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Costly Iowa Health Insurance Can be Detrimental to One's Health

Increasing Health Care Costs are Changing How and When Iowans' Access Health Care

The Iowa State Planning Grant (IA-SPG) first looked for evidence of the pressure of increasing health care costs on consumer behavior in 2001. Initially, the research effort focused more on the behavior of uninsured Iowans, and accordingly, one of the questions asked in the 2001 IA-SPG Survey of the Uninsured was if respondents felt they had needed to go to the doctor in the preceding 12 months, but did not go due to the cost. Thirty-seven percent (37%) of respondents said they had made the choice not to seek medical help when they needed it. The response was not surprising as numerous studies have shown the uninsured often delay seeking medical care. That finding, as well as insights drawn from focus groups of both insured and uninsured Iowans conducted by the IA-SPG in 2001, acted as a catalyst to move the focus of the SPG research effort in a direction of examining how rising health care costs affect the behavior of Iowa firms, as well as insured Iowans.

Throughout the IA-SPG term (2001-2005), there have been annual double-digit or near double-digit increases in the cost of health insurance premiums in Iowa and across the nation. Drawing from the work of Miller (2004) and the Institute of Medicine, as well as from the overall IA-SPG research effort, it is clear these increases have significant effects, at the societal member level and to the overall society, resulting from the uninsured's foregone health care access. Commentators suggest increases in health care costs and insurance premiums have changed insurance plan benefit design. This, they say, is moving the country to an insurance model that provides less comprehensive coverage than in the past and demands more financial participation from insureds in the form of higher deductibles, greater patient cost-sharing, and for some plans, a more restricted scope of benefits. Expanding on the work of Miller and Schoen, the question arises, could delayed or reduced access to care in the already insured population, over time, lead to the same deleterious effects arising from the uninsureds' lack of access to care? As a preliminary attempt to respond to that question, we look at how insured and uninsured Iowans respond to health care cost pressures as they make medical care decisions.

As health care costs increase, insured and uninsured Iowans try to save on medical expenses, sometimes in ways potentially detrimental to their good health.

Survey results show Iowans have a number of strategies they use to try to save on health care expenses. Their most common savings strategy is to wait a little longer when they are sick before going to the doctor in the hope they will feel better on their own. This strategy is used by 53% of insured Iowans (including 63% of insured Iowans with incomes below $50,000) and 75% of Iowans without health insurance coverage. Some Iowans, over the course of the past two or three years, have taken this cost-saving strategy a bit further. Twenty-nine percent (29%) of those with insurance coverage and 63% of those without coverage have chosen to not go to the doctor when they felt it was needed. In 2001, when a similar question was asked of both the total Iowa population and the uninsured population, 7% of the total population indicated they had needed to go to the doctor in the past 12 months, but did not do so due to cost, and 37% of the uninsured stated they refrained from going to the doctor due to cost. This apparent increase in the reluctance of the total population to seek medical care when a need is perceived confirms that double-digit increases in heath care costs affect health care consumption in both insured and uninsured populations.

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