Correspondence
Cost as a Barrier to Medical Care in Relation to Unemployment Rates
N Engl J Med 1998; 339:1644-1645November 26, 1998
- Article
To the Editor:
There is strong evidence that people who receive medical treatment in a timely manner have improved health outcomes.1,2 Thus, delays in seeking medical care because of concern about cost can have serious effects. This consideration was prominent in the debate on health care reform in the early 1990s but received much less publicity once the national effort to reform health care failed.
We examined trends in the perception that cost is a barrier to medical care. Data from 1991 through 1996 were obtained from the 45 states (all but Arkansas, Kansas, Nevada, Rhode Island, and Wyoming) that participated in the Behavioral Risk Factor Surveillance System in each of these years.3 Monthly telephone surveys of randomly selected adults were conducted in each state; the median annual rates of response ranged from 77.8 to 84.2 percent. Data were weighted according to each state's population and pooled, resulting in monthly sample sizes ranging from 5756 to 7947 respondents. Our analysis of the perception that cost was a barrier to medical care was based on the response to the following question: “Was there a time during the last 12 months when you needed to see a doctor, but could not because of the cost?” We used a time-series approach to analyze these data for all months and then compared our findings with monthly unemployment rates during the same period.
The prevalence of the perception that cost was a barrier to medical care increased from 11 percent to 15 percent from January 1991 to January 1993 but then declined nearly to the 1991 value by late 1996 (Figure 1Figure 1
Prevalence of the Perception That Cost Was a Barrier to Medical Care, According to the Unemployment Rate, from January 1991 through December 1996.). Comparisons of monthly unemployment rates and the prevalence of the perception that cost was a barrier to care showed a slight difference between the two during the first nine months of 1991, with the patterns of the two variables then becoming similar for the rest of the study.Although other factors (e.g., increased enrollment in managed care and extensive media coverage of health care reform efforts) may have had a role,3,4 changes in unemployment seem to correlate strongly with trends in people's perception that cost is a barrier to obtaining medical care. This makes sense, given the reliance in the United States on employer-based health insurance. Concern about health care costs and pressure for health care reform may increase in conjunction with increases in unemployment, as occurred from January 1991 to January 1993.
4 ReferencesDavid E. Nelson, M.D., M.P.H.
Betsy L. Thompson, M.D., M.S.P.H.
Shayne D. Bland, M.S.
Centers for Disease Control and Prevention, Atlanta, GA 30341-37171
The Hypertension Detection and Follow-up Program Cooperative Group
CrossRef | Web of Science2
The Lipid Research Clinics Coronary Primary Prevention Trial results
CrossRef | Web of Science3
State- and sex-specific prevalence of selected characteristics -- behavioral risk factor surveillance system, 1994 and 1995Mor Mortal Wkly Rep CDC Surveill Summ 1997;46:1-31
Medline4
Centers for Disease Control and Prevention. Health, United States, 1996-97: injury chartbook. Hyattsville, Md.: National Center for Health Statistics, 1997.
- Citing Articles (3)
Citing Articles
1
N. Muramatsu, S.-Y. D. Lee, J. A. Alexander. (2000) Hospital Provision of Institutional Long-Term Care: Pattern and Correlates. The Gerontologist 40:5, 557-567
CrossRef2
D E Nelson, B L Thompson, S D Bland, R Rubinson. (1999) Trends in perceived cost as a barrier to medical care, 1991-1996.. American Journal of Public Health 89:9, 1410-1413
CrossRef3
(1999) Cost as a Barrier to Medical Care. New England Journal of Medicine 340:16, 1293-1293
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