Kantar Health Blog

Will an influx of newly insured patients overwhelm healthcare resources?

by Patricia Ensor | Feb 18, 2014
Patricia Ensor

One of the most debated aspects of the Affordable Care Act (ACA) is how the newly insured will use existing healthcare resources. Will they overwhelm emergency rooms? Will out-of-pocket costs continue to pose access barriers for these newly insured patients?

Resource UseBy examining the U.S. uninsured population based on our proprietary patient research of 50,000 individuals, we found the uninsured visit the emergency room more often but see a doctor far less often than the insured. Our analysis, and research conducted by other sources, indicates that this population uses the emergency room not only for acute situations but also as a substitute for having a primary care physician. Young families among the uninsured in particular are more likely to have visited the ER in the past six months. While this type of ER use declined mildly in Massachusetts after its healthcare reform, it remains to be seen whether a similar decline will happen with the expanded coverage under the ACA.

Costs are likely a reason for the uninsured population to forgo regular physician visits. In a previous blog, we noted that the uninsured have substantially lower incomes than the insured. In fact, nearly 75 percent of the uninsured have an annual income of $50,000 or less, compared with about 45 percent of the insured populations with a similar income. Considering that the uninsured would have to pay the full cost of an office visit, it stands to reason that they would forgo them.   

When considering prescription drug use, we see that a third of the uninsured have not filled a prescription because of the cost. Despite this, they are much less likely than the insured to try a cost-saving strategy on their prescription, such as asking for a generic or a sample. When they do try to save on their prescription, it’s often in ways that would ultimate hurt their health, such as taking less medication than prescribed or buying their prescription less often.

OOP CostsKeeping in mind these healthcare behaviors, it follows that the uninsured pay lower out-of-pocket health expenses than the insured, about $5 per month less. In fact, 43 percent of the uninsured say they pay nothing on healthcare or insurance each month, compared with 24 percent of the insured.

The best possible outcome for the ACA is that it will allow those covered to visit a physician regularly, a preventive measure that would hopefully improve their health and reduce their need to visit the ER.

For more insights into the uninsured populations in the United States, check out our infographic: How do the uninsured use healthcare resources?

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