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Americans are frustrated with the health care system for two reasons. First, it costs too much. But—second—it provides too little. While most of the dialogue on health system reform focuses on cost, there is a growing awareness that Americans aren’t getting what they pay for.
This can be seen most clearly around access, which is the ability to receive needed care. The obstacles to access are myriad, but there is growing evidence that insurance company policies around utilization management are driving access issues.
Utilization management includes tactics such as prior authorization and step therapy, which drown patients and providers in paperwork, requiring care to be delayed or changed. New polling data from KFF suggests that such policies have a direct, negative impact on patients.
Here’s what a national poll by the organization found:
- Prior authorizations are the single largest non-cost issue that patients face. KFF found that 69% of Americans consider such policies to be a burden to getting health care.
- Nearly half of all Americans—47%—have said that care has been denied, deferred, or altered as a result of insurer policies.
- Of those whose care was impacted, 73% said the obstacles had a negative impact on their physical health. Seventy-one percent said the policies hurt them financially.
Fortunately, policymakers are well aware of these challenges. Efforts to reform prior authorization policies have come close to passage in Congress, and there remain active efforts to reshape the system so that the American people aren’t restricted from getting the care they need because of insurance restrictions that often diverge from clinical guidelines.
BIO’s View: We need a new approach. In the same way that policymakers and the health care system collaborated to accelerate 21st Century Cures, we need a broad coalition to push for 21st Century Access, a movement designed to fight against policies that make it harder for patients to get the care they need.
