Cost Of Care A Big Concern Despite Universal Coverage

We’re hearing from a lot of different groups lately about what’s wrong with health care and how to fix it. But what do patients think? To find out, we asked Massachusetts residents who said they had a serious illness, medical condition, injury or disability requiring a lot of medical care, or spent at least one night in the hospital within the last year.

Our poll, Sick In Massachusetts, finds that 78 percent of patient respondents say the cost of care is a very serious or somewhat serious problem. And 63 percent say the problem has gotten worse over the last five years. 

For more details about how Massachusetts patients view the cost and quality of their care, WBUR's Deborah Becker visited the office of Harvard School of Public Health professor Bob Blendon, who conducted our poll.

Deborah Becker: We heard from many of the patients in Martha Bebinger's piece that folks are not happy about the costs of their premiums and added out-of-pocket costs for their health care. The poll found that eight out of 10 residents said that cost is a big issue.

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More stories on WBUR's Sick In Massachusets poll:

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Bob Blendon: When you just talk about universal coverage, you lose the fact that many people who have coverage are paying premiums that are very hard for them to pay. And they actually have very substantial out-of-pocket costs or restrictions. And when you talk to people who are sick, that's suddenly when they discover that this really affects them.

But this poll suggests that there are some people who may not be getting health care.

We're talking about people here who actually said they were seriously ill over the year and they needed a lot of medical care. And yet one in seven said they couldn't get the kind of medical care they needed. And I think all of us were quite surprised because this is the state where you're never supposed to see this in a finding.

One in 12 people with a serious illness said they were turned away by a hospital or physician due to some financial or insurance reason. That suggests that just having coverage alone without worrying about these other problems does not solve the situations that many people will face when they're ill.

One person we spoke with, his name was Alan Papscun, and he lives in western Massachusetts, and he told us that when he switched from private to state-subsidized insurance, there was a big difference in the quality of his care and his ability to get care. Alan describes the private insurance doctors were very good, the public insurance doctors, he calls them awful.

I think it boils down to what you can afford and who can afford it. You know, I think each one has a different standard and it seems it gets applied in a different degree.

Did you hear this in the poll, that there was this discrepancy in the quality of care based on insurance?

There clearly is a perception by people who are lower income and reliant on those programs, that at times the treatment is not the same as middle-income people. Both the individual cases and the poll are a warning sign in a world where we're so pleased with universal coverage, beneath the surface there are still people who think they're being treated differently based on their insurance.

One of the patients we spoke with quit her job and moved into a homeless shelter to be able to afford care for her diabetic toddler. What does the poll suggest about how prevalent something like that might be, that people actually have to take very drastic [steps] to be able to afford their health care?

We were not able to really explore that much in depth. What you did see is that of people who said they had a serious illness, a third of them had a financial problem that seriously affected their family. We have people who are trying to say to us, "We had a serious illness and it had a real consequence financially." For most, it would never be that significant, but there are clearly people who are having trouble absorbing the impact of the combination of premiums and what they have to pay out of pocket.

The survey of 1,000 random Massachusetts residents was conducted between April 19 and May 7. The margin of error is 5 percent. On Tuesday, we'll hear more about patients unhappy with the quality of health care they receive and what might be done to improve it.

The Blue Cross Blue Shield of Massachusetts Foundation, the Harvard School of Public Health (HSPH) and WBUR worked in partnership to produce Sick in Massachusetts. The Foundation commissioned and funded the HSPH poll. An independent research firm, SSRS, conducted the telephone interviews and provided WBUR with the names of poll participants. WBUR met with the partners to review the poll questions and analyze the results. WBUR shared story scripts with Robert Blendon at HSPH for fact checking purposes. WBUR, using internal editing procedures, decided how to frame and expand on issues raised by the poll results.