The New Crisis Affecting Primary Care: Patients Without Health Insurance

With many patients feeling more comfortable resuming in-office appointments, some are facing another issue: loss of health insurance.

From the beginning of the COVID-19 pandemic to now, the way Americans approach preventive healthcare has fluctuated. Many healthcare organizations had to make changes to the way their physicians and advanced practitioners interact with and treat patients. At the peak of the pandemic, elective procedures and visits were canceled, and primary care practices shuttered their doors to combat the spread of the virus, whether voluntarily or due to government mandates.

LocumTenens.com conducted a survey of the public and found that at what they considered to be the peak of the pandemic in their region, 44% of patients stopped going to preventive care visits in person. In order to accommodate patients and keep up with demand for services, many primary care practices and healthcare organizations chose to implement telemedicine programs so they could continue to see patients from the safety of their own homes. 

In fact, according to a separate LocumTenens.com survey of physicians and advanced practitioners, almost three-quarters (74%) of respondents say their organization has increased their use of telehealth services due to COVID-19, and almost half (44%) say they have invested in new technology solutions to be able to communicate with patients remotely. Thirty-one percent of patient respondents indicated they utilized telehealth services at some point during the pandemic, and 22% indicated they took advantage of telehealth services whenever possible.

However, now that the curve has started to flatten in many states, Americans’ approach to preventive healthcare is beginning to realign with what it was pre-pandemic. But for many, there are additional barriers to accessing that care. As of September 2020, 70% of patients reported they feel comfortable attending in-office preventive care visits. While patients’ current comfort level is encouraging, there is another concern looming, and its impact on the public and the healthcare industry as a whole shouldn’t be discounted: 12% of patient respondents reported losing health insurance due to the pandemic, and 73% of physicians and advanced practitioners are fearful the rise in newly uninsured patients will continue keeping people away from routine visits and elective procedures.

Other notable findings include:

• Men are more likely than women to say they lost health insurance due to the pandemic (15% vs 9%)
• Younger Americans are more likely than older Americans to say they lost health insurance due to the pandemic (16% aged 18-29, 18% aged 30-44, 9% aged 45-60, and 5% aged 60+)

What does this mean for the future of healthcare?

The cancelation of elective procedures and discontinuation of preventive care visits, along with the subsequent influx of emergency medicine visits to accommodate both those who need treatment for COVID-19 and those whose once non-urgent conditions turned emergent due to a delay in care, has shaken the healthcare industry. What once was a minor ailment can quickly turn into a dire situation when patients don’t receive timely care, whether it’s due to their PCP office being closed to combat the spread of the virus, choosing to delay care due to fear of contracting the virus or because it’s simply too difficult for them to afford an office visit or procedure.

As of early September, emergency departments all over the country reported their volumes are now at 80-90% of pre-COVID-19 levels, but the acuity of patients is much higher: very sick patients are presenting to the ED with complications related to postponed care for cardiac disease, chronic illness and neurological/stroke issues. This, combined with the loss of health insurance many Americans have experienced this year, can create a crisis for patients.

How primary care practices can help

Visiting a primary care clinician, whether in-person or virtually, should be a patient’s first choice when taking a proactive approach to their health, so it’s important to remain mindful there are many patients who feel as though they currently aren’t able to be proactive when it comes to their health due to losing their health insurance sometime this year. Primary care practices can help by continuing to provide both current and potential patients with the tools they need to be as proactive as possible, not only for their own health, but also for the health of the practice and to avoid overburdening EDs.

Take a proactive approach

Losing access to health insurance is overwhelming. It could be helpful to have staff members proactively reach out to patients who have missed or canceled appointments to see whether they have any questions or concerns with which they might be able to help. If your practice was one that adopted telehealth solutions at the beginning of the pandemic, you might find your patients have been hesitant to use them because they’re unfamiliar with the technology or unsure how to get started. In many cases, telemedicine solutions can be more affordable for patients than in-office appointments; they might just need some assistance trouble-shooting technology issues or getting started.

Make self-pay policy readily available to patients

For some patients, it is their first time navigating a practice’s self-pay policy and procedures. If it isn’t already, consider publishing your practice’s self-pay policy or procedures on your practice’s website. You might be hesitant to publicly publish specific self-pay pricing for services and different appointments; that’s understandable. Just make sure to publish a phone number where patients can easily reach a staff member who is able to discuss a range of self-pay pricing and give them an idea of what they should expect to pay for their appointment. Don’t forget to let patients know that should additional testing be required, it will affect the price they pay. Remind them that in most cases, your office is only able to provide a range or estimate, and the amount they are expected to pay may vary based on provider recommendations. Patients will find it helpful for you to preemptively specify when payment will be due, whether it’s at the time of the visit or they’ll be receiving a bill in the mail. Does your practice offer payment plans? This is all information your patients will appreciate knowing but might not even realize they should ask if they are used to relying on their health insurance coverage.

Every patient’s circumstances are unique; approach each one with patience and empathy

This year has been incredibly stressful for everyone. From fears of contracting COVID-19 or spreading it to older or immunocompromised family and friends, to balancing kids’ virtual learning while also working from home or trying to find new work, almost every person is experiencing an increased amount of stress. This is especially true for those who have recently lost health insurance.

Your practice’s staff members are already well trained in treating patients with compassion and respect. However, it’s never a bad idea to remind everyone to be especially patient during this unusual time and treat patients with increased empathy. Some patients might need more help than others while navigating their healthcare options now that they don’t have health insurance. Remind them your staff members aren’t just here to provide the high-quality care they’ve come to expect when they visit your office; you’re also here to help them overcome the obstacles they’re facing so they can best receive that care.