For all the talking about "the uninsured" and "access to health care" in America, you'd think that having health insurance was
more important than actually seeing a doctor. As a recent study and wee bit of reflection suggests, it's the other way around.
The premise that health insurance is important to the quality of health care you receive is wrong, according to a "New England
Journal of Medicine" study "Who Is at Greatest Risk for Receiving Poor-Quality Health Care" published in the March 16 issue
and written by Dr. Steven M. Asch of RAND Health with multiple other authors.
After reviewing reams of statistics, these authors concluded, "health insurance status was largely unrelated to the quality of care
among those with at least minimal access to care." Although not stated in the article, showing up at a hospital emergency room
guarantees such a minimal access to care. Calling 911 provides transportation to the hospital.
Comparing groups of people according to their kind of health insurance showed a remarkable lack of significant statistical
differences between the groups:
No health insurance - 53.7 percent
Medicaid - 54.9 percent
Medicare - 56.9 percent
Managed care - 55.2 percent
Private nonmanaged care - 53.6 percent
The differences among these groups are statistically insignificant or marginal. People with private nonmanaged insurance
actually received an insignificant 0.1 percent lower quality of care than people without any health insurance at all.
Seeing a doctor is more important than whatever kind of insurance you have. Indeed, having or not having health insurance
didn't make much difference in health-care quality in this study.
So, based on what kind of insurance you have, the answer to who is at greatest risk for receiving poor-quality health care, is
"everybody." Having or not having health insurance didn't make much difference to the quality of health care these subjects
received.
The authors comment, "Although having insurance increases the ease of access to the health-care system, it is not sufficient to
ensure appropriate use of services or content of care." Translation: If you have insurance, you might not have to wait as long to
see a doctor in a doctor's office or in a hospital emergency department.
Other factors were much more statistically significant. For example, blacks and Hispanics got 57.6 percent and 57.5 percent of
desired health-care services, compared with only 54.1 percent for whites, a statistically much more significant difference than
the borderline differences among the insurance coverage groups.
Yet many politicians and public policy experts, both Republican and Democrat, conservative and liberal, assume that having
insurance is an important element in getting adequate health care. If they didn't, they wouldn't be so concerned about the
uninsured, estimated at 40 to 45 million Americans. I suggest we celebrate the fact that more than 250 million Americans do
have health insurance.
For an example on the conservative side, Deroy Murdock notes in the Jan. 23 Washington Times, "The Health Care Choice
Act, sponsored by Republicans Rep. John Shadegg of Arizona and Sen. Jim DeMint of South Carolina, would let American
consumers buy health insurance across state lines, as they now may shop coast to coast for mortgages." He quotes Mr.
Shadegg saying, "Two-thirds of the uninsured have incomes below 200 percent of the federal poverty level, and most cite
unaffordability as the top reason for why they are uninsured."
A recent liberal example is a Feb. 27 Newsweek article "Health Care's New Lottery" by Jane Bryant Quinn. She writes "The
winners: the healthy and well insured, with good corporate coverage or Medicare. When they're ill, they get — as the cliché
goes — 'the best health care in the world.' The losers: those who rely on shrinking public insurance, such as Medicaid [nearly
45 million of us], or go uninsured [46 million and rising]."
John C. Goodman, president of the National Center for Policy Analysis, comments that although the authors of the NEJM
study don't say so, "an implication is that public policies that make it easier for people to see physicians [such as Health Savings
Accounts] may be a lot more important than policies designed to insure people [such as Medicaid]."
Wouldn't universal coverage or a single-payer system help people get the other 45 percent of health care the experts think they
should? According to the NEJM study authors, "In the United Kingdom, with universal coverage, a study using our methods
found that the overall proportion of recommended health care that was received was similar to what we have reported."
Translation: "No." One way of looking at these results is that people around the world don't want to put up with everything we
medicos and other experts throw their way, even if somebody else is paying for it.
So, if you suspect you have a health problem, see a doctor. Don't worry too much about your health insurance coverage.
Editor's Note:: Robert J. Cihak wrote this week's column.
