Nurses, Physicians Say Health Insurer Policies Restrict Access to Care

 In Nurses Weekly

Nurses and physicians see health insurer policies as barriers to patient care, according to data from the American Hospital Association (AHA).

Morning Consult conducted three surveys on behalf of AHA between December 2022 and April 2023 that included responses from 1,500 patients, 500 nurses, and 500 physicians.

As health insurance plans increase their administrative requirements, other stakeholders are suffering the consequences. Almost 85 percent of surveyed nurses reported that insurance administrative policies delay patent care, while 74 percent said the policies reduce care quality. Nearly two-thirds of nurses (63 percent) said insurer requirements interfere with transferring patients to the right care setting.

Over 80 percent of nurses indicated that the amount of administrative paperwork required has increased in the past few years. As these requirements grow, nurses are becoming less happy in their positions, with 56 percent reporting decreased job satisfaction.

Insurance policies are also impacting physicians, with 80 percent reporting that the requirements affect their ability to practice medicine. Additionally, 94 percent of physicians think operating a solo practice has become more financially and administratively difficult. Similarly, 84 percent of physicians said the administrative burden from insurer policies impacts their ability to operate a solo practice.

“These surveys bear out what we’ve heard for years — certain insurance companies’ policies and practices are reducing health care access and making it more difficult for our already overwhelmed clinicians to provide care,” Rick Pollack, president and CEO of AHA, said in the press release.

“Health insurance should be a bridge to medical care, not a barrier to it for patients. If policymakers are serious about expanding access and addressing the health care workforce crisis, then we must hold insurance companies accountable for these harmful practices.”

The consumer-focused survey revealed that patients are also concerned about health insurance policies.

Around 60 percent of patients reported having medical care delayed because of their insurance provider in the last two years. Almost half of those patients (43 percent) noted their health has subsequently gotten worse.

More than half of patients (55 percent) believed health insurance companies were responsible for the care barriers they have faced. Roadblocks to care often revolve around costs. Nearly 70 percent of patients said higher insurance costs are driving excessive healthcare expenses, and 54 percent indicated their health insurance premiums were too expensive.

The majority of patients agreed that more transparency around insurer practices is needed, specifically on which services and medications require prior authorization and what policies are used to determine approvals. Most patients also concurred that policymakers should increase oversight of insurer practices that create barriers to care.

The burden of prior authorization has been escalating in the past few years. Data from the American Medical Association (AMA) found that 88 percent of physicians in 2023 described the burden as high or extremely high. Furthermore, 94 percent of physicians said the prior authorization process delays access to necessary care.

(This story originally appeared in Revcycle Intelligence.)

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