Invited Commentary <\/p>\n\n\n\n
February 7, 2024<\/p>\n\n\n\n
Health care access depends on financial resources to pay for health care. Health insurance allows healthy people to pool resources to pay for health care when one becomes ill or injured. The RAND Corporation\u2019s Health Insurance Experiment of the 1970s demonstrated that health insurance was associated with increased health care use but not necessarily better health.1<\/a><\/sup> That work has been justification for not expanding universal insurance coverage in the US. However, does lack of health insurance lead to lower health care access and thus worse health?<\/a><\/p>\n\n\n\n This is the question that Dualeh et al2<\/a><\/sup> explored, studying the complex interplay between health insurance, surgical care access, and postoperative outcomes. Their recent multistate cohort study compared insured vs uninsured patients\u2019 unplanned surgery rates for access-sensitive conditions. Access-sensitive conditions are symptomatic, progressive conditions for which there are good screening tests to diagnose the need for early elective surgery.3<\/a><\/sup>However, if access to screening or surgery is limited, these conditions can progress and require unplanned, emergent surgery. These conditions include abdominal aortic aneurysm, colon cancer, and ventral hernia. The authors elegantly demonstrated that uninsured patients were more likely to undergo unplanned surgery for access-sensitive conditions and had worse postoperative outcomes than insured patients.<\/a><\/p>\n\n\n\n This study is an important addition to the body of evidence that lack of health insurance is associated with lower surgical care access and worse health. The authors propose using unplanned surgery rates for access-sensitive conditions to measure how policies that aim to expand insurance coverage impact health care access. However, insurance is necessary but not sufficient for health care access. Even among the insured group, 33% still underwent unplanned surgery. Similarly, unplanned surgery for access-sensitive conditions occurs even in health systems with universal health insurance coverage.4<\/a><\/sup> Patients do not access health care because work or family roles do not permit them time to access care.5<\/a><\/sup> Among vulnerable patients, immediate basic needs such as housing, transportation, or food are often prioritized over health care.6<\/a><\/sup> Other barriers such as medical mistrust, health literacy, rurality, language, and other social drivers of health inequity further limit accessing health care.7<\/a><\/sup> Lastly, health insurers and health systems have increasingly consolidated, leading to complex referral processes with long wait times for specialists such as surgeons.7<\/a><\/sup> Unplanned surgery for access-sensitive conditions must not be considered only a health policy failure. It is a health system failure.<\/a><\/p>\n\n\n\n