Articles

(April 2006) Access to health care is important to all Pennsylvanians, yet there still are places in the state where access to high quality, affordable health care is limited. The result? An unwanted situation that affects Pennsylvania’s overall quality of life. IssuesPA examined just how well the current systems provide access to health care services and what state government’s role in assuring access should be.

Pennsylvania compares favorably to other states in the percentage of its citizens with basic health insurance. In 2003, 11.4% of Pennsylvania residents lacked health insurance coverage, compared to the national average of 15.6%. However, these percentages have increased slightly in the last year, both nationally and in Pennsylvania, and Pennsylvania may be losing ground. Meanwhile, children are insured at a higher rate than the general population. About 8.4% of children are without coverage in Pennsylvania compared to the 11.4% national average.

Why do a larger percentage of Pennsylvanians have basic health care, compared to the national average? Four reasons. 

• One, the relatively large number of elderly in Pennsylvania who are covered by Medicare. 
• Two, Pennsylvania’s comparatively high percentage of employers offering coverage to employees. 
• Three, several state initiatives expanding access to health care coverage for the uninsured – such as the Children’s Health Insurance Program (CHIP) and the PACE and PACE/NET programs. These programs fill major health care coverage gaps for children and seniors. 
• Four, Pennsylvania has a comparatively low number of foreign-born residents, who generally have lower rates of coverage.

Still, 1 of every 9 Pennsylvania residents – including almost 240,000 children – lack basic health care coverage. Hundreds of thousands of households delay preventive/primary care and have no insurance protection in the event of a sudden medical emergency.

Are there other barriers?

Yes. In addition to access problems caused by lack of health insurance coverage, other barriers to health care faced by many Pennsylvanians include:

• Geographic pockets, such as rural areas and certain inner city communities, where a shortage of health care professionals compromises access to health care services. The number of primary care physicians per 1,000 population is significantly lower in rural areas than the rest of the state. According to the Pennsylvania Department of Health, approximately 1.4 million Pennsylvanians live in areas designated as lacking access to primary care physicians, dentists, and mental health professionals. 
• Gaps in services covered by health insurance plans. For example, Medicare coverage for seniors doesn’t cover all prescription drug costs, and in some cases cost remains a problem. In addition, mental health coverage is inconsistent or inadequate in many basic plans.
• The impact of medical malpractice insurance. According to The Project on Medical Liability in Pennsylvania [http://medliabilitypa.org/], Pennsylvania medical specialists say they limit practices and turn away patients because of liability fears. Young doctors say they’re leaving Pennsylvania because of malpractice burdens. On the other hand, high premiums haven’t had dramatic effects on the overall supply of specialists statewide in Pennsylvania.

So what does this mean?

Even though Pennsylvania fares comparatively well in providing access to services compared to other states, there will be continued pressure to do even better, especially considering the current trend in the increasing number of uninsured. Several issues of access to health care services now face policymakers. Among them:

• Maintaining and improving health care access for Pennsylvania residents without health insurance. 
• Encouraging increased coverage by private sector employers. 
• Further addressing Pennsylvania’s medical malpractice situation. 
• Finding the funds to pay for expanded programs to address health insurance access and barriers to care.

Maintaining and expanding the level of health care coverage and addressing barriers to health care access requires a delicate balancing act. That’s certainly a challenge for Pennsylvania moving forward.