National Healthcare Disparities Report - LDI Health Economist

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Access to Health Care Findings Health Insurance Health insurance facilitates entry into the health care system. Uninsured people are less likely to receive medical care and more likely to have poor health status. The cost of poor health among uninsured people was almost $125 billion in 2004 (Hadley & Holahan, 2004). Chapter 9 The financial burden of uninsurance is also high for uninsured individuals; almost 50% of personal bankruptcy filings are due to medical expenses (Jacoby, et al., 2000). Uninsured individuals report more problems getting care, are diagnosed at later disease stages, and get less therapeutic care. They are sicker when hospitalized and more likely to die during their stay (Hadley & Holahan, 2004). Figure 9.1. People under age 65 with health insurance, by race and income, 1999-2009 100 White Black Asian NHOPI AI/AN >1Race 100 Poor Low Income Middle Income High Income 90 90 Percent 80 Percent 80 70 70 60 60 50 Z 0 1999 2000 2001 2002 2003 20042005 2006 2007 2008 2009 50 Z 0 1999 2000 20012002 2003 2004 20052006 2007 2008 2009 Key: AI/AN = American Indian or Alaska Native; NHOPI = Native Hawaiian or Other Pacific Islander. Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey (NHIS), 1999-2009. Denominator: Civilian noninstitutionalized population under age 65. Note: NHIS respondents are asked about health insurance coverage at the time of interview. Respondents are considered insured if they have private health insurance, Medicare, Medicaid, State Children’s Health Insurance Program, a State-sponsored health plan, other government-sponsored health plan, or a military health plan. If their only coverage is through the Indian Health Service, they are not considered insured. Estimates are not adjusted. n Overall, there was no statistically significant change from 1999 to 2009 in the percentage of people with health insurance. In 2009, about 83% of people under age 65 had health insurance (data not shown). 220 National Healthcare Disparities Report, 2011
Access to Health Care n In 2009, Blacks under age 65 were less likely than Whites to have health insurance (81% compared with 83%), and American Indians and Alaska Natives (AI/ANs) under age 65 were less likely than Whites to have health insurance (68% compared with 83%). There were no statistically significant differences for other racial groups. n In 2009, Hispanics under age 65 were less likely than non-Hispanic Whites to have health insurance (data not shown; 67% compared with 87%). n From 1999 to 2009, while the percentage of people with health insurance increased for poor people (from 66% to 70%), the percentage decreased for middle-income people (from 86% to 82%). In 2009, the percentage of people with health insurance was significantly lower for poor, low-income, and middle-income people than for high-income people (70%, 70%, and 82%, respectively, compared with 94%). n In 2009, the percentage of people ages 25-64 with health insurance was about one-third lower for people with less than a high school education than for people with at least some college education in the same group (data not shown, 56% compared with 88%). Also, in the NHQR: Chapter 9 n From 1999 to 2009, the percentage of children ages 0-17 who had health insurance improved. However, for adults ages 18-44 and 45-64, the percentage decreased. n In 2009, adults ages 18-44 and 45-64 were less likely than children ages 0-17 to have health insurance. n Females were more likely to have health insurance than males throughout this period. Asian Subgroups To show differences within racial groups, this year’s NHDR includes information from the California Health Interview Survey (CHIS) on Asians in California. The geographic distribution of Asian subpopulations allows such comparisons in California using CHIS data. In 2010, an estimated 5.6 million Asian people, or about 32% of the Asian population in the United States, lived in California (U.S. Census Bureau, 2011). The proportion of many Asian subpopulations in California is also greater than the proportion in the overall U.S. population. For example, in 2010, the Vietnamese population was 1.6% of California’s population compared with only 0.4% of the U.S. population, and the Filipino population was 3.2% of California’s population compared with only 0.7% of the U.S. population (U.S. Census Bureau, 2010). This finding is especially important when examining data for these relatively smaller groups, as most national data sources do not have sufficient data to report estimates for these groups. Uninsurance Prolonged periods of uninsurance can have a particularly serious impact on a person’s health and stability. Uninsured people often postpone seeking care, have difficulty obtaining care when they ultimately seek it, and may have to bear the full brunt of health care costs. Over time, the cumulative consequences of being uninsured compound, resulting in a population at particular risk for suboptimal health care and health status. National Healthcare Disparities Report, 2011 221
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