Expanding Health Coverage May Not Improve Access

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In Boston, the average wait time for an appointment with a family physician is 63 days -- the highest among 15 metropolitan markets surveyed by the national physician recruitment firm Merritt, Hawkins & Associates in Irving, Texas. The 15-city average was 20.3 days.

Boston's long wait times may be driven by Massachusetts' 2006 health reform legislation, which expanded health insurance coverage to nearly everyone in the state, Merritt, Hawkins noted. Many health policy experts worry that similar access problems will be experienced nationwide if Congress enacts legislation extending health insurance coverage.

Patients on Medicaid already have difficulty accessing health-care providers, according to a recent national online consumer survey by PricewaterhouseCoopers (PWC) Health Research Institute. Nearly a third of Medicaid patients reported waiting 30 days or more for an appointment with a doctor.

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What's more, many Americans still use the emergency room inappropriately. According to PWC's consumer survey, more than half of those who went to the emergency room in the last year did so for non-emergency reasons.

"One of the key things that we have found is that the emergency room turns out to be the front door for many folks trying to gain access into the health-care system," said Dr. David Chin, a principal in PricewaterhouseCoopers and leader of its Health Research Institute.

The Institute's findings appear in a new report, "Jammed access: Widening the front door to healthcare".

To improve access without boosting the cost of care, some health-care organizations across the country are experimenting with different models of care, the report finds. One is the use of online consultations for patients who don't require a face-to-face visit.

"Many insurers now are, in fact, engaged in pilots to pay for electronic visits," Chin said.

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