Counties with more restrictive Medicaid eligibility have the highest prevalence of adults delaying medical care, especially in areas with a lower concentration of primary care doctors, researchers reported today in The New England Journal of Medicine.
Researchers from the Harvard School of Public Medicine and Brigham and Women's Hospital found "stark geographic differences" in the numbers of people delaying healthcare because of costs, they wrote in a letter to the editor. Areas in the South were "particularly vulnerable," they said, including in Texas and Florida.
The odds of delayed care increased 16 percent among people with incomes between 67 percent and 127 percent of the federal poverty line, and by 42 percent for those with incomes between 17 percent and 44 percent of the poverty line. Those numbers fell in areas with a higher concentration of primary care doctors, the researchers said.
The highest prevalence of delayed care occurred among low-income Hispanic populations with high prevalence of chronic disease in areas with a "relatively late history of state Medicaid expansion." The highest rate of delayed care was found in the Rio Grande Valley town of Hidalgo, Texas, where 40.6 percent of the population delayed care because of cost concerns.
Understanding the variation in delayed-care rates can help states planning to expand Medicaid under the Affordable Care Act, the researchers said. States with limited primary care infrastructure may need to spend more to "catch up," they added.
A Gallup poll released last year found that nearly one-third of U.S. adults said they delayed seeking medical because of the cost--up from 19 percent in 2001. Among the uninsured respondents, 55 percent reported having to delay care, compared with 30 percent of those with private health insurance and 21 percent on Medicare or Medicaid.
In a separate study published last year in the NEJM, Harvard researchers concluded Medicaid expansion would reduce mortality rates. Looking at three states that expanded Medicaid prior to passage of the Affordable Care Act, they found the expansion was associated with a 6.1 percent drop in deaths. Patients with Medicaid coverage were less likely to delay needed care, the researchers noted.
To learn more:
- here's the letter in NEJM