Profile of the Health Care Consumer Steven P. Wallace, Ph.D. Professor of Community Health Sciences Assoc. Director Center for Health Policy Research UCLA School of Public Health
Jan 18, 2016
Profile of the Health Care Consumer
Steven P. Wallace, Ph.D.Professor of Community Health Sciences
Assoc. Director Center for Health Policy Research
UCLA School of Public Health
Key Points
• Most people visit a doctor during the year• Insurance status varies by race,income, and
region of Los AngelesMost uninsured persons are in employed families
• Most uninsured persons are in employed families
• Communty clinics are particularly important for those with low-incomes and no insurance
Elderly & Kids, Women & those with Health Insurance most likely to see a
doctor in past year
88%
78%
89%
79%
95%87%
64%
*All ages ** Ages 0-64
Source: 2003 California Health Interview Survey
Insurance by Race/Ethnic Group Los Angeles County
13.4%4.6%
10.9%5.8% 8.5%
12.6%
34.9%
19.6% 19.1% 20.5%6.7%
27.4%
13.2%25.7%
16.4%
67.3%
33.2%
56.3%
49.4%54.5%
White Latino Asian Americanand Pacific
Islander
African American OtherSingle/Multiple
Race
Uninsured All/Part Year Medi-Cal/Healthy Families All YearEmployer-Based Ins. All Year Other Insurance All Year
Source: 2003 California Health Interview Survey
Insurance by Household Income Los Angeles County
39.8%32.7%
24.3%
10.6%
45.2%
28.0%
10.0%
2.2%
9.3%
31.2%
57.3%
77.1%
5.8% 8.1% 8.4% 10.1%
0-99% of FPL 100-199% of FPL 200-299% of FPL 300% of FPL andAbove
Uninsured All or Part Year Medi-Cal or Healthy Families All Year
Employer-Based Insurance All Year Other Insurance All Year
Source: 2003 California Health Interview Survey
Insurance by SPALos Angeles County
Uninsured All or Part Year
Medi-Cal or Healthy
Families All Year
Employer-Based
Insurance All Year
Other Insurance All Year Total
Antelope Valley 18.5% 21.5% 55.5% 4.5% 100.0%
San Fernando Valley 20.7% 15.3% 55.6% 8.5% 100.0%
San Gabriel Valley 22.5% 17.9% 50.5% 9.1% 100.0%
Metro 33.8% 22.3% 36.0% 7.8% 100.0%
West 17.3% 8.9% 55.4% 18.3% 100.0%
South 31.8% 32.8% 30.5% 4.9% 100.0%
East 23.2% 16.4% 53.7% 6.7% 100.0%
South Bay 21.4% 17.4% 53.1% 8.1% 100.0%
Source: 2003 California Health Interview Survey
Uninsured Rates in Assembly Districts, Los Angeles County, 2002
Estimated based on CHIS 2001 data
Uninsured rates vary by legislative district
Uninsurance problem is worse in California and LA than nationally
• Over 6.5 million California children and adults uninsured all or part of year
– 1 in 5 of state’s nonelderly population
– Nearly 1 in 6 of nation’s uninsured lives in California
• LA is epicenter of national problem
– over 2 million uninsured
– 1 in 4 of county’s nonelderly residents
• Parts of LA have even more uninsured residents
– 33% in Metro and South areas (SPAs 4 and 6)
Source: 2003 California Health Interview Survey and 2004 Current Population Survey
Percent Uninsured All or Part of Year, Nonelderly Adults and Children
Uninsured are overwhelmingly in working families
At Least One Adult Works Part-time
101,0005%
At Least One Adult is Self-Employed
224,00011%
Non-working Family531,000
25%
At Least One Adult Works Full-time
1,235,00059%
Source: 2003 California Health Interview Survey
• Over 1.2 million uninsured children and adults live in a household headed by a full-time working employee.
• Only one-fourth of the uninsured are in non-working families.
– Many non-working families are headed by a single or disabled adult.
Low rate of employers offering coverage drives low job-based insurance rate
818,000 Los Angeles County workers are employed by firms that don’t offer coverage
Offer Eligibility Take-up
All employees (5,933,000) 80.5% 90.5% 86.7%
Race/Ethnicity
White 88.6% 92.0% 89.9%
Latino 68.6% 87.8% 81.8%
Asian American & Pacific Islander 82.8% 93.1% 87.9%
African American 88.8% 90.8% 88.1%
Other & Multiple Race 85.0% 86.5% 82.2%
Citizenship Status
U.S.-born Citizen 88.2% 90.3% 87.8%
Naturalized Citizen 82.6% 94.1% 89.1%
Noncitizen With Green Card 66.4% 90.5% 84.1%
Noncitizen Without Green Card 50.8% 81.8% 72.4%
Offer, Eligibility, and Take-up Rates for Own Job-based Health Insurance, Employees Ages 19-64, California, 2003
Source: 2003 California Health Interview Survey
Providing outpatient care can improve the health of the uninsured
• Asthma, hypertension, and poor self-assessed health are ambulatory sensitive conditions
6%
29%24%
0%5%
10%15%20%25%30%
25.3%
2.6%
28.5%
2.7%
15.4%
82.%
8.1% 8.7%
Safety-net providers are important to uninsured adults and those on Medi-Cal
• California safety-net providers are usual source of care for 1 in 4 uninsured adults and 1 in 4 adult Medi-Cal beneficiaries
Source: 2003 California Health Interview Survey
85.8%
58.6%
25.9%
7.1%
28.8%28.3%
6.8%11.6%
44.7%
Uninsured All or Part Year
Medi-Cal or Healthy Families All Year
Employer-Based Insurance All Year
Doctor's Office/HMO/KaiserCommunity or Government Clinic, Community Hospital
No Usual Source of Care
Adults, Ages 19-64
31.2%
40.3%
1.1%
37.9%
5.9%
85.3%
10.2%
0.5%3.6%
Safety-net providers are important to uninsured children and those on Medi-Cal and Healthy Families
• Safety-net clinics and hospitals are usual source of care for: 4 in 10 uninsured children and 4 in 10 children with Medi-Cal or Healthy Families coverage
• The longer people are uninsured, the more they rely on safety net clinics and hospitals
Source: 2003 California Health Interview Survey
74.2%
46.3%
37.5%
14.7%
41.5%
37.2%
10.1%11.5%
24.8%
Uninsured All or Part Year
Medi-Cal or Healthy Families All Year
Employer-Based Insurance All Year
Doctor's Office/HMO/Kaiser
Community or Government Clinic, Community Hospital
No Usual Source of Care
Children, Ages 0-18
Conclusions
• Access of medical care is essential for everyone
• The uninsured are less likely to see the doctor, but still need medical care
• Uninsured persons exist across all groups and regions, but not equally
• Safety net providers are key to the health of low income and uninsured persons