Minnesotans lacking health insurance seek less care, study says

Nov. 21--Minnesotans who lack health insurance were less likely in 2011 to receive clinic and in-patient hospital care than those with private or public health insurance, according to a state health department report released Thursday.

The report can't definitively say if the differences demonstrate a failure to get needed care by uninsured Minnesotans. But there are hints that "the uninsured consumed health care at a suboptimal level," concludes the report from the Health Economics Program at the Minnesota Department of Health.

The findings fit with what other studies have shown, experts say, and help establish a baseline for evaluating changes beginning next year with the federal Affordable Care Act, which requires almost all Americans to have coverage. With the law, Minnesota expects the number of people lacking health insurance in the state to shrink by 290,000 people by 2016.

"Generally, the uninsured were less likely to report visiting a doctor or having an overnight hospital stay than people with insurance coverage, a difference that persists even when health status is taken into account," the report states.

"What is particularly noteworthy is that the uninsured in poor health -- those among the uninsured with presumably the highest health care needs -- displayed lower utilization of health care in some categories than people with favorable health status who had insurance coverage," the report says.

The report draws in part from a 2011 health department survey that found 490,000 Minnesotans, or about 9.1 percent of the state's population, lacked health insurance.

Minnesota's rate of people who lack coverage is one of the lowest in the nation. But health department surveys have shown a long-term increase in Minnesota's uninsured rate, which stood at 6.1 percent in 2001.

The new report found that Minnesotans, overall, are going to the doctor more often than they were a decade ago -- so long as they have health insurance.

The share of all residents surveyed who said they visited a doctor in the past six months increased from 61.9 percent in 2001 to 73.3 percent in 2011, according to the report. But only 43.2 percent of uninsured state residents in 2011 said they had visited a doctor in the past six months -- a rate that was statistically unchanged from a decade earlier.

In addition, the report found that "uninsured people in poor health were less likely to have seen a doctor over a six month window (63.3 percent) than people in good health who had public coverage ... or were privately insured."

Uninsured people were three to six times more likely than people with coverage to say they did not get needed routine medical or specialist care due to cost, the report found.

People with individual health insurance policies also were more likely to say they didn't get routine medical care due to cost. Those consumers also were less likely to have had an inpatient hospital stay during the past 12 months.

One goal of the health law is to make individual health insurance policies provide richer benefits -- a requirement that has proved controversial in recent weeks, as some consumers have balked at the cost impact of those changes.

The report found that people with public health insurance, as a group, were most likely to have had an emergency room visit during the past 12 months.

"The only category of health care utilization that the uninsured experienced at comparable rates is the use of hospital emergency departments, a place of care delivery less conducive to providing continuity of care, but one that is also required to treat all comers," the report states.

What's likely to happen if more Minnesotans gain coverage?

"Health care use is expected to expand for the formerly uninsured (and people with expanded health benefits) and ... certain patterns of utilization may change as a result," the report concludes. "Research suggests that higher utilization may follow the event of obtaining coverage, perhaps even extending to the first years of newly holding health coverage."

Christopher Snowbeck can be reached at 651-228-5479. Follow him at www.twitter.com/chrissnowbeck.

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