The ability for adults to access basic health care services has declined in nearly every state, including Kansas, during the last decade, according to a new report released early today by the Robert Wood Johnson Foundation.
Researchers at the Urban Institute looked at three indicators for adults ages 19 to 64:
• having a routine checkup during the previous year.
• having a dental visit during the previous year.
• having unmet medical needs because of cost.
Researchers found a decline across all three measures between 2000 and 2010. Nationally, they found:
• 63 percent — had a routine checkup in 2010, down from 68 percent in 2000. In Kansas, it was 66 percent down from 68 percent.
• 65 percent — had a dental visit, down from 69 percent. In Kansas, it was 68 percent, down from 72 percent.
• 18 percent — had unmet medical needs because of cost, up from 12 percent. In Kansas, it was 15 percent, up from 10 percent.
It’s the first report to provide a state-by-state look at changes in access and the first to compare access in every state for those with insurance to those without insurance.
“Our study shows that the uninsured experience substantially worse access to care relative to the insured in all states,” said Genevieve Kenney, the study’s lead author. “This indicates that the health care safety net is not acting as an effective substitute for health insurance coverage when it comes to providing basic health care to the uninsured.”
Among the uninsured in Kansas in 2010:
• 42 — percent had a routine checkup.
• 37 — percent had dental visit.
• 45 — percent had unmet medical needs because of costs.
When people don’t have access to preventive care, the consequences can be devastating financially and physically, Kenney said.
“The kinds of things that would concern me are whether it leads to later diagnosis of health problems, and that could have morbidity and mortality implications,” she said. “It also could lead to higher costs down the road.”
For people who don’t access dental care, she fears there could be unnecessary pain and suffering.
“Oral health issues are of particular interest because so many of them are preventable and yet, if not attended to, they can lead to severe problems,” she said. “There’s an economic dimension to that too. If you have real problems with your teeth, it can mean you may have a harder time in the job market.”
The results of the report were no surprise to Julie Branstrom, executive director of Douglas County Dental Clinic, which provides dental care for low-income residents who don’t have private insurance. She said the wait for a nonemergency appointment is mid-July.
“We continue to see an increase in the number of uninsured adults and especially the number of adults who qualify for the services at our lowest fee level,” she said. The clinic charges patients on a sliding scale based on household income. The lowest fee level is 100 percent of the federal poverty level, which is $10,890 annual income for an individual or $22,350 for a family of four.
She said the clinic is struggling to meet the growing needs because the clinic has received no increase in state funding and it lost $8,000 in United Way of Douglas County funding this year.
“I am trying to figure out a way to pay the bills and keep the doors open,” she said.
In 2011, the clinic had 6,816 patient visits. It provided care for 3,676 patients and of those 1,466 were uninsured.
Inadequate access to dental services was among the top challenges unveiled in a 38-page Community Health Assessment released last week by the Lawrence-Douglas County Health Department. It found one in five residents had not seen a dentist in the past year. Insufficient access to health care also was mentioned. Thirty-five percent of adults said they had not had a checkup in the past year.
Kenney thinks a number of factors are causing the decline in access to care. Among them:
• A decline in health insurance coverage.
• For those with insurance, there have been rising costs for co-payments and premiums.
• For those with Medicaid coverage, she thinks there is a lack of providers because more people are qualifying for services.
• For the uninsured, there has been a lack of funding for safety net clinics and therefore, they can’t keep up with demand.
“It’s interesting because we know some states have been more aggressive about trying to support the safety net clinics to provide direct care to the uninsured, but it looks like that just doesn’t substitute for having health insurance coverage,” Kenney said.