Expanding Health Coverage May Not Improve Access

Innovations in financing, delivery of care are needed to close gaps, experts say

By Karen Pallarito
HealthDay Reporter

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FRIDAY, Aug. 7 (HealthDay News) -- Even if Congress extends health coverage to the nation's 46 million uninsured Americans, there's no guarantee that everyone will have access to care -- unless payment reforms and new models of care are adopted, some experts say.

Significantly expanding coverage without reforming health-care delivery is "a recipe for failure," said Alwyn Cassil, a spokeswoman for the Center for Studying Health System Change in Washington, D.C. "You won't be able to sustain the expanded coverage because it will just bankrupt us."

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Spending on health care this year is projected to reach $2.5 trillion, or 17.6 percent of the U.S. gross domestic product, according to a Kaiser Family Foundation analysis of Medicare and Medicaid data. That's up from 7.2 percent in 1970, and by 2018 it could swell to one-fifth of the GDP, which is a measure of all goods and services produced in the United States.

Meanwhile, a worsening shortage of primary-care providers and rising demand for certain specialists will continue to strain the system, perhaps creating long waits for appointments.

The existing health-care delivery system cannot seamlessly respond to a surge in demand for services, said Jeffrey Bauer, a medical economist.

This is "one of the Achilles heels of reform," said Bauer, management consulting partner at Affiliated Computer Services Inc. and leader of the health futures practice at ACS Healthcare Solutions in Chicago.

"People are already strapped to get a doctor," Bauer said. "As more people have insurance, they will try to get appointments with more doctors, and that will lead to dramatic increases in the time it takes to get an appointment."

Depending on the coverage people have, where they live and whether they have an existing relationship with a physician, some Americans could encounter long delays in getting in to see a doctor.

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