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 ColorFamilies USA

Washington, DCJanuary 25, 2006

Why the Concern about Insurance Coverage

Potential Sources of Disparities in Care

• Patient-Level

• Provider-Level

• Healthcare Systems-Level

SOURCE: IOM, 2002. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.

Figure 1

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.

17.7%

9.3%11.4%

20.3%

34.3%

44.8%20.3%

5.5%30.1%

36.0%

21.2%

12.9%21.0%

11.8%

Uninsured Rates

Poor (<100% Poverty level)100-199% of Poverty

400%+ of Poverty

Children (<Age 19)Poor Children

Adults (Age 19-64)Poor Adults

WhiteBlack

Hispanic

National

FloridaTexas

CaliforniaNew Hampshire

Minnesota

Figure 2

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

National Average18%

Uninsured Rates

Figure 3

Distribution by Race/Ethnicity Risk of Being Uninsured

What is the link between insurance coverage and health care access?

The Consequences of Being Uninsured

Research demonstrates that the uninsured:

• use fewer preventive and screening services;

• are sicker when diagnosed;

• receive fewer therapeutic services;

• have poorer health outcomes (higher mortality and disability rates); and

• have lower annual earnings because of poorer health.

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

Disparities in Cardiac Care for Chronic Renal Disease Patients by Race and Gender:

Uninsured vs. Medicare Insured, 1986-1992

0.30*0.32*

0.750.66*

0.00

0.50

1.00

1.50

2.00

African American Men African American Women

Pre-Medicare Post-Medicare

Odds ratio < 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.

Equally likely as white men

Figure 5

• Review of four studies; 8 comparisons (4 of Hispanic-White disparities and 4 of African American-White disparities

• Seven of 8 comparisons show insurance coverage as the single largest factor explaining racial disparities in having a regular source of medical care

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.

42% 17% 39% 2%

Role of Health Coverage in Racial/Ethnic Disparities in Access to Medical Care

24% 12% 64%

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 & Taliaferro, 2003

EX: Percent of gap in having regular source of care

Health Insurance Income Unexplained

Health Insurance Income Other** Unexplained

Disparity

Promising Strategies for Reducing HealthCare Disparities

• Increasing awareness of the problem

• Assuring adequate and meaningful health insurance coverage

• Improving healthcare quality through government regulatory and purchasing mechanisms

Figure 8

What Can Be Done To Improve Insurance Coverage

• Create a more uniform system of coverage that guarantees a defined benefit

• Expand the reach of the current mix of private and public coverage, while maintaining the scope of benefits

Figure 9

What Can Be Done To Improve Coverage & Reduce Disparities

• Nearly three-quarters of the 23 million uninsured persons of color have family incomes below 200% of poverty

• Many, therefore, would qualify for Medicaid or S-CHIP

• Policy Options - expand outreach and enrollment efforts to ensure that all

eligible children are enrolled in Medicaid and S-CHIP

- expand coverage to parents of enrolled children

- expand coverage to low-income adults without dependent children

Figure 10

Challenges and Opportunities

• Perceptions on the scope and nature of the problem vary

• Health costs continuing to rise

• Public resources limited (federal deficits, state budget crises)

• Lack of political will to implement best evidence

Figure 11

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