Concerned – Seeing the Doctor of Your Choice
The ability to see the doctor of your choice is called ACCESS.
According to the Kaiser Family Foundation, here is where you obtain your ACCESS to the doctor of your choice (2016 data).
- Employer: Includes those covered by employer-sponsored coverage either through their own job or as a dependent in the same household: 49%
- Non-Group: Includes individuals and families that purchased or are covered as a dependent by non-group insurance: 7%
- Medicaid: Includes those covered by Medicaid, the Children’s Health Insurance Program (CHIP), and those who have both Medicaid and another type of coverage, such as dual eligible who are also covered by Medicare: 19%
- Medicare: Includes those covered by Medicare, Medicare Advantage, and those who have Medicare and another type of non-Medicaid coverage where Medicare is the primary payer. Excludes those with Medicare Part A coverage only and those covered by Medicare and Medicaid (dual eligibles): 14%
- Other Public: Includes those covered under the military or Veterans Administration: 2%
- Uninsured: Includes those without health insurance and those who have coverage under the Indian Health Service only: 9%
Our ability to understand ACCESS to American Healthcare in Transition encompasses three components: coverage, services, and timeliness. Having health care coverage is the key.
- Gaining entry into the healthcare system, which usually requires insurance coverage
- Accessing a location where “needed health care services are provided (geographic availability).”
- Finding a health care provider “whom the patient trusts and can communicate with (personal relationship).” 
1. Gaining entry into the healthcare system, which usually requires insurance coverage
Health insurance coverage helps patients gain entry into the healthcare system. Lack of adequate coverage makes it difficult for people to get the health care they need and, when they do get care, burdens them with large medical bills.
Snapshot of Latest Uninsured Figures
- Uninsured 2016
- Number of persons under age 65 uninsured at the time of interview: 28.2 million
- Percent of persons under age 65 uninsured at the time of interview: 10.4%
- Percent of children under age 18 uninsured at the time of interview: 5.1%
- Percent of adults aged 18-64 uninsured at the time of interview: 12.4%
- The current uninsured rate as of 2016
And what are your chances of being impacted by healthcare reform? That is a misnomer: the healthcare debate has really been about deficit reduction. And the biggest targets remain Medicare, Medicaid, and the Affordable Care Act. So, the correct question would be-will our Congress’ focus on debt reduction masquerading as health care reform impact you? The answer is yes if the Congressional Budget Office is to be believed. Deficit reduction will lead to loss of healthcare coverage. Without health care coverage, your access to the doctor of your choice is curtailed. So, the answer is definitely YES! Deficit reduction will impact your ACCESS to healthcare and the ability to see the doctor of your choice.
Here is a snapshot of the potential impact of other Administration proposed/enacted reforms.
Changes in the Tax law passed by Congress at the end of 2017 could lead to a reduction of almost 16 percent in insurance coverage. If the idea of Medicaid block grants comes to fruition, a whopping 25 percent loss in covered lives might occur. The short term insurance plan fixes including association health insurance plans (we will discuss these tectonic plates in a later blog) could result in another 15 percent drop in health care coverage.
2. Accessing a location where needed health care services are provided (geographic availability).
Improving access to healthcare services depends in part on ensuring that people have a usual and ongoing source of care — that is, a provider or facility where one regularly receives care. Having a primary care provider (PCP) who serves as the usual source of care is especially important.
Up to 50 percent of the uninsured and 12 percent of those with Government sponsored and employer provided healthcare have no usual source of care.
3. Finding a health care provider whom the patient trusts and can communicate with (personal relationship).
Having a primary care provider (PCP) who serves as the usual source of care is especially important. PCPs can develop meaningful and sustained relationships with patients and provide integrated services while practicing in the context of family and community.
Having a usual PCP is associated with:
-Greater patient trust in the provider
-Better patient-provider communication
-Increased likelihood that patients will receive appropriate care
-Lower mortality from all causes
As I said previously, the health care reform debate is really about deficit reduction. Deficit reduction means your ability to have health care coverage has a major barrier-COST. If we add the rest of the bar graph seen previously, the impact of COST on ACCESS is very real.
Even those with insurance coverage through employers (15%) or Government provided healthcare (31%) find cost to be a burden to access. The uninsured suffer the greatest impact (62%). Women are impacted more than men when it comes to COST.  Twenty to thirty-two percent of women did not access their physician for some variation of cost related reasons. Men were impacted 12-22 percent.
Logistical barriers also impact women’s ability to see the doctor of their choice. And this impact occurs across socio-economic status.
Regardless of socio-economic status, a quarter of women can’t find time to go to the doctor. Not being able to find time off from work also plays a big role (18-19 percent) but more so amongst low income females (26 percent). Transportation is also a major factor for that impacts lower income women (18 percent) more than their sisters who make more money (4-9 percent). Childcare (11-15 percent) ranks between time off from work and transportation, but it also seems to impact poorer women the most (19 percent).
At the end of the day, deficit reduction and other Administration approaches to health care will impact your ACCESS to healthcare and the ability to see the doctor of your choice.
 Early release of selected estimates based on data from the 2016 National Health Interview Survey, tables 1.1a, 1.1b- https://www.cdc.gov/nchs/fastats/health-insurance.htm
 IBID www.kff.org
 IBID kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population
 IBID kaiserfamilyfoundation.files.wordpress.com