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
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
