kate nordahl assistant commissioner division of health care finance and policy
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Health Insurance Coverage and Access to Care for Communities of Color Presentation for the Health Disparities Council. Kate Nordahl Assistant Commissioner Division of Health Care Finance and Policy. Presentation Overview. Who are the uninsured? Uninsurance rates by race/ethnicity and age - PowerPoint PPT PresentationTRANSCRIPT
Health Insurance Coverage and Access to Care for Communities of Color
Presentation for the Health Disparities Council
Kate NordahlAssistant Commissioner
Division of Health Care Finance and Policy
2
Presentation Overview
• Who are the uninsured?
• Uninsurance rates by race/ethnicity and age
• Type of insurance coverage by race/ethnicity and age
• Access to and use of care– Usual source of care– Doctors visit in past 12 months– ER visit in past 12 months
• Barriers to care due to cost
3
Source: Urban Institute tabulations on the 2008 Massachusetts HIS
Massachusetts Division of Health Care Finance and Policy
Uninsurance was low among Massachusetts residents, with less than 3% (167,300 people) uninsured at the time of the survey (summer 2008).
Uninsurance Ratefor All Massachusetts Residents
Uninsurance
4
Who are the Uninsured?
• More likely to be:– Male (57% of the uninsured are male vs. 48.2% in general population)– Young adult - 19 to 25 years of age (32.1% vs. 15.2%)– Hispanic (18.8% vs. 6.8%)– Non-citizen (14.5% vs. 4.6%)– Low-income
• <150% FPL (45.1% vs. 20.2%)• 151-299% FPL (33.9% vs. 18.7%)
– With less formal education• Less than high school (12.0% vs. 3.9%)• High school graduate or GED (55.6% vs. 40.0%)
– Non-working or working only part-time• If work, work for a small sized firm (<51 employees) and for a firm
that doesn’t offer employer-sponsored insurance (ESI)
5
Hispanic residents were most likely to go without coverage in Massachusetts, with an uninsurance rate more than twice as high as other non-Hispanic groups (7.2% versus less than 3%).
Massachusetts Division of Health Care Finance and Policy
Uninsurance Rates by Race/Ethnicity, All Ages
Uninsurance
Source: Urban Institute tabulations on the 2008 Massachusetts HIS
2.6 2.23.2
1.0
4.2
7.2
0%
2%
4%
6%
8%
10%
12%
14%
TotalPopulation
White,Non-
Hispanic
Black, non-Hispanic
Asian,non-
Hispanic
Other race,non-
Hispanic
Hispanic
6
Uninsurance was highest among non-elderly Hispanic adults in Massachusetts, with an uninsurance rate roughly three times that of other, non-Hispanic groups.
Massachusetts Division of Health Care Finance and Policy
Uninsurance Rates of Non-Elderly Adults (ages 19-64) by Race/Ethnicity
Uninsurance
Source: Urban Institute tabulations on the 2008 Massachusetts HIS
3.73.0
5.9
1.6
7.7
12.6
0%
2%
4%
6%
8%
10%
12%
14%
TotalPopulation
White,Non-
Hispanic
Black, non-Hispanic
Asian,non-
Hispanic
Other race,non-
Hispanic
Hispanic
7
Uninsurance was highest among Hispanic children in Massachusetts, with 2.6% uninsured.
Note: there was not large enough sample size to report Black, non-Hispanic and Asian, non-Hispanic separately
Massachusetts Division of Health Care Finance and Policy
Uninsurance Rates of Children (<18) by Race/Ethnicity
Uninsurance
Source: Urban Institute tabulations on the 2008 Massachusetts HIS
1.2 1.3
0.0
2.6
0%
2%
4%
6%
8%
10%
12%
14%
Total Population White, Non-Hispanic
Other Race, Non-Hispanic
Hispanic
8
Employer-sponsored insurance was more common among white, non-Hispanic residents of Massachusetts (71%) than among other race, non-Hispanic or Hispanic residents (63% and 45%, respectively).
Type of Health Insurance Coverage* by Race/Ethnicity, All Ages
Massachusetts Division of Health Care Finance and Policy
*Insurance coverage is based on the hierarchy: Medicare, employer-sponsored insurance, public or other coverage. Public and other coverage are combined because of the survey respondents’ difficulties in reporting type of coverage. For lower-income residents, public or other coverage is mostly MassHealth or Commonwealth Care, while for higher-income residents it is non-group coverage and, to a lesser extent, Commonwealth Choice.Source: Urban Institute tabulations on the 2008 Massachusetts HIS
Type of Coverage
15 16 12 11
68 71
63
45
17 1326
44
0%
20%
40%
60%
80%
100%
Total InsuredPopulation
White, Non-Hispanic
Other Race,Non-Hispanic
Hispanic
Medicare Employer-Sponsored Insurance Public or Other Coverage
9
Employer-sponsored coverage was most common among white, non-Hispanic adults (83%), compared to other race, non-Hispanic adults (73%) and Hispanic adults (54%).
Type of Health Insurance Coverage* of Non-Elderly Adults by Race/Ethnicity
Type of Coverage
Massachusetts Division of Health Care Finance and Policy
*Insurance coverage is based on the hierarchy: Medicare, employer-sponsored insurance, public or other coverage. Public and other coverage are combined because of the survey respondents’ difficulties in reporting type of coverage. For lower-income residents, public or other coverage is mostly MassHealth or Commonwealth Care, while for higher-income residents it is non-group coverage and, to a lesser extent, Commonwealth Choice.Source: Urban Institute tabulations on the 2008 Massachusetts HIS
5 4 8 11
81 83 7354
15 13 1935
0%
20%
40%
60%
80%
100%
Total InsuredPopulation
White, Non-Hispanic
Other Race,Non-Hispanic
Hispanic
Medicare Employer-Sponsored Insurance Public or Other Coverage
10
Type of Health Insurance Coverage* of Children by Race/Ethnicity
Massachusetts Division of Health Care Finance and Policy
Type of Coverage
*Insurance coverage is based on the hierarchy: Medicare, employer-sponsored insurance, public or other coverage. Public and other coverage are combined because of the survey respondents’ difficulties in reporting type of coverage. For lower-income residents, public or other coverage is mostly MassHealth or Commonwealth Care, while for higher-income residents it is non-group coverage and, to a lesser extent, Commonwealth Choice.Source: Urban Institute tabulations on the 2008 Massachusetts HIS
Employer-sponsored coverage was most common among non-Hispanic, white children (79%), compared to other race, non-Hispanic children (56%) and Hispanic children (42%).
2 1 3 4
7079
5642
2920
4155
0%
20%
40%
60%
80%
100%
Total InsuredPopulation
White, Non-Hispanic
Other Race,Non-Hispanic
Hispanic
Medicare Employer-Sponsored Insurance Public or Other Coverage
11Massachusetts Division of Health Care Finance and Policy
Non-Elderly Adults with a Usual Source of Care by Race/Ethnicity
Other, non-Hispanic adults were less likely to have a usual source of care than white adults and adults reporting other race/ethnicities.
Non-Elderly Adults
Source: 2008 Massachusetts Health Insurance Survey
89% 90% 93%85% 86%
0%
20%
40%
60%
80%
100%
TotalPopulation
White,non-
Hispanic
Black,non-
Hispanic
Other,non-
Hispanic
Hispanic
12Massachusetts Division of Health Care Finance and Policy
Non-Elderly Adults with a Usual Source of Care by Insurance Status
Compared with the insured, uninsured non-elderly adults were much less likely to have a usual source of care (42% versus 91%).
Non-Elderly Adults
Source: 2008 Massachusetts Health Insurance Survey
89% 91%
42%
0%
20%
40%
60%
80%
100%
Total Population Insured Uninsured
13Massachusetts Division of Health Care Finance and Policy
Children with a Usual Source of Care by Race/Ethnicity
Hispanic children were least likely to have a usual source of care, compared to other race/ethnicity groups.
Children
Source: 2008 Massachusetts Health Insurance Survey
97% 98% 98%93%
0%
20%
40%
60%
80%
100%
TotalPopulation
White, non-Hispanic
Other, non-Hispanic
Hispanic
14Massachusetts Division of Health Care Finance and Policy
Non-Elderly Adults with a Doctor Visit in Past 12 Months by Race/Ethnicity
Among non-elderly adults, those who reported other, non-Hispanic race/ethni-cities were less likely than white, non-Hispanic or Hispanic adults to have had any doctor visits or a preventive care visit.
Non-Elderly Adults
Source: 2008 Massachusetts Health Insurance Survey
85% 86% 84%76%
87%
72% 73% 73%68%
73%
0%
20%
40%
60%
80%
100%
TotalPopulation
White,non-
Hispanic
Black,non-
Hispanic
Other,non-
Hispanic
Hispanic
Any doctor visit Visit for preventive care
15Massachusetts Division of Health Care Finance and Policy
Children with a Doctor Visit in Past 12 Months by Race/Ethnicity
Hispanic and other, non-Hispanic children were less likely than white, non-Hispanic children to have had any doctor visit or a preventive care visit in the past 12 months.
Children
Source: 2008 Massachusetts Health Insurance Survey
94% 95%91% 92%89% 90%
86% 86%
0%
20%
40%
60%
80%
100%
TotalPopulation
White, non-Hispanic
Other, non-Hispanic
Hispanic
Any doctor visit Visit for preventive care
16Massachusetts Division of Health Care Finance and Policy
Non-Elderly Adults with an ER Visit in the Past 12 Months by Race/Ethnicity
Among non-elderly adults, Hispanics were much more likely to have had an ER visit overall and an ER visit for a non-emergency than other race/ethnicity groups.
Non-Elderly Adults
*A non-emergency ER visit is one that the respondent says could have been treated by a regular doctor if one had been available.Source: 2008 Massachusetts Health Insurance Survey
23% 22%25%
20%
45%
7% 7% 7% 8%
18%
0%
10%
20%
30%
40%
50%
TotalPopulation
White,non-
Hispanic
Black, non-Hispanic
Other, non-Hispanic
Hispanic
Any ER visit Most recent ER visit was a non-emergency ER visit*
17Massachusetts Division of Health Care Finance and Policy
Children with an ER Visit in the Past 12 Months by Race/Ethnicity
Hispanic children were much more likely than non-Hispanic children to have had an emergency or non-emergency ER visit.
Children
*A non-emergency ER visit is one that the respondent says could have been treated by a regular doctor if one had been available.Source: 2008 Massachusetts Health Insurance Survey
32% 31%28%
44%
13%11% 12%
24%
0%
10%
20%
30%
40%
50%
TotalPopulation
White, non-Hispanic
Other, non-Hispanic
Hispanic
Any ER visit Most recent ER visit was a non-emergency ER visit*
18Massachusetts Division of Health Care Finance and Policy
Non-Elderly Adults Not Getting Needed Care Due to Cost in Past 12 Months by Race/Ethnicity Among non-elderly
adults, one-quarter of white, non-Hispanic adults skipped needed health care due to cost, compared with 29% of other, non-Hispanic adults and 35% of Hispanic adults.
Non-Elderly Adults
Source: 2008 Massachusetts Health Insurance Survey
26% 25%
31%29%
35%
0%
10%
20%
30%
40%
50%
TotalPopulation
White,non-
Hispanic
Black, non-Hispanic
Other, non-Hispanic
Hispanic
19Massachusetts Division of Health Care Finance and Policy
Children Not Getting Needed Care Due to Cost in Past 12 Months by Race/Ethnicity Unmet need for health
care due to cost was highest for Hispanic children, at 22%.
Children
Source: 2008 Massachusetts Health Insurance Survey
12%10% 11%
22%
0%
10%
20%
30%
40%
TotalPopulation
White, non-Hispanic
Other, non-Hispanic
Hispanic
20Massachusetts Division of Health Care Finance and Policy
Non-Elderly Adults in Families with Problems Paying Medical Bills in Past 12 Months by Race/Ethnicity Among non-elderly
adults, black, non-Hispanics were more likely to report problems paying medical bills than were white, non-Hispanic adults.
Non-Elderly Adults
Source: 2008 Massachusetts Health Insurance Survey
17% 16%
25%
20% 20%
0%
10%
20%
30%
40%
TotalPopulation
White,non-
Hispanic
Black, non-Hispanic
Other, non-Hispanic
Hispanic
21Massachusetts Division of Health Care Finance and Policy
Children in Families with Problems Paying Medical Bills in Past 12 Months by Race/Ethnicity Other, non-Hispanic
and Hispanic children were most likely to live in families that had trouble paying medical bills (22%).
Children
Source: 2008 Massachusetts Health Insurance Survey
17%15%
22% 22%
0%
10%
20%
30%
40%
TotalPopulation
White, non-Hispanic
Other, non-Hispanic
Hispanic
22
Summary
• While Massachusetts has made great strides to reduce uninsurance and improve access to care the Hispanic population is more likely to:– be uninsured– use the emergency department in the past 12 months – have sought care in the ER for a non-emergency– have not sought needed care due to cost
• The Hispanic, non-elderly adult population is less likely to have a usual source of care
• In addition, Black, non-Hispanic non-elderly adults were more likely to:– have not sought needed care due to cost– have problems paying medical bills