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Mass Health Insurance Survey

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  • 1. Deval L. Patrick, Governor Commonwealth of Massachusetts Timothy P. Murray Lieutenant Governor JudyAnn Bigby, Secretary Executive Office of Health and Human Services Sarah Iselin, Commissioner Division of Health Care Finance and Policy Sharon K. Long, Allison Cook, and Karen Stockley Urban Institute Access to Health Care in Massachusetts: Estimates from the 2008 Massachusetts Health Insurance Survey March 2009
  • 2. Executive Summary Massachusetts Division of Health Care Finance and Policy In 2008, Massachusetts residents reported relatively good access to health care across a number of key measures. However, access to affordable health care remains an issue for many residents, especially for the uninsured, lower-income, the disabled, and those in fair or poor health. Source of Care In 2008, the vast majority of Massachusetts residents (92%) had a usual place they went to seek health care. A smaller share of non-elderly adults (89%) had a usual source of care compared with children (97%) and elderly adults (95%). Doctor Visits In the 12 months prior to the survey, most residents (88%) had at least one doctor visit, and 78% had a preventive care visit. The uninsured were much less likely to have had any type of doctor visit or a visit for preventive care. Only 45% of uninsured non-elderly adults visited a doctor and only 31% had a visit for preventive care. Emergency Care Across all residents, 26% made at least one visit to the emergency room (ER) in the previous year. Some 9% of all residents reported that their most recent ER visit was for a non-emergency condition, suggesting that these residents may be seeking care in the ER that could be obtained in the community. Barriers to Care Despite relatively high use of health care services among residents, nearly one quarter (24%) reported having difficulty obtaining health care in 2008. The disabled and those in fair or poor health were most likely to report difficulties. Some 27% of children with an activity limitation or in fair or poor health reported difficulties obtaining care, compared with 16% of healthy, non-disabled children. Similarly, some 40% of non-elderly adults in fair or poor health reported difficulties, compared with 27% of other non-elderly adults. Unmet Need More than one-fifth (21%) of residents did not get the care they needed due to cost in the 12 months prior to the survey. Uninsured residents had an especially high degree of unmet need, with 64% of uninsured non-elderly adults forgoing needed care due to cost. Among children and non-elderly adults, those in families with incomes between 150-299% of the federal poverty level (FPL) were more likely than any other income groups to forgo necessary care due to cost (19% and 40% for children and adults, respectively). Among elderly adults, those in families with income less than 150% FPL reported more unmet need due to cost (22%) than did higher income adults. Access to Health Care in Massachusetts
  • 3. Executive Summary Massachusetts Division of Health Care Finance and Policy Medical Bills Some 16% of residents lived in families reporting difficulties paying medical bills. The uninsured, the disabled, and those in fair or poor health had the greatest difficulties paying for health care within all age groups. Again, among children and non-elderly adults, those with family incomes between 150-299% FPL were the income groups most likely to experience problems paying medical bills (25% and 32%, respectively). Among elderly adults, those in families with incomes below 150% FPL had the most difficulties (14%). Access for Different Population Groups Not surprisingly, lower-income residents had lower access to care across all measures compared with higher-income groups. Across age groups, non-elderly adults (19-64) consistently reported lower access compared with children and elderly adults. Among race/ethnicity groups, Hispanics were more likely to experience lower access to care compared with white, non-Hispanics and other, non-Hispanic residents. The largest users of health care services, the disabled and those in fair or poor health, also experienced greater barriers to care and had more unmet need due to cost compared with non-disabled residents and those in better health. Although a lower share of uninsured non-elderly adults reported difficulties obtaining care compared with insured residents, this most likely reflects the reluctance of uninsured residents to seek care they can not afford, as unmet need is much higher for this group. Access to Health Care in Massachusetts Table of Contents Methodology 3 All Residents 4 Usual Source of Care 5 Doctor Visits 6 Not Getting Needed Care 7 Difficulty Obtaining Care 8 Emergency Room Visits 9 Medical Bills 10 Non-Elderly Adults 11 Usual Source of Care 12 Doctor Visits 17 Not Getting Needed Care 22 Difficulty Obtaining Care 27 Emergency Room Visits 32 Medical Bills 37 Children 42 Usual Source of Care 43 Doctor Visits 46 Not Getting Needed Care 49 Difficulty Obtaining Care 52 Emergency Room Visits 55 Medical Bills 58 Elderly Adults 61 Usual Source of Care 62 Doctor Visits 66 Not Getting Needed Care 70 Difficulty Obtaining Care 74 Emergency Room Visits 78 Medical Bills 82
  • 4. Methodology Massachusetts Division of Health Care Finance and Policy The 2008 Massachusetts Health Insurance Survey (HIS) provides information on health insurance coverage and access to and use of health care for the non-institutionalized population in Massachusetts. In the survey, an adult member of the household responded to questions about health insurance coverage and demographic information for all members of the household. More detailed socioeconomic characteristics and health care information were collected for one randomly selected household member and other members of his or her family who were residing in the household. In order to ensure that the survey covered nearly all residents of Massachusetts, a dual sample frame was employed, combining a random-digit-dial (RDD) sample with an address-based sample. The survey was conducted between June and August 2008 via telephone, web, and mail by International Communications Research (ICR). It was available in English, Spanish, and Portuguese and took, on average, about 19 minutes to complete. Surveys were completed with 4,910 Massachusetts households. The margin of error was +/-1 percentage point for estimates based on the full sample. The response rate was 42% for the RDD-sample and 28% for the address-based sample, for a combined response rate of 32%. A lack of standardization in calculating response rates makes it difficult to compare response rates across surveys and likely explains much of the difference in the response rate for the RDD-sample in the 2008 HIS and those reported for prior years of the survey. (Prior years of the HIS relied on RDD-samples.) Further, unlike earlier years of the HIS, the 2008 HIS has very little missing data, with item nonresponse generally less than 2% for most key questions and only 6% for the primary income question. Additional information on the 2008 HIS is available at www.mass.gov/dhcfp. For these charts, we define children as age 0 to 18, non-elderly adults as age 19 to 64, and elderly adults as age 65 and older. Survey Methodology
  • 5. Massachusetts Division of Health Care Finance and Policy All Residents
  • 6.
    • The majority of children, non-elderly adults, and elderly adults in Massachu-setts have a usual source of care, with non-elderly adults least likely (89%) and children most likely (97%) to have a usual source of care.
    Massachusetts Division of Health Care Finance and Policy Residents with a Usual Source of Care by Age Group All Residents Source: 2008 Massachusetts Health Insurance Survey
  • 7.
    • High shares of both children and elderly adults had a doctor visit and a preventive care visit. Among non-elderly adults, 85% had a doctor visit and 72% had a preventive care visit.
    Massachusetts Division of Health Care Finance and Policy Residents with a Doctor Visit in Past 12 Months by Age Group All Residents Source: 2008 Massachusetts Health Insurance Survey
  • 8.
    • Non-elderly adults were most likely to have gone without needed health care because of cost. Some 26% skipped needed health care, compared with 12% of children and 13% of elderly adults.
    Massachusetts Division of Health Care Finance and Policy Residents Not Getting Needed Care Due to Cost in Past 12 Months by Age Group All Residents Source: 2008 Massachusetts Health Insurance Survey
  • 9.
    • Non-elderly adults were the most likely to report difficulty obtaining health care, at 28%.
    Massachusetts Division of Health Care Finance and Policy Residents with Difficulty Obtaining Care in Past 12 Months by Age Group All Residents Source: 2008 Massachusetts Health Insurance Survey
  • 10.
    • Children and elderly adults were more likely to have an ER visit than were non-elderly adults. Children were about twice as likely as adults to have had a non-emergency visit as their most recent ER visit.
    Massachusetts Division of Health Care Finance and Policy Residents with an ER Visit in the Past 12 Months by Age Group All Residents *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
  • 11.
    • Non-elderly adults and children were more than twice as likely to be in families with difficulties paying medical bills than were elderly residents (17% versus 8%).
    Massachusetts Division of Health Care Finance and Policy Residents in Families with Problems Paying Medical Bills in Past 12 Months by Age Group All Residents Source: 2008 Massachusetts Health Insurance Survey
  • 12. Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults (Ages 19 through 64)
  • 13.
    • Most non-elderly adults have a usual source of care.
    • Those with higher family incomes were more likely to have a usual source of care than those with lower incomes
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults with a Usual Source of Care by Income Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 14.
    • Other, non-Hispanic adults were less likely to have a usual source of care than white adults and adults reporting other race/ethnicities.
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults with a Usual Source of Care by Race/Ethnicity Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 15.
    • Most Massachusetts adults, regardless of health status, have a usual source of care.
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults with a Usual Source of Care by Health Status Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 16.
    • Disabled and non-disabled non-elderly adults are equally likely to have a usual source of care (89%).
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults with a Usual Source of Care by Disability Status Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 17.
    • Compared with the insured, uninsured non-elderly adults were much less likely to have a usual source of care (42% versus 91%).
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults with a Usual Source of Care by Insurance Status Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 18.
    • Non-elderly adults with family income between 150% and 299% of FPL were the least likely to have had any doctor visit or a visit for preventive care in the past 12 months.
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults with a Doctor Visit in Past 12 Months by Income Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 19.
    • 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.
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults with a Doctor Visit in Past 12 Months by Race/Ethnicity Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 20.
    • Non-elderly adults in fair or poor health were more likely than those in better health to have had any doctor visits (91% versus 84%) or a preventive care visit (77% versus 72%).
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults with a Doctor Visit in Past 12 Months by Health Status Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 21.
    • Non-elderly adults with a disability were more likely than those without a disability to have had any doctor visits (91% versus 83%) or a preventive care visit (78% versus 71%).
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults with a Doctor Visit in Past 12 Months by Disability Status Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 22.
    • Uninsured non-elderly adults were much less likely than those with insurance to have had any doctor visits (45% versus 86%) or a preventive care visit (31% versus 74%).
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults with a Doctor Visit in Past 12 Months by Insurance Status Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 23.
    • Unmet need for care because of cost was highest among non-elderly adults with family income between 150% and 299% FPL. Some 40% of residents in this income group skipped needed health care in the past 12 months, compared with 15% of those with family income at or above 500% FPL.
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults Not Getting Needed Care Due to Cost in Past 12 Months by Income Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 24.
    • 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.
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults Not Getting Needed Care Due to Cost in Past 12 Months by Race/Ethnicity Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 25.
    • Non-elderly adults in fair or poor health were more likely than those in better health to have gone without needed health care because of cost (43% versus 24%).
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults Not Getting Needed Care Due to Cost in Past 12 Months by Health Status Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 26.
    • Non-elderly adults with a disability were more likely than those without a disability to have gone without needed health care because of cost (38% versus 23%).
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults Not Getting Needed Care Due to Cost in Past 12 Months by Disability Status Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 27.
    • Non-elderly adults without insurance were much more likely than those with insurance to have gone without needed health care because of cost (64% versus 24%).
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults Not Getting Needed Care Due to Cost in Past 12 Months by Insurance Status Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 28.
    • More than a quarter of non-elderly adults at all income levels reported difficulty obtaining health care in the past 12 months, with close to a third of those with the lowest family incomes reporting problems.
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults With Difficulty Obtaining Care in Past 12 Months by Income Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 29.
    • Hispanic non-elderly adults were most likely to report problems obtaining care, compared to other race/ethnicity groups.
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults With Difficulty Obtaining Care in Past 12 Months by Race/Ethnicity Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 30.
    • Non-elderly adults in fair or poor health were more likely to report difficulty obtaining health care than those in better health (40% versus 27%).
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults with Difficulty Obtaining Care in Past 12 Months by Health Status Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 31.
    • Non-elderly adults with a disability were more likely to report difficulty obtaining health care than those without a disability (38% versus 26%).
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults With Difficulty Obtaining Care in Past 12 Months by Disability Status Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 32.
    • Non-elderly adults with insurance were more likely to report difficulties obtaining health care than those without insurance (28% versus 15%).
    • Note: Uninsured adults were less likely to use care and more likely to report skipping needed health care because of cost.
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults with Difficulty Obtaining Care in Past 12 Months by Insurance Status Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 33.
    • Low-income non-elderly adults were more likely to have had an ER visit than higher income adults. Some 36% of those with family income below 150% FPL had an ER visit, compared with 19%-24% of those at higher income levels.
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults with an ER Visit in the Past 12 Months by Income 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
  • 34.
    • 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.
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults with an ER Visit in the Past 12 Months by Race/Ethnicity 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
  • 35.
    • Among non-elderly adults, those in fair or poor health were much more likely to have had an ER visit and an ER visit for a non-emergency than those in better health.
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults with an ER Visit in the Past 12 Months by Health Status 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
  • 36.
    • Among non-elderly adults, those with a disability were much more likely to have had an ER visit and an ER visit for a non-emergency than those without a disability.
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults with an ER Visit in the Past 12 Months by Disability Status 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
  • 37.
    • Among non-elderly adults, those without insurance were more likely to have an ER visit and an ER visit for a non-emergency than those with insurance.
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults with an ER Visit in the Past 12 Months by Insurance Status 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
  • 38.
    • Non-elderly adults with family income between 150% and 299% FPL were most likely to have problems paying medical bills (32%), while adults with family incomes at or above 500% FPL were the least likely (9%).
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults in Families with Problems Paying Medical Bills in Past 12 Months by Income Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 39.
    • Among non-elderly adults, black, non-Hispanics were more likely to report problems paying medical bills than were white, non-Hispanic adults.
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults in Families with Problems Paying Medical Bills in Past 12 Months by Race/Ethnicity Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 40.
    • Non-elderly adults in fair or poor health were twice as likely to have had trouble paying medical bills than adults in better health (31% versus 15%).
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults in Families with Problems Paying Medical Bills in Past 12 Months by Health Status Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 41.
    • Non-elderly adults with a disability were more than twice as likely to have had trouble paying medical bills as adults without a disability (30% versus 14%).
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults in Families with Problems Paying Medical Bills in Past 12 Months by Disability Status Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 42.
    • Uninsured non-elderly adults were more than twice as likely to have had trouble paying medical bills as insured adults (34% versus 16%).
    Massachusetts Division of Health Care Finance and Policy Non-Elderly Adults in Families with Problems Paying Medical Bills in Past 12 Months by Insurance Status Non-Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 43. Massachusetts Division of Health Care Finance and Policy Children (Ages 0 through 18)
  • 44.
    • While nearly all children had a usual source of care, those with family income less than 150% FPL were least likely to have a usual source of care (93%).
    Massachusetts Division of Health Care Finance and Policy Children with a Usual Source of Care by Income Children Source: 2008 Massachusetts Health Insurance Survey
  • 45.
    • Hispanic children were least likely to have a usual source of care, compared to other race/ethnicity groups.
    Massachusetts Division of Health Care Finance and Policy Children with a Usual Source of Care by Race/Ethnicity Children Source: 2008 Massachusetts Health Insurance Survey
  • 46.
    • Children who are in fair or poor health or are disabled are less likely to have a usual source of care than children in better health and without a disability (94% versus 98%).
    Massachusetts Division of Health Care Finance and Policy Children with a Usual Source of Care by Health and Disability Status Children Source: 2008 Massachusetts Health Insurance Survey
  • 47.
    • Nearly all children with family income above 300% FPL had a doctor visit in the past 12 months, compared with 89 to 92% of poorer children. Poorer children were also less likely to have had a preventive care visit.
    Massachusetts Division of Health Care Finance and Policy Children with a Doctor Visit in Past 12 Months by Income Children Source: 2008 Massachusetts Health Insurance Survey
  • 48.
    • 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.
    Massachusetts Division of Health Care Finance and Policy Children with a Doctor Visit in Past 12 Months by Race/Ethnicity Children Source: 2008 Massachusetts Health Insurance Survey
  • 49.
    • Children in good health and with no activity limitations were more likely than those in fair or poor health or with an activity limitation to have had a doctor visit in the past 12 months.
    Massachusetts Division of Health Care Finance and Policy Children with a Doctor Visit in Past 12 Months by Health and Disability Status Children Source: 2008 Massachusetts Health Insurance Survey
  • 50.
    • Unmet need for health care because of cost was greater among lower-income children. Of children with family income less than 300% FPL, 17%-19% went without needed care, compared with 3% of children at the highest income level.
    Massachusetts Division of Health Care Finance and Policy Children Not Getting Needed Care Due to Cost in Past 12 Months by Income Children Source: 2008 Massachusetts Health Insurance Survey
  • 51.
    • Unmet need for health care due to cost was highest for Hispanic children, at 22%.
    Massachusetts Division of Health Care Finance and Policy Children Not Getting Needed Care Due to Cost in Past 12 Months by Race/Ethnicity Children Source: 2008 Massachusetts Health Insurance Survey
  • 52.
    • Children in fair or poor health or with a disability were more than twice as likely to have unmet need for health care as children in better health and without a disability (22% versus 10%).
    Massachusetts Division of Health Care Finance and Policy Children Not Getting Needed Care Due to Cost in Past 12 Months by Health and Disability Status Children Source: 2008 Massachusetts Health Insurance Survey
  • 53.
    • Children with family income less than 150% FPL were most likely to face difficulties getting health care, at 24%.
    Massachusetts Division of Health Care Finance and Policy Children with Difficulty Obtaining Care in Past 12 Months by Income Children Source: 2008 Massachusetts Health Insurance Survey
  • 54.
    • While Hispanic children were most likely to face difficulties obtaining health care, 17% of all children faced barriers to getting care.
    Massachusetts Division of Health Care Finance and Policy Children with Difficulty Obtaining Care in Past 12 Months by Race/Ethnicity Children Source: 2008 Massachusetts Health Insurance Survey
  • 55.
    • Children in fair or poor health or with a disability were more likely to face difficulties obtaining care than children in better health and without a disability (27% versus 16%).
    Massachusetts Division of Health Care Finance and Policy Children With Difficulty Obtaining Care in Past 12 Months by Health and Disability Status Children Source: 2008 Massachusetts Health Insurance Survey
  • 56.
    • Lower-income children were more likely to have had an ER visit, with 41% of those with family income less than 150% FPL visiting the ER.
    Massachusetts Division of Health Care Finance and Policy Children with an ER Visit in the Past 12 Months by Income 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
  • 57.
    • Hispanic children were much more likely than non-Hispanic children to have had an emergency or non-emergency ER visit.
    Massachusetts Division of Health Care Finance and Policy Children with an ER Visit in the Past 12 Months by Race/Ethnicity 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
  • 58.
    • Over half of children in fair or poor health or with a disability had an ER visit (55%), compared with nearly three out of ten children in better health and without a disability (29%). Rates of non-emergency ER visits were also higher among children in poorer health or with a disability (20% versus 12%).
    Massachusetts Division of Health Care Finance and Policy Children with an ER Visit in the Past 12 Months by Health and Disability Status 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
  • 59.
    • Problems paying medical bills were most common in the families of lower-income children, particularly those with family income between 150 and 299% FPL.
    Massachusetts Division of Health Care Finance and Policy Children in Families with Problems Paying Medical Bills in Past 12 Months by Income Children Source: 2008 Massachusetts Health Insurance Survey
  • 60.
    • Other, non-Hispanic and Hispanic children were most likely to live in families that had trouble paying medical bills (22%).
    Massachusetts Division of Health Care Finance and Policy Children in Families with Problems Paying Medical Bills in Past 12 Months by Race/Ethnicity Children Source: 2008 Massachusetts Health Insurance Survey
  • 61.
    • Children in fair or poor health or with a disability were twice as likely to live in families with difficulty paying medical bills than were other children (31% versus 15%).
    Massachusetts Division of Health Care Finance and Policy Children in Families with Problems Paying Medical Bills in Past 12 Months by Health and Disability Status Children Source: 2008 Massachusetts Health Insurance Survey
  • 62. Massachusetts Division of Health Care Finance and Policy Elderly Adults (Ages 65 and Older)
  • 63.
    • Nearly all elderly adults had a usual source of care, although those with lower family incomes were less likely to have a usual source of care.
    Massachusetts Division of Health Care Finance and Policy Elderly Adults with a Usual Source of Care by Income Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 64.
    • Among elderly adults, white, non-Hispanic adults were more likely to have a usual source of care than other adults (96% versus 88%).
    Massachusetts Division of Health Care Finance and Policy Elderly Adults with a Usual Source of Care by Race/Ethnicity Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 65.
    • Elderly adults in fair or poor health were less likely than those in better health to have a usual source of care (92% versus 96%).
    Massachusetts Division of Health Care Finance and Policy Elderly Adults with a Usual Source of Care by Health Status Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 66.
    • Nearly all elderly adults had a usual source of care, regardless of disability status.
    Massachusetts Division of Health Care Finance and Policy Elderly Adults with a Usual Source of Care by Disability Status Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 67.
    • Nearly all elderly adults had a doctor visit over the prior year and most had a preventive care visit. However, elderly adults with family income less than 150% FPL were less likely than higher-income elderly adults to have had a doctor visit or a preventive care visit.
    Massachusetts Division of Health Care Finance and Policy Elderly Adults with a Doctor Visit in Past 12 Months by Income Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 68.
    • Among elderly adults, white, non-Hispanic adults were more likely to have a doctor visit and a preventive care visit than adults of other races/ethnicities.
    Massachusetts Division of Health Care Finance and Policy Elderly Adults with a Doctor Visit in Past 12 Months by Race/Ethnicity Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 69.
    • Nearly all elderly adults, regardless of health status, had a doctor visit. Those in fair or poor health were less likely than other elderly adults to have had a preventive care visit.
    Massachusetts Division of Health Care Finance and Policy Elderly Adults with a Doctor Visit in Past 12 Months by Health Status Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 70.
    • Nearly all elderly adults, regardless of disability status, had a doctor visit and most had a preventive care visit.
    Massachusetts Division of Health Care Finance and Policy Elderly Adults with a Doctor Visit in Past 12 Months by Disability Status Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 71.
    • Unmet need for care because of cost was highest among elderly adults with family income below 150% FPL. Some 22% of those adults skipped needed health care compared with 8% of those with family income at 500% FPL or higher.
    Massachusetts Division of Health Care Finance and Policy Elderly Adults Not Getting Needed Care Due to Cost in Past 12 Months by Income Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 72.
    • White, non-Hispanic elderly adults were much less likely to have unmet need for care because of cost than were other elderly adults (11% versus 31%).
    Massachusetts Division of Health Care Finance and Policy Elderly Adults Not Getting Needed Care Due to Cost in Past 12 Months by Race/Ethnicity Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 73.
    • Among elderly adults, those in fair or poor health were more likely to have unmet need for care because of cost than were those in better health (20% versus 11%).
    Massachusetts Division of Health Care Finance and Policy Elderly Adults Not Getting Needed Care Due to Cost in Past 12 Months by Health Status Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 74.
    • Among elderly adults, those who were disabled were more likely to have unmet need for care because of cost than were those without a disability (20% versus 10%).
    Massachusetts Division of Health Care Finance and Policy Elderly Adults Not Getting Needed Care Due to Cost in Past 12 Months by Disability Status Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 75.
    • About 1 in 7 elderly adults at all family income levels reported difficulty obtaining care in the past 12 months.
    Massachusetts Division of Health Care Finance and Policy Elderly Adults With Difficulty Obtaining Care in Past 12 Months by Income Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 76.
    • White, non-Hispanic elderly adults were less likely to have had difficulty obtaining care than were other elderly adults (14% versus 18%).
    Massachusetts Division of Health Care Finance and Policy Elderly Adults With Difficulty Obtaining Care in Past 12 Months by Race/Ethnicity Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 77.
    • About 1 in 7 elderly adults, regardless of health status, reported difficulty obtaining health care.
    Massachusetts Division of Health Care Finance and Policy Elderly Adults With Difficulty Obtaining Care in Past 12 Months by Health Status Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 78.
    • Elderly adults with a disability were more likely to have had difficulty obtaining health care than those without a disability (17% versus 13%).
    Massachusetts Division of Health Care Finance and Policy Elderly Adults With Difficulty Obtaining Care in Past 12 Months by Disability Status Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 79.
    • Elderly adults with family incomes below 300% FPL were more likely to have had an ER visit in the past 12 months than higher-income adults.
    Massachusetts Division of Health Care Finance and Policy Elderly Adults with an ER Visit in the Past 12 Months by Income 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
  • 80.
    • About 3 in 10 elderly adults, regardless of race or ethnicity, had an ER visit in the past 12 months. White, non-Hispanic elderly adults were half as likely to visit the ER for a non-emergency as elderly adults in other race/ethnicity groups.
    Massachusetts Division of Health Care Finance and Policy Elderly Adults with an ER Visit in the Past 12 Months by Race/Ethnicity 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
  • 81.
    • Elderly adults in fair or poor health were much more likely than those in better health to have had an ER visit (46% versus 26%).
    Massachusetts Division of Health Care Finance and Policy Elderly Adults with an ER Visit in the Past 12 Months by Health Status 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
  • 82.
    • Nearly 4 in 10 (38%) elderly adults with an activity limitation had an ER visit in the past 12 months, compared with close to 3 in 10 (27%) non-disabled residents.
    Massachusetts Division of Health Care Finance and Policy Elderly Adults with an ER Visit in the Past 12 Months by Disability Status 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
  • 83.
    • Elderly adults with family incomes below 300% FPL were most likely to live in families that had had problems paying medical bills in the past 12 months.
    Massachusetts Division of Health Care Finance and Policy Elderly Adults in Families with Problems Paying Medical Bills in Past 12 Months by Income Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 84.
    • Compared with white, non-Hispanic elderly adults, other elderly adults were three times as likely to live in families that had problems paying medical bills (6% versus 18%).
    Massachusetts Division of Health Care Finance and Policy Elderly Adults in Families with Problems Paying Medical Bills in Past 12 Months by Race/Ethnicity Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 85.
    • Elderly adults in fair or poor health were more than 4 times as likely than those in better health to live in families that had problems paying medical bills (17% versus 4%).
    Massachusetts Division of Health Care Finance and Policy Elderly Adults in Families with Problems Paying Medical Bills in Past 12 Months by Health Status Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 86.
    • Elderly adults with a disability were much more likely than those without a disability to live in families that had problems paying medical bills (14% versus 4%).
    Massachusetts Division of Health Care Finance and Policy Elderly Adults in Families with Problems Paying Medical Bills in Past 12 Months by Disability Status Elderly Adults Source: 2008 Massachusetts Health Insurance Survey
  • 87. Division of Health Care Finance and Policy Two Boylston Street Boston, MA 02116 Phone: (627) 988-3100 Fax: (617) 727-7662 Website: www.mass.gov/dhcfp Publication Number: 12-345-02 HCF

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