NEW YORK – Universal coverage could swamp the healthcare system unless steps are taken to create innovative new care delivery models such as telehealth and online doctor appointments, according to a survey by PricewaterhouseCoopers.

PwC's survey of 1,000 American consumers showed that 55 percent of respondents are worried that universal health coverage will not ensure equal access to care because of capacity constraints, particularly in hospital emergency rooms.

Americans in general – not just the uninsured – are using costly hospital emergency rooms more often as the first point of entry into the health system, according to the PwC report.

PwC's analysis found an inverse relationship between insurance status and emergency department use. States with high uninsured populations generally have lower emergency room use than do states with lower uninsured populations. For example, Massachusetts, which has one of the lowest rates of uninsured residents (3 percent), has one of the highest per-capita use rates of hospital emergency rooms in the country. Massachusetts also has the highest number of physicians per capita but has been plagued by a severe physician shortage since introducing near-universal coverage in 2006.

"It's clear that access to insurance coverage does not translate into access to care," said David Chin, MD, a principal at PricewaterhouseCoopers and leader of the PricewaterhouseCoopers Health Research Institute. "The quick fix is to build bigger emergency rooms, but increasing supply will only drive up healthcare costs. We must find solutions that expand access without adding costs, and we believe the answer lies in new flexible models to care that use the right technologies and incentives and behavior changes to unclog jammed access points."

PwC's research shows that Americans are willing to participate in alternative ways to access healthcare including:

• Electronic interaction with providers and payers: 50 percent of consumers surveyed said they'd be willing to seek healthcare through the Internet or other computer technology as a substitute for a face-to-face, non-emergency visit. Of those, an e-mail consultation was the preferred method of interaction (76 percent), followed by telehealth, question/answer fee-based consults and an online forum/chat room monitored by a doctor.
• Retail and worksite clinics for patients: Of consumers surveyed, 37 percent said they'd be likely to use a worksite clinic, and 36 percent would use a retail health clinic. Ten percent of large employers surveyed in PricewaterhouseCoopers' 2009 Annual Employer Barometer Survey said they are now providing worksite clinics, up from 1 percent in 2008.
• Use of telehealth technologies: Telehealth, the use of medical information exchanged from one site to another via electronic communications, such as video conferencing or biometric remote monitoring, is expanding access, particularly to specialty physicians for patients in remote and underserved areas. Nearly three-quarters (73 percent) of consumers said they would use biometric electronic remote monitoring services to track their condition and vital signs.
• Shared medical appointments: 28 percent of consumers surveyed said they would be willing to participate in a shared medical appointment, typically a 60- to 90-minute session that includes a private or personal exam integrated with patient education and discussion with a group of 10 to 15 people. Providers currently offering shared medical appointments have found both patient and physician satisfaction has soared.    Instituting one shared medical appointment can increase patient access and a physician's productivity by an additional six patients during a four-hour clinic session.