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Your uninsured neighbors are costing you big time

You probably know that people without health insurance have trouble getting the care they need. But if you think it's not your problem because you have health insurance coverage, think again.

A new study shows that in communities where a large share of residents lack medical insurance, those who are insured have trouble gaining access to care and often are dissatisfied with the treatment they receive.

Stealing money"This study underscores the fact that all Americans, regardless of whether we have health insurance coverage or not, have a stake in seeing that all people in this country have health insurance," says Andy Hyman, team director and senior program officer of the coverage team at the Robert Wood Johnson Foundation, which funded the study.

Researchers Jose Escarce, a professor of medicine in the David Geffen School of Medicine at UCLA and senior natural scientist at RAND Corp., and Carole Roan Gresenz, a senior economist at the RAND Corp., analyzed medical expenditure and health care satisfaction data to estimate the spillover effects on insured people when many area residents lack health insurance. They compared the data among metropolitan areas with different levels of uninsured residents.

Compared to their counterparts in cities where a small share of the population is uninsured, researchers found that insured working-age people in communities where many residents lack insurance were:

  • Less likely to have a usual source of care, such as a primary care physician, and were less likely to visit a health care provider.
  • More likely to have trouble getting the care they needed.
  • Less likely to be satisfied with the care they received.

Seniors on Medicare pay a price

The researchers also analyzed the impact on seniors. They found that seniors with Medicare coverage who lived in areas where a large share of the population was uninsured were more likely to report difficulty in getting care and the prescription drugs they needed. They also were more likely to report lower satisfaction with their care than seniors in other cities.

Previous studies suggested similar spillover effects, although they didn't look at the impact on Medicare beneficiaries.

"Our findings validate previous findings and extend them," says Gresenz.

Possible reasons for reduced care

Researchers aren’t sure why spillover effects occur, but they have theories.

Gresenz says physicians in communities where many people are uninsured may change how they practice. Uninsured patients can’t demand the same amount or quality of care as insured people because they can’t afford it. Physicians may find it difficult to provide different levels of care to patients, so doctors who provide care for free or at a discount to many uninsured people may provide a lower level of care to everyone. They may shorten hours and restrict the most unprofitable services, even for patients with insurance.

In addition, specialists may be less likely to practice in communities where many people are uninsured and unable to pay for their care.

It's long been known that medical costs are shifted when uninsured patients can't pay for their care. Hospitals, clinics and physicians charge insured people more for services to make up for the financial losses. This translates into higher premiums for employer-sponsored insurance and higher health insurance quotes when consumers shop for individual insurance.

A hidden health insurance tax

Families USA calls it a “hidden health tax.” A 2009 national study for the health care advocacy group found that insured families paid an extra $1,017 in health insurance premiums on average in 2008 because uninsured people could not fully pay for their own care.

 "We should all care about the level of uninsurance because our care is affected as insured people," Gresenz says.

The new study is particularly timely in the wake of federal health care reform legislation, Hyman says. Passed by Congress in March 2010, reform measures are expected to expand the number of people with health insurance by 32 million people in the next several years.

"This report shows that the benefits will extend far beyond the 32 million newly covered people," Hyman says.

Groups across the political spectrum agree that having coverage for more people is a good idea. However, debate continues about how best to provide affordable health insurance and whether there will be enough physicians to provide access to care for everyone.

More from Barbara Marquand here

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