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Invited Critique
February 21, 2011

Health Care Reform and Access: Will It Work?Comment on “Equal Access to Care Eliminates Racial and Socioeconomic Disparities in the Treatment of Appendicitis in Patients With Equal Health Care Access”

Author Affiliations

Author Affiliation: Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, and University of Washington School of Medicine, Seattle.

Arch Surg. 2011;146(2):161. doi:10.1001/archsurg.2010.312

The article by Lee and colleagues hypothesizes that universal health insurance coverage for their patient population eliminates racial and socioeconomic disparities in access to care. In the current debate on health care reform, this is an important topic since the findings in this article might be extrapolated to suggest that universal coverage of the US population may have significant, demonstrable health care and cost benefits. One must be careful, however, in taking the conclusions of this article too far; further research, which the authors are conducting, is needed. The annual median household incomes examined may not be separated enough to determine any real differences in the defined groups because people at the income levels chosen may face similar problems with loss of income from time off their jobs, as addressed in the article. In southern California where the cost of living is one of the highest in the United States, the income levels may not adequately reflect differences in a family's access to outside resources when coping with a sick family member. The study is limited in that it deals only with adults and it is not clear whether the same findings will be noted in children. In addition, it is not clear whether the Kaiser Permanente patient population base in southern California can be extrapolated to be used as a surrogate for the entire US population. Recognition of these limitations, however, does not minimize the potential importance of this article. If further study substantiates the findings, this will add evidence that universal coverage and health care reform are not only beneficial for society but may also be associated with health care cost savings by dealing with illness early in its course rather than later when it has become more difficult, complex, and costly to treat.

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