Different Health Experiences in These United States

The variances in health care use across the nation are nothing new — but the factors that influence them are compelling.

“Health disparities are a big problem,” said Dr. John Meigs, a family physician in Centreville, Alabama, and president-elect of the American Academy of Family Physicians.

Dr. Jie Chen, an assistant professor at the University of Maryland’s School of Public Health, said some factors influencing health care use include age, ethnicity, income, and language barriers; the amount of providers in a given area and socioeconomic issues in a region; how providers are paid; and how people communicate with providers.

“All of these factors will influence each other,” Chen said.

The 2014 National Health Interview Survey examined factors that affect health care utilization. Participants were adults, ages 18 to 64. The report also looked at differences by Medicaid expansion status and state health insurance marketplace type.

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A few interesting takeaways from the data include:

1.) Implementation of the ACA
There was state variation in the implementation of the Affordable Care Act, as well as variation in health care use based on where people lived. The percentage of adults without a usual place of medical care or who did not see a general doctor in the past 12 months was lower in states with partnership marketplaces, compared with states with Federally Facilitated Marketplaces.

In addition to access issues, Dr. Kevin Campbell, a cardiologist in North Carolina, said many patients remain uninsured and cannot afford care.

“Others have plans in the ACA that have very high deductibles and are basically unable to use their insurance,” he explained. Health care analysts are predicting that scenario will only get worse in 2017.

2.) Certain States Still Insist on ER Visits for Regular Care
Compared to the national average of 17.3 percent, Western states tended to have more people who did not have a usual place of medical care in 2014.

[lz_bulleted_list title=”National Health Interview Survey, 2014″ source=”http://www.cdc.gov”]Adults without a usual place of medical care ranged from 2.8 percent in Vermont to 26.7 percent in Nevada.|Adults who did not have a general doctor visit in past 12 months ranged from 15.9 percent in Vermont to 48.1 percent in Montana.[/lz_bulleted_list]

Adults who went to the emergency room for typical care were defined as those who did not have a usual place for medical care. In Vermont, for example, just 2.8 percent of people relied on emergency rooms, while 26.7 percent of people in Nevada turned to emergency rooms more often.

ER visits were highest in such states as Idaho, Texas, Oregon, Arizona, Alaska, and Florida.

Massachusetts, Wisconsin, Hawaii, Connecticut, Rhode Island, North Dakota, South Dakota, and New York saw a greater percentage of people who have a regular place of receiving medical care.

Adults in Medicaid expansion states were less likely to not have a usual place of medical care, compared with non-expansion states.

A few states that expanded Medicaid include Arizona, California, Colorado, Connecticut, District of Columbia, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New York, Ohio, and West Virginia.

Alabama, Alaska, Florida, Georgia, New Hampshire, North Carolina, Pennsylvania, and South Carolina are some of the states that did not expand the program.

Frequency of Doctor Visits Varies by State
In 2014, 34 percent of adults had not seen or talked to a general doctor in the past 12 months. That number ranged from 15.9 percent in Vermont to 48.1 percent in Montana.

Why such a difference?

“It boils down to access and cost,” Campbell said. “If patients have a high deductible, they are very unlikely to use their insurance. It becomes nothing more than an emergency or catastrophe plan.”

He added, “In addition, many states now only have one or two choices of ACA exchanges. Many exchanges have limited networks of doctors so access is often limited.”

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States Differ, as Do Attitudes on Which Care is Needed
In many rural areas, the only doctor nearby is a primary care doctor, Dr. Meigs of Alabama noted. In many cases, though, people do not use them enough and instead choose to go emergency rooms for routine care. That drives up costs for both consumers and insurers.

“[Emergency rooms are an] expensive and inefficient way [to receive health care] unless you’ve got a life-or-death emergency — then they’re the best place to get health care,” Meigs said.

Another reason people do not have a primary care doctor or don’t choose to see theirs is because people want care quickly. In the rush, they inadvertently seek inefficient or ineffective solutions and miss out on receiving care from a provider who truly understands their background and needs.

“We live in a consumer-driven economy of ‘I want what I want and I want it now,'” Meigs said.

Often, patients won’t take an appointment with him if they have to wait a few hours for it, he said. They go to the emergency room and wind up spending more time there — plus they pay more.

“It’s a cultural thing, I think,” he said.

Campbell agreed, adding that patients are not participating in their own health care in productive ways.

“Patients are not willing to work on prevention. Americans want a quick fix,” Campbell said. “Management of chronic disease requires a partnership by doctor and patient and involves hard work. Many patients are simply not willing to put in the time to maximize their health status.”