1 consumer knowledge of health insurance plans and affordability of care: an emergency department...
TRANSCRIPT
1
Consumer Knowledge of Health Insurance Plans and Affordability of Care: An Emergency Department Survey in Three Diverse Communities
Massachusetts Center for Health Information Analysis
August 14, 2013
2
Research Team
Principal Investigator Danny McCormick, MD, MPH
Co-InvestigatorsRachel Nardin, MDAssaad Sayeh, MDLeah Zallman, MD, MPH
3
Background
Goals of Chapter 58 and 224: improve affordability, access and quality of care
Despite MA reform, rate of uninsurance remains high in some communities Everett: 16% Revere: 15%
Affordability continues to be a barrier for both uninsured and the insured
4
Background
Knowledge of insurance products may influence care seeking yet plan knowledge and informational needs are not well understood
Prior population-based surveys on affordability and plan knowledge: May have under-sampled populations at highest risk
—immigrants, non-English speakers and poor Have not analyzed according to insurance type
Understanding these has relevance for ACA
5
Research Objectives
In disadvantaged populations and across insurance types:
What is truly affordable for consumers? Do consumers understand their health plans and
the insurance options available to them? To what extent do consumers experience gaps in or
changes to their insurance coverage? What level of cost-sharing is associated with
avoidance of medical care?
6
Methods Overview
Phase I: Develop, pilot and administer a consumer survey to patients seen in three socioeconomically diverse communities. Examine by demographic and insurance
characteristics Phase II: Conduct semi-structured, qualitative
interviews (N=10-12) to explore key issues in depth.
7
Setting: 3 EDs of Cambridge Health Alliance
Whidden Hospital
Somerville Hospital
Cambridge Hospital
8
Study Population
> 230 MA communities travel to overcome access-to-care barriers.
Age <65: 57% state payment sources (36% Medicaid, 5% Comm
Care, 16% HSN), 3% uninsured and 40% privately insured.
Allows sample enriched with policy relevant groups.
9
Study Sample
1290 patients Equal numbers of Uninsured, CommCare,
MassHealth, HSN and private insurance Ages 18 to 64 English, Spanish, Portuguese and Haitian
Creole Not intoxicated, delirious, or severely ill
10
Survey
Face to face interview Four domains:
Knowledge/Access to information Insurance “churn” Affordability Tipping points
Demographic information Insurance verified, not self report
11
Generalizability
3 socioeconomically and racially/ethnically diverse communities
Individuals actually needing care
Trade-off between policy relevant populations and generalizability to the state as a whole
12
Progress
Study staff hired
Developed, piloted and started survey
Completed ~75 surveys
Qualitative interviews will begin late August
12
13
Policy Implications
As the Commonwealth of Massachusetts prepares for changes to insurance products under ACA, we hope to provide better information on affordability, knowledge needs, tipping points and churning for disadvantaged populations that are highly affected by these changes but may be underrepresented in state-wide population based surveys.
13
15
Sample questions: Knowledge
Knowledge: “Under your current insurance, do you Have a premium/deductible/copay for medication/copay to
see doctor/coninsurance?” Amount of that premium/deductible/…etc. Compared to g
Consequences: “Has uncertainty about what is covered and how much
you have to pay for services ever caused you to delay or to not get any medical care?”
16
Sample questions: Sources and Quality of Information
“At the time you applied for or were considering a health plan, did you try to get information . . . through the Health Connector or MassHealth helpline?” through the Health Connector or plan websites?” from a person at health center or other organization?” Helpfulness of these sources
“It was difficult to figure out how to apply for your current insurance.”
“It was difficult to complete the application process.”
17
Sample questions: Quality and Understanding of Information
When signing up for insurance. . . Had information needed to make a good decision Had information in primary language Were able to get questions answered Was hard to understand the information
“Have your out-of-pocket costs on your current plan ended up being as you expected?”
18
Sample questions: Affordability: General
“Your plan is affordable for you.” Concerned about paying premiums Among uninsured
Lost coverage due to cost Could not find affordable plan
19
Affordability: Delayed or Forgone Care
Any Specialist care Regular doctor Preventive care Tests Medications Mental or emotional care Dental Vision Home services such as visiting nurses,