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Changing Insurance Plans Costly to Health

But U.S. Census finds more Americans have no coverage at all

TUESDAY, Sept. 30, 2003 (HealthDayNews) -- In these difficult economic times, many people have to change their health insurance plans, either because they can no longer afford it or their employer changes their coverage.

That change -- at least temporarily -- is linked to a decrease in the quality of health care and higher health-care costs, says a new study by researchers at the University of California in Davis.

The study comes in tandem with a gloomier report by the U.S. Census Bureau, which finds the number of Americans who have no health insurance rose by 2.4 million in 2002. The report, issued Tuesday, says the number of uninsured now stands at 43.6 million -- 15 out of every 100 people.

Still, many others either switch plans or have the plans switched on them. The study on these people, published in the September/October issue of the Annals of Family Medicine, reports an average annual turnover rate of 20 percent.

The researchers found that during the first year after an insurance change, women were less likely to get mammograms and both men and women faced a greater risk of avoidable hospitalizations and had higher medical costs, particularly for tests.

"There is a downside in terms of optimal care for patients and costs for insurance companies associated with changing insurance plans," says study author Dr. Peter Franks, a professor of family and community medicine at the UC-Davis. "While there might be advantages to switching, people need to realize that there's a downside in terms of health-care delivery and costs."

Health insurance claims records for more than 300,000 people insured by one managed care company were analyzed for this study. All of the people lived in a 10-county area surrounding Rochester, N.Y.

Those included in the study were between 21 and 64 years of age. Each person was assigned a primary-care physician; more than 95 percent of the physicians in the area participated in this health insurance plan.

The researchers looked for information on screening tests, such as Pap smears and mammograms, physician visits, avoidable hospitalizations, total health-care expenditures, and socioeconomic status in the first year on an insurance plan compared to other years.

Avoidable hospitalizations were 89 percent higher during the first year on an insurance plan compared to the fourth year, according to the study. Costs for physician visits and medical tests were also higher in the first year, reports the study.

The researchers also found that in the first year on a new health insurance plan, women were 13 percent less likely to receive a mammogram than women in their fourth year on an insurance plan. No statistically significant difference was found for Pap smears.

Franks says he thinks one of the most important factors in the additional costs has to do with "developing a relationship with a provider." He explains that when you change doctors it may be easier for them to repeat tests than to try to track down lab work you've already had done.

For tests such as mammograms, Franks says there are a lot of barriers that women have to overcome, such as concern over the pain from the test, that a doctor who has a long-term relationship with the patient can better help them deal with.

James Walsh, publisher of the book Hassle-Free Health Coverage, says he's not surprised by the study's findings.

"In this hard market, any change is going to come with caveats and exclusions and exceptions that are difficult to bear," says Walsh.

"At this point in time, and for the foreseeable future, any person should think very carefully about changing insurance," he adds.

If your employer changes insurance companies and you don't have a choice in the matter, Walsh says it's worth asking your primary-care physician if the office takes your new insurance. If it doesn't, he says you can ask if it would consider becoming a provider on that plan, and he says many will.

Of course, having to change health plans is much better than having your insurance taken away altogether. The Census study found the rate of uninsured rose from 14.6 percent in 2001 to 15.2 percent in 2002.

The number of people covered by employment-based health insurance dropped from 62.6 percent in 2001 to 61.3 percent last year, according to the report. Having a job was hardly a guarantee of having coverage of any kind: 16.8 percent of those who were employed full-time had no insurance. And while the rate for children remained unchanged, the Census found that one in four kids were covered by Medicaid.

The state-by state figures on the uninsured ranged from 8 percent in Minnesota, Rhode Island, Wisconsin, and Iowa to 24.1 percent in Texas.

More information

Here are some tips on choosing an insurance plan from the Agency for Healthcare Research and Quality and the State of Wisconsin. You can read the report on the uninsured by visiting the U.S. Census Bureau.

SOURCES: Peter Franks, M.D., professor, family and community medicine, University of California, Davis; James Walsh, editorial director, Silver Lake Publishing, Los Angeles; September/October 2003 Annals of Family Medicine; Sept. 30, 2003, U.S. Census Bureau report, Health Insurance Coverage in the United States: 2002
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