National Healthcare Disparities Report - LDI Health Economist

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Access to Health Care Financial Burden of Health Care Costs Health insurance is supposed to protect individuals from the burden of high health care costs. However, even with health insurance, the financial burden for health care can still be high and is increasing (Banthin & Bernard, 2006). High premiums and out-of-pocket payments can be a significant barrier to accessing needed medical treatment and preventive care (Alexander, et al., 2003). According to one study, uninsured families can afford to pay for only 12% of hospitalizations that they experience (HHS, 2011). One way to assess the extent of financial burden is to determine the percentage of family income spent on a family’s health insurance premium and out-of-pocket medical expenses. Chapter 9 Figure 9.6. People under age 65 whose family’s health insurance premium and out-of-pocket medical expenses were more than 10% of total family income, by race, ethnicity, and family income, 2008 35 30 Percent 25 20 15 10 5 0 Total White Black AI/AN Asian >1 Race Non-Hispanic White Hispanic Poor Low Income Middle Income High Income Key: AI/AN = American Indian or Alaska Native. Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2008. Denominator: Civilian noninstitutionalized population under 65. Note: Total financial burden includes premiums and out-of-pocket costs for health care services. Data do not meet the criteria for statistical reliability, data quality, or confidentiality for Native Hawaiians and Other Pacific Islanders. n Overall, in 2008, 17% of people under age 65 had health insurance premium and out-of-pocket medical expenses that were more than 10% of total family income (Figure 9.6). n In 2008, the percentage of people under age 65 whose family’s health insurance premium and out-ofpocket medical expenses were more than 10% of total family income was lower for Blacks than for Whites (15% compared with 18%). The percentage was also lower for Hispanics than for non- Hispanic Whites (14% compared with 19%). n The percentage of people under age 65 whose family’s health insurance premium and out-of-pocket medical expenses were more than 10% of total family income was more than four times as high for poor individuals (29%), more than three times as high for low-income individuals (25%), and more than twice as high for middle-income individuals (20%) compared with high-income individuals (7%). Also, in the NHQR: n The percentage of people under age 65 whose family’s health insurance premium and out-of-pocket medical expenses were more than 10% of total family income was nearly three times as high for 226 National Healthcare Disparities Report, 2011
Access to Health Care individuals with private nongroup insurance as for individuals with private employer-sponsored insurance. n Adults ages 45-64 were more likely to have family’s health insurance premium and out-of-pocket medical expenses that were more than 10% of total family income. Usual Source of Care People with a usual source of care (a provider or facility where one regularly receives care) experience improved health outcomes and reduced disparities (smaller differences between groups) (Starfield & Shi, 2004) and costs (De Maeseneer, et al., 2003). Evidence suggests that the effect on quality of the combination of health insurance and a usual source of care is additive (Phillips, et al., 2004). In addition, people with a usual source of care are more likely to receive preventive health services (Ettner, 1996). Specific Source of Ongoing Care The term “specific source of ongoing care” accounts for patients who may have more than one source of care, such as women of childbearing age and older people, who tend to have more than one doctor. A specific source of ongoing care can include an urgent care/walk-in clinic, doctor’s office, clinic, health center facility, hospital outpatient clinic, health maintenance organization/preferred provider organization, military or other Veterans Affairs health care facility, or some other similar source of care (however, hospital emergency rooms are excluded). Chapter 9 Figure 9.7. People with a specific source of ongoing care, by ethnicity and income, 1999-2009 100 Non-Hispanic White Hispanic 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 200420052006 2007 2008 2009 Key: AI/AN = American Indian or Alaska Native. Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 1999- 2009. Denominator: Civilian noninstitutionalized population of all ages. Note: Measure is age adjusted. A hospital emergency room is not included as a specific source of primary care. 50 Z 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 National Healthcare Disparities Report, 2011 227
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