The federal health reform known as the Affordable Care Act has dramatically reduced the number of Americans without insurance. In California, the rate of adults under age 65 without coverage has fallen from 23.7 percent to 11.1 percent since the law took effect.
But as many of the newly insured have discovered, there’s a big problem lurking behind those numbers: Even with insurance coverage, it can still be very difficult for consumers to find a doctor.
A new study by researchers at the University of Wisconsin, published in the journal Health Affairs, shows just how bad the situation can be.
The researchers used “secret shoppers” to try to schedule appointments with more than 700 doctors listed in directories from two major health plans: Blue Cross and Blue Shield. What they found was distressing.
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About 70 percent of the time, consumers were unable to schedule an appointment with a doctor listed as part of a health plan’s network. And even when they were able to get an appointment, wait times for conditions that required urgent care were disturbingly long.
The problems were many, and varied.
For example, in about 30 percent of the cases, doctors were listed with the wrong specialty. Since only certain doctors can serve as a primary care physician, this meant that nearly a third of the doctors listed in the directories were useless for a patient in need of a regular doctor to be a gatekeeper for all their health needs.
About 10 percent of the doctors were no longer with the medical group with whom they were listed, and sometimes never had been. In nearly 20 percent of the cases, callers were unable to reach the doctors because the line was disconnected, the wrong number was listed or was constantly busy, or repeated messages were unreturned.
Another 10 percent of physicians were not accepting new patients.
Even when a caller was able to reach a doctor and he or she was accepting patients, wait times were unacceptably long. After describing a condition that needed urgent attention, patients were told they would have to wait, on average, more than a week for an appointment.
Critics of the Affordable Care Act might be surprised to learn that all of these issues were similar whether the insurance tested was purchased through Covered California – the state’s new, subsidized insurance exchange – or on the open market.
Simon Haeder, one of the paper’s co-authors and now an assistant professor at the University of West Virginia, said the findings show that access to care continues to be a major problem.
“For a well-educated person, they might get frustrated, but they are probably able to get the care they want eventually,” he said. “But if you are low socio-economic status, don’t have a lot of time and money on your hands, don’t understand the system, might not speak English, maybe you have your child calling for you, you call one doctor, maybe try another, but at some point you do what you’re familiar with, you go to the emergency room.
“That doesn’t help the consumer, and it doesn’t help the overall health care system.”
He’s right. For all of the cost and complexity in our health care system, access starts with a simple phone call to a doctor listed in a plan directory. This is basic stuff in an era of high-tech health care wizardry.
If the insurance companies can’t get that step right, it undermines everything else they are trying to do.
Daniel Weintraub is editor of the California Health Report at calhealthreport.org. Contact him at firstname.lastname@example.org.