Americans Worry About Access to Care If Universal Health Insurance is Passed, According to PricewaterhouseCoopers Study

Telehealth, Shared Doctor Visits, Online Consultation Seen as Cures for Capacity Constraints

NEW YORK, July 21, 2009 (GLOBE NEWSWIRE) -- In a recent survey of 1,000 American consumers, more than half (55%) believe that if universal health insurance coverage is passed by Congress it will not ensure equal access to care because of capacity constraints, particularly in hospital emergency rooms, according to a report released today by PricewaterhouseCoopers LLP (PwC). A significant number of people, however, would be open to the idea of shared doctor appointments, online physician consultations, worksite clinics and other alternative ways of receiving medical care.

PricewaterhouseCoopers' research reveals that universal coverage could swamp the health system unless simultaneous steps are taken to create innovative, new care delivery models that will expand access to care without adding costs to the system. Research conclusions and survey findings are in a new PricewaterhouseCoopers' Health Research Institute (HRI) paper entitled "Jammed access: Widening the front door to healthcare."

Americans in general, not just the uninsured, are increasingly using costly hospital emergency rooms as the first point of entry into the health system, according to the PwC report. Per capita visits to hospital emergency departments already are at an all-time high, reflected in overcrowded emergency rooms, ambulance diversions and long waits. The reasons are varied and include shortage of physicians, lack of access to specialists, Medicaid reimbursement disincentives, high costs for the under-insured, poor coordination among practitioners, growing consumer demand and inefficiencies throughout the system, all of which have created jammed access points.

PricewaterhouseCoopers' research found:

 * Patients covered by Medicaid use hospital emergency rooms at
   twice the rate of the uninsured even though the uninsured are
   most often blamed. Forty-four percent of Medicaid respondents
   visited an emergency department in the past year compared to 20
   percent of uninsured respondents.
 * More than half of people who went to a hospital emergency
   department in the past year said they went for a reason other
   than an emergency, for example, their doctor's office was closed
   or they couldn't get an appointment in an acceptable time.
 * Hospital emergency rooms have become holding tanks for mental
   health patients because of a shortage of mental health providers
   and beds. The average length of stay in the emergency department
   for patients in need of mental health services is double that of
   other patients.
 * One in four consumers and one-third of Medicaid patients said it
   takes more than 30 days to see a doctor. One in 10 said they've
   had to wait three months or longer.

PricewaterhouseCoopers' analysis found an inverse relationship between insurance status and emergency department usage. States with high uninsured populations generally have lower emergency room utilization than states with lower uninsured populations. For example, Massachusetts, which has one of the lowest rates of uninsured residents (3%), has one of the highest per-capita utilization rates of hospital emergency rooms in the country. In addition, Massachusetts has the highest number of physicians per capita but has been plagued by a severe physician shortage since introducing near-universal coverage in 2006.

"It's clear that access to insurance coverage does not translate into access to care," said David Chin, MD, principal, PricewaterhouseCoopers and leader of the PricewaterhouseCoopers Health Research Institute. "The quick fix is to build bigger emergency rooms, but increasing supply will only drive up healthcare costs. We must find solutions that expand access without adding costs, and we believe the answer lies in new flexible models to care that use the right technologies and incentives and behavior changes to unclog jammed access points."

New Models of Care Could Expand Access without Increasing Costs

PwC's research shows that Americans are willing to participate in alternative ways to access healthcare, many of which bring access to the patient. Some of these solutions are in use today and include:

 * Electronic interaction with providers and payers: One-half (50%)
   of consumers surveyed said they'd be willing to seek healthcare
   through the Internet or other computer technology as a substitute
   for a face-to-face, non-emergency visit. Of those, e-mail
   consultations was the preferred method of interaction (76%),
   followed by telehealth, question/answer fee-based consults and an
   online forum/chat room monitored by a doctor.

 * Retail and worksite clinics for patients: Of consumers surveyed,
   37 percent said they'd be likely to use a worksite clinic, and 36
   percent would use a retail health clinic. Ten percent of large
   employers surveyed in PricewaterhouseCoopers' 2009 Annual
   Employer Barometer Survey said they are now providing worksite
   clinics, up from one percent in 2008.

 * Use of telehealth technologies: Telehealth, the use of medical
   information exchanged from one site to another via electronic
   communications, such as video conferencing or bio-metric remote
   monitoring, is expanding access, particularly to specialty
   physicians for patients in remote and underserved areas. Nearly
   three-quarters (73%) of consumers said they would use biometric
   electronic remote monitoring services to track their condition
   and vital signs.

 * Shared medical appointments: One in four (28%) of consumers
   surveyed said they would be willing to participate in a shared
   medical appointment, typically a 60- to 90-minute session that
   includes a private or personal exam integrated with patient
   education and discussion with a group of 10 to 15 people.
   Providers currently offering shared medical appointments have
   found both patient and physician satisfaction has soared.
   Instituting one shared medical appointment can increase patient
   access and a physician's productivity by an additional six
   patients during a four-hour clinic session.


PwC HRI commissioned an online survey in April 2009 of 1,000 consumers regarding access to care in the U.S. HRI also conducted a thorough literature review of current access issues and models of care, as well as an analysis of publicly available data and conducted more than 35 in-depth interviews with thought leaders and executives representing healthcare providers, Veterans' Health Administration, community health centers, private and professional healthcare organizations, private sector technology organizations, and academic medical centers.

About PricewaterhouseCoopers' Health Research Institute

PricewaterhouseCoopers' Health Research Institute ( is an unparalleled resource for health industry expertise. By providing cutting-edge intelligence, perspective and analysis on issues impacting the health industry, HRI assists executive decision-makers and stakeholders worldwide in navigating their most pressing business challenges. PricewaterhouseCoopers is one of the only firms with a dedicated global healthcare research unit, capitalizing on fact-based research and collaborative exchange among our network of professionals with day-to-day experience in the health industries.

About PricewaterhouseCoopers' Health Industries Group

PricewaterhouseCoopers' Health Industries Group serves as a catalyst for change and is the leading advisor to public and private organizations across the health continuum, including payers, providers, academic institutions, health sciences, biotech/medical devices, pharmaceutical companies and employers. With a distinctive approach that is collaborative, multi-disciplinary and multi-industry, PricewaterhouseCoopers draws from its broad perspective and capabilities across and beyond the health industries to help solve the array of emerging complex problems health organizations face, lead cultural and clinical transformation, and create a new sustainable model for care delivery that is quality-driven, patient-centered and technology-enabled.

PricewaterhouseCoopers' Health Industries' clients include 40 of the top 100 hospitals in the U.S. and 16 of the 18 best hospitals as ranked by US News & World Report; all 20 of the world's major pharmaceutical companies; all of the top 20 commercial payers in the U.S.; municipal, state and federal government agencies and many of the world's preeminent medical foundations and associations.

PricewaterhouseCoopers has a network of more than 4,000 professionals worldwide and 1,200 professionals in the U.S. dedicated to the health industries. Our health industries professionals include a cadre of physicians, nurses, ancillary health providers and some of the nation's leading minds in medicine, science, information technology, operations, administration and health policy.

About PricewaterhouseCoopers

PricewaterhouseCoopers ( provides industry-focused assurance, tax and advisory services to build public trust and enhance value for its clients and their stakeholders. More than 155,000 people in 153 countries across our network share their thinking, experience and solutions to develop fresh perspectives and practical advice.

"PricewaterhouseCoopers" refers to PricewaterhouseCoopers LLP or as the context requires, the PricewaterhouseCoopers global network of other member firms of the network, each of which is a separate and independent legal entity.

Note to editors: A full copy of the report, "Jammed access: Widening the front door to healthcare," is available at


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