Tens of millions of adults under 65 — both those with insurance and those without — saw their access to health care dramatically worsen over the past decade, according to a study released Monday (Galewitz, 5/7).

Reuters: Healthcare Access To Erode If Law Struck Down: Study
Most Americans have seen a decade-long erosion in access to medical services that is likely to continue if President Barack Obama's healthcare law is struck down by the Supreme Court or repealed in Congress, a study released on Monday shows. The study ... says access to health care deteriorated for U.S. adults aged 19 to 64 between 2000 and 2010, even among those with private health insurance (Morgan, 5/7).

Politico Pro: Report: Access To Care 'Deteriorating'
[T]he gap in care is worst in states where the political leaders oppose implementation of the Affordable Care Act. Researchers from the Urban Institute looked at three key questions asked in surveys of American adults in each state: Did they get a routine check-up over the past year? Did they go to the dentist during that time? Were they not dealing with certain medical needs because of cost? They found that between 2000 and 2010, almost every single state population experienced a decrease in health care access in one of those three key areas (Smith, 5/8).

Milwaukee Journal Sentinel: Access To Health Care Declines In Wisconsin, Nationwide 
An estimated 13% of the adults under 65 in Wisconsin reported not seeking health care because of the cost in 2010, according to the study. That was up from 8.5% in 2000 (Boulton, 5/7).

Baltimore Sun: Harder For Americans To Get Health Insurance, Report Says
In Maryland, the number of people who found it too expensive to get care increased 5.1 percentage in the decade to 15.4 percent. About 530,000 adults in the state could not meet their medical needs (Walker, 5/8).

Another study focused on consumer-directed health plans -

Reuters: Consumer-Directed Health Plans Show Mixed Results
Employer-sponsored health insurance plans with low premiums and high deductibles could cut healthcare costs significantly but not without potential risks for workers, according to a study published on Monday. A Rand Corporation study, published in the May issue of the journal Health Affairs, said so-called "consumer-directed" health plans would cut healthcare costs for the nonelderly by 4 percent, or $57 billion a year, if they accounted for half of all employer-sponsored health insurance (5/7).

MarketWatch: Higher Health Deductibles May Save Billions: Study
[B]y giving consumers more “skin in the game,” according to Rand Corp., higher deductibles could help push for greater transparency in medical costs, as well as force caregivers to keep charges more in line with normal inflation (Britt, 5/7).

The Associated Press: Study: Savings And Risks In Health Insurance Trend
It's the hottest trend in job-based health insurance: plans that give you a personal savings account for medical bills but also require you to pay a hefty share of costs before coverage kicks in. ... But there's a warning flag, a risk that workers will forgo needed care, even preventive services covered at no extra cost to them. Some consumers were apparently unsure that prevention was covered (Alonso-Zaldivar, 5/7).

National Journal: Consumer-Directed Plans Save Money, But At What Cost?
 About a third of the time, the savings came from reduced spending at each encounter with a health care provider. Families in consumer-directed plans used fewer brand-name drugs, used specialists less often, and had fewer elective hospital procedures than those in different plans. But people did skip screenings, such as blood tests for diabetes and Pap smears to check for cervical cancer (Fox, 5/7).

The Hill: Study: Market-Driven Plans Could Lower Healthcare Costs
The question remains whether the plans' cutbacks in care would lead to poorer health and higher costs later, study authors said. The RAND study was the most comprehensive to date looking at consumer-directed health plans, which account for about 13 percent of all healthcare coverage provided by employers (Viebeck, 5/7).

Related, earlier KHN story: Quick Facts About High-Deductible Health Plans (Kulkarni, 4/27)

Another study examined hospital mergers -

Politico: Study: Bigger Hospitals Drive Cost Increases
For everyone out there worried that President Barack Obama's health reform law will spur monopolies and make it easier for hospitals to raise their prices, a new study says it's already happening, and it's not because of the health law. ... “What we found is that the leverage of some hospitals is growing,” said Paul Ginsburg, president of the Center for Studying Health System Change and a co-author of the report. “That’s a contributor to rising health care spending" (DoBias, 5/7).

And, a look at "difficult" patients and a new model for delivering care -

Modern Healthcare: Patients Fear Being Seen As 'Difficult': Study
Patients have a strong desire to engage in shared decisionmaking with their physicians but this wish is often stymied by "authoritarian" doctors or patients' fears of being perceived as "difficult," according to a study by the Palo Alto (Calif.) Medical Foundation Research Institute published by Health Affairs... The researchers wrote that they uncovered four main themes from the participants' responses: Patients feel compelled to conform to "socially sanctioned roles" when speaking with their doctor; physicians can be authoritarian; patients work to fill information gaps; and patients feel the need to bring social support to consultations with their physician (Robeznieks, 5/7).

San Francisco Chronicle: Patient's Fear Of Being 'Difficult' May Hurt Care
Hugo Campos doesn't view himself as a difficult patient. But he senses his doctors' exasperation with him because of his insistence he be given all the medical information they have about him. ... In the study, 48 Bay Area patients recruited from Palo Alto medical practices said they feared that challenging their physicians or asking too many questions might result in lower-quality care or strain their relationship (Colliver, 5/7).

Finally --

Kaiser Health News: Capsules: Grand-Aides Could Offer 'Family-Style' Health Care Help
Assuming the 2010 health law survives its Supreme Court challenge, about 32 million more people are expected to be eligible for coverage in 2014 through the law's Medicaid expansion or new health insurance exchanges. If the law is struck down, the number of uninsured will continue to increase. With experts warning of physician shortages and rising health expenditures, how can all those people get medical care without costs going through the roof? Dr. Arthur Garson Jr. has a plan (Carey, 5/7).