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Disparities in Access: a presentation to the Massachusetts Health Disparities Council

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... household incomes 300% MA poverty level used the ED compared to 12% of higher ... Critical Takeaways. Barriers to access are not new ... – PowerPoint PPT presentation

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Title: Disparities in Access: a presentation to the Massachusetts Health Disparities Council


1
Disparities in Accessa presentation to the
MassachusettsHealth Disparities Council
  • Jarrett T. Barrios
  • April 27, 2009

2
Overview
  • The Foundations approach
  • Overview of our research
  • The critical access issues
  • Where to from here?

3
The Foundations approach to disparities
  • Emphasis on access and equity
  • Broad definition of disparities

4
The Foundations disparities-related research
agenda
  • Monitoring impact of Chapter 58
  • Public polling on insurance and usage (Blendon,
    Globe)
  • Survey of consumers (Urban)
  • Research focused on access issues in immigrant
    communities
  • Care Beyond Coverage

5
Data Issues
  • Limited pre/post Chapter 58 data
  • Proxies for race and ethnicity
  • Oversamples to be able to comment on differences
    by R/E
  • Difficultly distinguishing legal immigrants and
    unauthorized

6
Research Findings
7
Mixed Evidence on Impact of Health Reform on
Disparities
  • Coverage
  • Access
  • Unmet Need
  • Affordability

8
Disparities in Uninsurance Rates by Income
  • Drop in uninsurance larger for low-income adults

Source Sharon Long, Massachusetts Health Reform
Survey, 2008
9
Health Reforms Impact on Access to Care for
Low-income Individuals
  • Low-income adults more likely to have a regular
    health care provider and to have had health care
    visits over the prior year

Source Sharon Long, Massachusetts Health Reform
Survey, 2008
10
Disparities in Unmet Need
  • Both low-income and higher-income adults less
    likely to have any unmet need for health care
    over the prior year

Source Sharon Long, Massachusetts Health Reform
Survey, 2008
11
Disparities in Unmet Need Because of
Difficulties Seeing a Provider
  • Low-income adults more likely have unmet need
    for health care over the prior year because of
    difficulties getting to see a provider

Source Sharon Long, Massachusetts Health Reform
Survey, 2008
12
Recent Evidence on Health Disparities
  • Personal Care Providers
  • Emergency Department Use
  • Health Status

13
Disparities in Having a Personal Care Provider
  • Racial/ethnic disparities
  • 79 of Hispanic respondents and 88 of
    non-Hispanic non-Whites report having a personal
    care provider, compared to 91 of non-Hispanic
    Whites.
  • Citizenship disparities
  • Non-US citizens are less likely to report having
    a personal care provider (85) than citizens
    (91).
  • Geographical disparities
  • The lowest rates of having a personal provider
    were found in Essex County (80) and Western MA
    (84). The highest rates were found in
    Suffolk/Norfolk Counties (95) and Southeastern
    Massachusetts/Cape Cod/Islands (94).

Source Massachusetts Health Care Access Survey,
Fall 2008
14
Disparities in Emergency Dept Use for
Non-emergency Conditions
  • Racial/ethnic disparities
  • Hispanics (26) and non-Hispanic non-Whites (24)
    are more likely to use the ED for conditions
    treatable by their PCP than non-Hispanic Whites
    (13).
  • Age disparities
  • 18-34 year olds are more likely to use the ED for
    non-emergency conditions (22) than older adults
    (35-49 yrs, 13 50-64 yrs, 15).
  • Education disparities
  • Individuals with a high school degree or less are
    more likely to use the ED (23) than individuals
    with college or postgraduate degrees (12).
  • Income disparities
  • 24 of residents with household incomes 300 MA
    poverty level used the ED compared to 12 of
    higher income individuals.

Source Massachusetts Health Care Access Survey,
2008
15
Disparities Access by Health Status
  • Individuals who self report being in poor/fair
    health are more likely than those with
    excellent/very good health to
  • Forego needed medical care (19 vs. 4)
  • Use the ED for non-emergency conditions (31 vs.
    10)
  • Have medical debt in the past year (26 vs. 9)
  • Avoid or postpone treatment because they owed
    money (18 vs. 7)
  • Avoid filling a prescription because of cost (29
    vs. 13)

Source Massachusetts Health Care Access Survey,
2008
16
Critical Takeaways
  • Barriers to access are not new
  • Disparities continue despite insurance coverage
  • Issues outside the medical arena cannot be
    ignored

17
Much is Known Whats the Action?
  • Opportunity for Disparities Council to serve as a
    catalyst
  • Foundation
  • Disseminate findings
  • SummitMay 28, 2009
  • Grantmakingfocus on community voice and broad
    understanding of disparities and SDOH
  • Selected areas for continued study
  • We can make a differencewe did with coverage
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