REPORT: Not What the Doctor Ordered: Barriers to Healthcare Access for Patients

Posted on

You can find the full report here: Not What the Doctor Ordered: Barriers to Healthcare Access for Patients.


More than 50 million Americans with health insurance may still lack access to essential treatments for chronic or persistent diseases because their insurance provider denied coverage. Of those denied, almost a third have seen their health deteriorate, according to a recent nationwide poll commissioned by DPRP.

“Our research reveals a hidden healthcare crisis,” said Stacey Worthy, Executive Director of Aimed Alliance and one of DPRP’s founding members. “The current debate about healthcare reform has focused on getting more Americans covered. Yet, the real crisis is among patients with chronic illnesses who tell us that insurance is worthless when their insurance providers withhold coverage of essential treatments prescribed by a doctor.”

DPRP’s survey also revealed:

  • Almost two out of every three patients denied coverage were denied multiple times and most had to wait more than a month before their insurance provider responded to their request for a prescribed treatment.
  • 70% of the denied treatments for chronic or persistent illnesses were for conditions described as “serious,” and 43% were for treatment of patients described as “in poor health.”
  • Nearly a third (29%) of patients initially denied coverage reported that their condition worsened, even if they eventually convinced their insurer to cover their treatments.
  • More than one out of every three patients (34%) denied coverage had to put off or forego treatment altogether.
  • The largest consensus of patients (91 percent) agreed that insurance providers should not have the final say in treatment decisions, and almost as many (87 percent) felt insurers should play either a secondary role or no role at all in deciding medical treatments.

“Insurers that deny patients coverage for a prescribed treatment are effectively overriding the judgment of the treating physician,” noted Dr. Theresa Rohr-Kirchgraber, President 2015-2016 of American Medical Women’s Association. “The widest margin of support we found was among the nine-in-ten patients who did not want their insurance company to have the final say in treatment decisions. Those patients felt that health insurance provides should facilitate healthcare, not impose decisions on doctors or patients,” she said.

According to Ms. Worthy, the decision by some health insurance companies to deny coverage for certain treatments is impacting Americans’ perception of all insurance providers.

“Interestingly, while most patients reported some level of satisfaction with their insurer, more than two-thirds indicated that their perception of their insurance company either had not changed or had worsened over the last five years,” Ms. Worthy noted. “A majority said that insurance providers deny coverage because they only care about profits, and felt that insurers are playing a less constructive role in healthcare now than they had previously. These negative perceptions impact all insurance companies, not just the insurers that actually denied the coverage.”

DPRP commissioned renowned pollster Douglas Schoen to survey insured Americans about their access to medications, screening and diagnostic tests, and medical procedures, as well as their perceptions about the role of doctors and insurance providers in making patient treatment decisions.