Many Doctors Nationwide Offering Reduced- Or No-Fee Care For Patients Who???ve Lost Health Insurance

NEW YORK CITY, Nov. 12 ??? Nearly two-thirds (65%) of primary care internists in private practice reduce or waive their office visit fees to help patients who???ve lost their health insurance, according to new research led by The New York Academy of Medicine and published in the November/December issue of Health Affairs. More than two-thirds (68%) of internists also provide at least some charity care for uninsured patients in financial need each month, Academy scientists found.

Yet internists are concerned about their ability to continue providing high-quality care to their uninsured patients, according to the study, which was based on a national survey of internists in general practice nationwide. Internists say they are less able to provide top-quality care for uninsured patients than for insured patients (49% vs. 91%), and they also feel less able to maintain continuity of care for uninsured patients than for insured patients (36% vs. 92%). Part of the reason is their inability to get medications and tests at reduced rates for financially strapped patients. Less than one-quarter of internists report they can often get medications for their uninsured patients at reduced cost, while only nine percent can often get reduced-cost lab tests and only five percent can often get reduced-cost diagnostic procedures. Cost constraints prevent uninsured patients from pursuing recommended follow-up tests or taking prescribed medications ???most of the time or often,??? said nearly half (47%) of the internists surveyed.

???Even though internists are making it possible for uninsured patients to have an office visit, these uninsured patients may still not be getting the medications or tests they need because of costs,??? said Gerry Fairbrother, Ph.D., Senior Scientist in the Academy???s Division of Health and Science Policy and lead author of the report, entitled ???Care for the Uninsured in General Internists??? Private Offices.??? The report was co-authored by Heidi L. Park, Ph.D., M.P.H., and Roberta Scheinmann, M.P.H., Research Associates in the Division of Health and Science Policy, and Michael K. Gusmano, Ph.D., Senior Research Analyst at the International Longevity Center-USA. The study was supported by The Commonwealth Fund and the American College of Physicians Foundation.

The survey found that when a patient is uninsured and has trouble paying for the visit, 65 percent of internists reduce the customary fee or charge nothing. Most internists will accept partial payment at the time of the visit or bill later, and more than two thirds (68 percent) will create a payment plan. Internists who are full or part owners of their practice are more likely than those who are employees to have policies that accommodate uninsured patients who have trouble paying (69% vs. 55%). Internists who do routinely reduce fees for uninsured patients are less likely to use a collection agency for unpaid bills than internists who don???t (22% vs. 35%).

Current market pressures from insurance companies, managed care plans, employers, and government payors are likely to reduce the willingness of private physicians to see uninsured patients, according to the report.

???If market forces and policy consequences cause internists and other private practitioners to reduce their care for uninsured patients, there will be nowhere for them to go,??? American College of Physicians President Munsey Wheby, M.D., F.A.C.P., said. ???The safety net is simply not large enough to absorb the uninsured now being seen by internists and other private practitioners.???

A majority of internists report that their uninsured patients are mostly established patients who lost their insurance (52%) or a mixture of established and new patients (10%). It appears that the uninsured patients served are not medically indigent, but rather, patients who have lost health insurance because of job loss or other circumstances. Internists say they are more likely to accept a new self-pay or uninsured patient as they are to accept a new Medicaid patient (80% vs. 45%).

"Doctors in private practice bear a significant share of the burden of providing health care for those without coverage, but charity care is not a solution to the crisis of rising numbers of uninsured," said Karen Davis, president of The Commonwealth Fund.

The New York Academy of Medicine is a non-profit institution founded in 1847 that is dedicated to enhancing the health of the public through research, education and advocacy, with a particular focus on urban populations, especially the disadvantaged. The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States, with more than 115,000 members. The Commonwealth Fund is a private foundation supporting independent research on health and social issues.

Posted on November 11, 2003

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