POST-REFORM CHANGES IN HEALTH CARE ACCESS AND AFFORDABILITY IN MINNESOTA Giovann Alarcón MN Health Services Research Conference March 1st, 2016
POST-REFORM CHANGES IN HEALTH CARE ACCESS AND
AFFORDABILITY IN MINNESOTA
Giovann Alarcón MN Health Services Research Conference March 1st, 2016
Purpose and overview
Provide an up-to-date and State specific overview of two important outcomes to monitor: health care access and affordability • How accessible and affordable is care in MN? • Has the situation changed post-ACA? • Does this depend on insurance type or income?
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Analytic sample
• MNHA 2007, 2009, 2011, 2013, and 2015 • Sample size
• 2007: 9,728 • 2009: 12,031 • 2011: 11,355 • 2013: 11,778 • 2015: 11,178
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Indicators on Health Care Access Access indicators in the Minnesota Health Access Survey include: • reports of having a usual source of care (2007-2015), • the ability –and confidence– in getting care when
needed (2013-2015), and • provider supply issues where potential patients are
told by a doctor’s office or clinic that they do not accept their health care coverage or they are not accepting new patients (2013-2015).
Other indicators available are: visit to a doctor’s office (2011-2015) and use of the emergency department (2009-2015).
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Indicators on Health Care Affordability Affordability indicators in the Minnesota Health Access Survey include: • forgone care due to costs (2011-2015), • having problems paying medical bills (2013-2015), • needing to establish a payment plan with a hospital
or doctor’s office (2013-2015), • having trouble paying other basic bills (e.g. food,
heat, or rent) due to care costs (2013-2015), and • being satisfied with the protection against high
medical bills provided by their insurance coverage (2015).
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ACCESS
Highlights
• Most Minnesotans have a (private) usual source of care and are confident in getting care when needed, but only about half of the uninsured report the same characteristics.
• One in ten Minnesotans could not get a doctor’s appointment as soon as needed, increasing for people with private coverage.
• Minnesotans with public coverage were more likely to face problems with providers than people with other types of insurance.
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Usual Source of Care by Insurance Type, 2007 - 2015
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* Indicates statistically significant difference (p≤.05) from previous year shown
89.4% 88.3% 86.4% 85.5% 85.7%
40%
60%
80%
100%
2007 2009 2011 2013 2015
Total Public Group Non-group Uninsured
Confidence in Getting Care When Needed by Insurance Type, 2013 - 2015
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* Indicates statistically significant difference (p≤.05) from 2013 estimates
91.7% 92.8% 96.1% 90.0%
58.2%
93.2%* 91.7% 96.3% 89.8%
67.2%
0%
20%
40%
60%
80%
100%
Total Public Group Non-group Uninsured
2013 2015
Level of Confidence in Getting Care When Needed by Insurance Type, 2015
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^ Indicates statistically significant difference (p≤.05) from Total estimates
TotalVery confident 75.8% 82.0% ^ 64.6% ^ 70.6% ^ 48.3% ^Somewhat confident 17.4% 14.3% ^ 25.1% ^ 21.1% ^ 18.9%A little confident 3.9% 2.3% ^ 5.2% 5.7% ^ 10.9% ^Not confident at all 2.9% 1.5% ^ 5.0% 2.6% 21.9% ^
Group Non-group Public Uninsured
Could Not Get an Appointment When Needed by Insurance Type, 2013 - 2015
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* Indicates statistically significant difference (p≤.05) from 2013 estimates
9.7%
12.2%
8.9%
5.6%
7.9%
12.1%* 13.2%
11.5%* 12.3%*
11.5%
0%
2%
4%
6%
8%
10%
12%
14%
Total Public Group Non-group Uninsured
2013 2015
Doctor Did Not Accept Their Health Coverage by Insurance Type, 2013-2015
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* Indicates statistically significant difference (p≤.05) from 2013 estimates
2.7%
4.8%
1.3%
2.1%
5.4%
3.7%*
6.2%
2.1%*
3.7%
6.6%
0%
2%
4%
6%
8%
Total Public Group Non-group Uninsured
2013 2015
Doctor Was Not Accepting New Patients by Insurance Type, 2013 - 2015
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* Indicates statistically significant difference (p≤.05) from 2013 estimates
2.9%
4.1%
2.2% 2.0%
3.9% 3.7%*
5.4%
2.3%
6.6%*
5.6%
0%
2%
4%
6%
8%
10%
Total Public Group Non-group Uninsured
2013 2015
AFFORDABILITY
Highlights
• About one in five people were likely to forgo care due to costs, although this has decreased for patients seeking routine or mental care.
• One in five insured Minnesotans who used some form of care reported having financial burdens related to these services. This doubles for uninsured Minnesotans.
• Financial Burden affects 1 in 3 Minnesotans with income between 138-250% FPG.
• Four in five people reported being satisfied with the protection against high medical bills provided by their insurance.
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Forgone Care Due to Cost, 2013 - 2015
16
* Indicates statistically significant difference (p≤.05) from 2013 estimates
18.6%
7.0%
12.4%
6.3%
3.7% 4.4%
18.4%
6.2%
12.4%
4.6%*
2.7%*
4.4%
0%
4%
8%
12%
16%
20%
Any forgonecare
Prescriptiondrugs
Dental care Routine care Mental care Specialist care
2013 2015
Forgone Care Due to Cost by Income Group, 2015
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Any forgone care
Prescription drugs Dental care Routine
care Mental care Specialist care
Total 18.4% 6.2% 12.4% 4.6% 2.7% 4.4%0 to <138%/275 FPG 22.5% 7.9% 14.8% 5.6% 3.2% 4.6%138-250% FPG 29.8% 9.3% 24.2% 7.3% 3.5% 8.3%<250-400% FPG 19.0% 6.2% 14.1% 4.5% 2.2% 4.4%<400% FPG 11.9% 4.0% 6.9% 3.2% 2.3% 3.0%
Forgone Care Due to Cost by Insurance Type, 2015
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Any forgone care
Prescription drugs Dental care Routine
care Mental care Specialist care
Total 18.4% 6.2% 12.4% 4.6% 2.7% 4.4%Public 20.1% 6.3% 16.5% 4.1% 2.0% 4.0%Group 14.7% 5.1% 9.0% 3.7% 2.3% 3.5%Non-group 29.4% 8.7% 21.8% 7.6% 5.1% 8.9%Uninsured 40.0% 16.4% 24.4% 17.4% 9.9% 14.0%
Type of Medical Financial Burden, 2013 - 2015
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* Indicates statistically significant difference (p≤.05) from 2013 estimates
23.0%
14.8%
17.0%
8.7%
20.8%*
12.1%*
16.0%
6.5%*
0%
5%
10%
15%
20%
25%
Financial Burden Medical bills Payment Plan Basic Bills
2013 2015
Financial Burden by Income Group, 2013 - 2015
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* Indicates statistically significant difference (p≤.05) from 2013 estimates
23.0%
31.3% 32.1%
24.7%
14.0%
20.8%* 22.8%*
31.7%
24.3%
14.4%
0%
5%
10%
15%
20%
25%
30%
35%
Total 0 to <138%/275FPG
138-250% FPG <250-400% FPG <400% FPG
2013 2015
Financial Protection by Insurance Type, 2015
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82.3% 87.7%
80.9%
66.9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Total Public Coverage Group Coverage Individual Coverage
Financial Protection by Insurance Type, 2015
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0%
10%
20%
30%
40%
50%
60%
70%
Verysatisfied
Somewhatsatisfied
Neutral Somewhatdissatisfied
Verydissatisfied
Public Group Non-group
Financial Protection by Insurance Type, 2015
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^ Indicates statistically significant difference (p≤.05) from Total estimates
Total
Very satisfied 50.6% 62.0% ^ 46.1% ^ 31.7% ^Somewhat satisfied 31.7% 25.8% ^ 34.8% ^ 35.3%Neither satisfied or dissatisfied 8.0% 5.9% ^ 8.9% 11.1%Somewhat dissatisfied 6.0% 4.0% ^ 6.6% 10.4% ^Very dissatisfied 3.7% 2.4% ^ 3.6% 11.6% ^
Public Group Non-group
CLOSING REMARKS
• Some access indicators show a clear improvement, including gains in coverage.
• Some issues related to providers have worsened, including the rate of people who reported not getting an appointment when they needed it.
• Forgone routine and mental care are less frequent. • Fewer Minnesotans had problems paying medical
bills or other basic bills due to medical costs. • Only low-income Minnesotans have experienced a
reduction in the financial burden they experience due to their health care costs.
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Acknowledgements
• Stefan Gildemeister • Alisha Simon • Sarah Hagge • Kendal Orgera
• Kathleen Call • Karen Turner • Jessie Kemmick-Pintor • Giovann Alarcon
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THANK YOU Giovann Alarcón [email protected]