An article appearing in the December 2014 issue of Health Services Research suggests that while access to coverage is important, other barriers to care still need to addressed.
The study examined over 1,400 patients from the Partners HealthCare network with high cholesterol, diabetes, or high blood pressure who were uninsured in the three years before the 2006 Massachusetts health reform implementation. They evaluated cholesterol, hemoglobin, and blood pressure for five years following health reform implementation. These results were compared with nearly 3,500 matched control subjects who remained insured for the eight-year study period.
Results demonstrated that previously uninsured patients did not show improvement, as was hypothesized by the researchers. In fact, the findings were even consistent among subsets of patients expected to experience the most benefit from health insurance – such as patients with poorly controlled disease, no primary care involvement prior to health reform, and those who received insurance in the first year after health reform.
The researchers suggest additional health care factors that may be responsible for a lack of improvement, including affordability of treatment, patient adherence, and timely follow-up care. They also question the impact of fragmented care delivery, inadequate focus on preventive health, and patient lifestyles.
Senior Author Dr. Frank Wharam, assistant professor at the Department of Population Medicine, believes the findings highlight the need for a deeper look at barriers to care for these patients including looking at the larger picture of how health care is delivered and paid for, and the patient’s role in their own care.