BALTIMORE—An annual low-income healthcare report card released today finds that large numbers of low-wage Baltimoreans are struggling to access basic medical care for themselves and their families despite an increase in the number of respondents who said they had publicly funded health insurance, typically Medicaid.
This is the fourth year in the row that the Open Society Institute-Baltimore and Baltimore REACH, a network of eight community clinics and resource centers promoting social justice and community health in Baltimore, have conducted the Baltimore Safety Net Access to Care Survey. The survey examines the state of healthcare for the city's destitute and disadvantaged residents.
This year, the percentage of respondents without publicly funded insurance, typically Medicaid, fell to 44.1 percent, which is down from 47.1 percent in 2003 and 59.5 percent in 2001. At the same time, the number of people reporting difficulty accessing primary or other types of specialized care is on the rise. For instance, the percentage who said they had trouble finding dental care jumped from 40.7 percent in 2003 to 58.2 percent this year.
"Low-income Baltimore families are facing a healthcare 'catch-22,'" said Thomas O'Toole, M.D., an OSI-Baltimore program officer and the study's author. "More people are becoming insured, yet at the same time access to basic care is harder than ever."
The overwhelming reason for lack of access was the unaffordable cost of care. Over half of all respondents reported having a medical debt with the overall reported average debt level approaching $5,000 per person. Yet respondents' yearly average salary was just $9,498. Moreover, billing delays and long waiting periods to enroll in insurance had a strongly negative impact on health-seeking behavior. Many people said that while they were uninsured or waiting for insurance they stopped taking necessary medications and visiting their physician or ended up in the city's emergency rooms for urgently needed care.
"The data verifies our anecdotal evidence that it is increasingly difficult for low-income people to survive in Baltimore without relying on already burdened social services, the health care safety net of low-cost clinics and charity programs," said Barbra Levin, executive director of Baltimore REACH. "Helping families access assistance is not enough. We need to ensure that all Baltimoreans have basic medical care, and in a timely manner. To date that is not happening."
Other key findings from the survey, conducted during June and July 2004, of 260 Baltimore residents attending eight community clinics and resource centers, include:
- More than three-quarters (77.8 percent) of respondents had at least one chronic medical problem like hypertension, asthma and other respiratory problems. Yet the cost of care kept approximately 4 out of 10 people from receiving primary or specialty care and 3 out of 10 from accessing mental health treatment.
- More than 7 out of 10 people interviewed were supposed to be taking prescribed medications. Yet almost 40 percent of people who had lost their insurance said they stopped taking needed medications or going to a doctor when they were uninsured.
- Fifty-five percent of the sample had been without insurance at some point during the past two years. On average, they were uninsured for 19.4 months during that time period.
The survey was officially released at a press conference today held at the Franciscan Center in Baltimore. At the press conference, State Delegate Dan Morhaim, M.D., who represents Baltimore County, joined medical students who conducted the survey and low-income Baltimore residents who discussed their experiences navigating the health system.