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  • Thank you for inviting me to talk about the role of health insurance coverage in inequalities in health. Standing before you in the aftermath of Hurricane Katrina isn’t easy. Katrina helped to cast a spotlight on a number of realities of life in America – including the consequences of being poor, a person of color, and in ill-health. From a survey of evacuees, we learned that half of the evacuees had no insurance coverage prior to Hurricane Katrina. After the hurricane, they were without insurance, homes, and many had lost some of their most precious possessions. In a nation as wealthy as the U.S., it is inexcusable to have such wide disparities in access to basic services
  • What role does health insurance coverage play in inequalities in health? Before answering that question, let’s make sure we all common understanding of the US system.
  • Figure 12 presents data from a study on cardiac care provided to patients with chronic renal disease The first set of bars are findings on men and the 2nd set of bars are on women AA men and women are compared to care provided to white men When uninsured, AA men and women were about 30 percent as likely as white men to obtain cardiac care After enrolling in Medicare, the disparity narrowed for both groups AND for women (BUT NOT MEN) there was no longer a statistically significant difference. These findings show that insurance matters in eliminating health care disparities, a question that was the focus of a recent review of the literature.
  • Given the substantial body of evidence that even with insurance individuals of color are at a disadvantage in the health system, the study described in Figure 13 presents findings from a review of studies that quantified the contribution of insurance to r/e disparities in care. The review identified four studies designed to answer that question; 8 comparison groups’ 4 H-W & 4 AA-W Seven of the 8 comparisons show HI is single largest factor explaining r/d in access to a regular source of medical care. The figure before you provides an example from one of the studies. for Hispanics, insurance explains about a quarter of the disparity For AA – insurance explains 42% of the disparity. Although HI is only one of several factors that affect disparities in care, but it is unquestionably a major factor that we can address.
  • Figure 1 sums up the several challenges and opportunities embedded in this dilemma See bullets Spending is higher… (reflecting the technological sophistication of health care resources in the U.S. COMBINED with consumer demand ) (We devote about 13% of national income on health, which is more than twice as much per person as [average for OECD countries) Outcomes are poorer… Performance is tarnished by glaring inequalities between those who are privileged and those who are less privileged.
  • Figure 1 sums up the several challenges and opportunities embedded in this dilemma See bullets Spending is higher… (reflecting the technological sophistication of health care resources in the U.S. COMBINED with consumer demand ) (We devote about 13% of national income on health, which is more than twice as much per person as [average for OECD countries) Outcomes are poorer… Performance is tarnished by glaring inequalities between those who are privileged and those who are less privileged.
  • Transcript

    • 1. Eliminating Healthcare Disparities: The Role of Insurance Coverage Marsha Lillie-Blanton, Dr.P.H. Vice President in Health Policy The Henry J. Kaiser Family Foundation Making Public Programs Work for Communities of Color Families USA Washington, DC January 25, 2006
    • 2. Why the Concern about Insurance Coverage
    • 3. Potential Sources of Disparities in Care <ul><li>Patient-Level </li></ul><ul><li>Provider-Level </li></ul><ul><li>Healthcare Systems-Level </li></ul>SOURCE: IOM, 2002. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care . Figure 1
    • 4. Uninsured Rates Among the Nonelderly Population: Poverty Status, Race, and Selected States, 2003 SOURCE: KCMU and Urban Institute estimates based on March 2004 Current Population Survey. Uninsured Rates Poor (&lt;100% Poverty level) 100-199% of Poverty 400%+ of Poverty Children (&lt;Age 19) Poor Children Adults (Age 19-64) Poor Adults White Black Hispanic National Florida Texas California New Hampshire Minnesota Figure 2
    • 5. Nonelderly Uninsured by Race/Ethnicity, 2003 SOURCE: KCMU and Urban Institute estimates based on March 2004 Current Population Survey. Total = 45 Million Uninsured American Indian/ Alaska Native 1% White (non-Latino) 48% 2 or More Races 1% Latinos 29% African American (non-Latino) 15% Asian/Pacific Islanders 5% White (non-Latino) African American (non-Latino) Latino Asian/Pacific Islander American Indian/ Alaska Native 13% 21% 34% 20% 28% 17% Two or More Races Uninsured Rates Figure 3 Distribution by Race/Ethnicity Risk of Being Uninsured National Average 18%
    • 6. What is the link between insurance coverage and health care access?
    • 7. The Consequences of Being Uninsured <ul><li>Research demonstrates that the uninsured: </li></ul><ul><ul><li>use fewer preventive and screening services; </li></ul></ul><ul><ul><li>are sicker when diagnosed; </li></ul></ul><ul><ul><li>receive fewer therapeutic services; </li></ul></ul><ul><ul><li>have poorer health outcomes (higher mortality and disability rates); and </li></ul></ul><ul><ul><li>have lower annual earnings because of poorer health. </li></ul></ul>SOURCE: Hadley, Jack. “Sicker and Poorer – The Consequences of Being Uninsured: A Review of the Research on the Relationship between Health Insurance, Medical Care Use, Health, Work, and Income,” Medical Care Research and Review (60:2), June 2003. Figure 4
    • 8. Disparities in Cardiac Care for Chronic Renal Disease Patients by Race and Gender: Uninsured vs. Medicare Insured, 1986-1992 Odds ratio &lt; 1.0 indicates group is less likely to undergo procedure compared to white men *Difference is statistically significant after adjustment. NOTE: Odds ratios are adjusted for age, sex, insurance, socioeconomic status, health status, and disease severity. SOURCE: Daumit and Powe, Seminars in Nephrology , Vol. 21, No. 4 (July), 2001. Figure 5 Equally likely as white men
    • 9. <ul><li>Review of four studies; 8 comparisons (4 of Hispanic-White disparities and 4 of African American-White disparities </li></ul><ul><li>Seven of 8 comparisons show insurance coverage as the single largest factor explaining racial disparities in having a regular source of medical care </li></ul>Role of Health Coverage in Racial/Ethnic Disparities in Access to Medical Care Figure 6 SOURCE: Lillie-Blanton and Hoffman. Health Affairs, March/April 2005.
    • 10. Role of Health Coverage in Racial/Ethnic Disparities in Access to Medical Care Figure 7 Hispanic-White* African American-White *Researchers did not separate income from other personal socio-economic factors. **Local area demographics and health care system. SOURCE: Zuvekas &amp; Taliaferro, 2003 EX: Percent of gap in having regular source of care Health Insurance Income Unexplained Health Insurance Income Other** Unexplained Disparity
    • 11. Promising Strategies for Reducing HealthCare Disparities <ul><li>Increasing awareness of the problem </li></ul><ul><li>Assuring adequate and meaningful health insurance coverage </li></ul><ul><li>Improving healthcare quality through government regulatory and purchasing mechanisms </li></ul>Figure 8
    • 12. What Can Be Done To Improve Insurance Coverage <ul><li>Create a more uniform system of coverage that guarantees a defined benefit </li></ul><ul><li>Expand the reach of the current mix of private and public coverage, while maintaining the scope of benefits </li></ul>Figure 9
    • 13. What Can Be Done To Improve Coverage &amp; Reduce Disparities <ul><li>Nearly three-quarters of the 23 million uninsured persons of color have family incomes below 200% of poverty </li></ul><ul><li>Many, therefore, would qualify for Medicaid or S-CHIP </li></ul><ul><li>Policy Options </li></ul><ul><ul><li>- expand outreach and enrollment efforts to ensure that all eligible children are enrolled in Medicaid and S-CHIP </li></ul></ul><ul><ul><li>- expand coverage to parents of enrolled children </li></ul></ul><ul><ul><li>- expand coverage to low-income adults without dependent children </li></ul></ul>Figure 10
    • 14. Challenges and Opportunities <ul><li>Perceptions on the scope and nature of the problem vary </li></ul><ul><li>Health costs continuing to rise </li></ul><ul><li>Public resources limited (federal deficits, state budget crises) </li></ul><ul><li>Lack of political will to implement best evidence </li></ul>Figure 11
    • 15. www.kff.org/whythedifference

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