mass health insurance survey

Deval L. Patrick, GovernorCommonwealth of Massachusetts

Timothy P. MurrayLieutenant Governor

JudyAnn Bigby, SecretaryExecutive Office of Health and Human Services

Sarah Iselin, CommissionerDivision of Health Care Finance and Policy

Sharon K. Long, Allison Cook, and Karen StockleyUrban Institute

Access to Health Care in Massachusetts:Estimates from the

2008 Massachusetts Health Insurance Survey

March 2009

2

Executive Summary

Massachusetts Division of Health Care Finance and Policy

In 2008, Massachusetts residents reported relatively good access to health care across a number of key measures. However, access to affordable health care remains an issue for many residents, especially for the uninsured, lower-income, the disabled, and those in fair or poor health.

Source of CareIn 2008, the vast majority of Massachusetts residents (92%) had a usual place they went to seek health care. A smaller share of non-elderly adults (89%) had a usual source of care compared with children (97%) and elderly adults (95%).

Doctor VisitsIn the 12 months prior to the survey, most residents (88%) had at least one doctor visit, and 78% had a preventive care visit. The uninsured were much less likely to have had any type of doctor visit or a visit for preventive care. Only 45% of uninsured non-elderly adults visited a doctor and only 31% had a visit for preventive care.

Emergency CareAcross all residents, 26% made at least one visit to the emergency room (ER) in the previous year. Some 9% of all residents reported that their most recent ER visit was for a non-emergency condition, suggesting that these residents may be seeking care in the ER that could be obtained in the community.

Barriers to CareDespite relatively high use of health care services among residents, nearly one quarter (24%) reported having difficulty obtaining health care in 2008. The disabled and those in fair or poor health were most likely to report difficulties. Some 27% of children with an activity limitation or in fair or poor health reported difficulties obtaining care, compared with 16% of healthy, non-disabled children. Similarly, some 40% of non-elderly adults in fair or poor health reported difficulties, compared with 27% of other non-elderly adults.

Unmet NeedMore than one-fifth (21%) of residents did not get the care they needed due to cost in the 12 months prior to the survey. Uninsured residents had an especially high degree of unmet need, with 64% of uninsured non-elderly adults forgoing needed care due to cost. Among children and non-elderly adults, those in families with incomes between 150-299% of the federal poverty level (FPL) were more likely than any other income groups to forgo necessary care due to cost (19% and 40% for children and adults, respectively). Among elderly adults, those in families with income less than 150% FPL reported more unmet need due to cost (22%) than did higher income adults.

Access to Health Care in Massachusetts

3

Executive Summary


Medical BillsSome 16% of residents lived in families reporting difficulties paying medical bills. The uninsured, the disabled, and those in fair or poor health had the greatest difficulties paying for health care within all age groups. Again, among children and non-elderly adults, those with family incomes between 150-299% FPL were the income groups most likely to experience problems paying medical bills (25% and 32%, respectively). Among elderly adults, those in families with incomes below 150% FPL had the most difficulties (14%).

Access for Different Population GroupsNot surprisingly, lower-income residents had lower access to care across all measures compared with higher-income groups. Across age groups, non-elderly adults (19-64) consistently reported lower access compared with children and elderly adults. Among race/ethnicity groups, Hispanics were more likely to experience lower access to care compared with white, non-Hispanics and other, non-Hispanic residents. The largest users of health care services, the disabled and those in fair or poor health, also experienced greater barriers to care and had more unmet need due to cost compared with non-disabled residents and those in better health. Although a lower share of uninsured non-elderly adults reported difficulties obtaining care compared with insured residents, this most likely reflects the reluctance of uninsured residents to seek care they can not afford, as unmet need is much higher for this group.

Access to Health Care in Massachusetts

Table of Contents

Methodology3

All Residents4

Usual Source of Care5

Doctor Visits6

Not Getting Needed Care7

Difficulty Obtaining Care8

Emergency Room Visits9

Medical Bills10

Non-Elderly Adults11


Doctor Visits17

Not Getting Needed Care22

Difficulty Obtaining Care 27

Emergency Room Visits 32

Medical Bills37

Children42


Doctor Visits46

Not Getting Needed Care 49



Medical Bills58

Elderly Adults61


Doctor Visits66

Not Getting Needed Care 70



Medical Bills82

4

Methodology


The 2008 Massachusetts Health Insurance Survey (HIS) provides information on health insurance coverage and access to and use of health care for the non-institutionalized population in Massachusetts. In the survey, an adult member of the household responded to questions about health insurance coverage and demographic information for all members of the household. More detailed socioeconomic characteristics and health care information were collected for one randomly selected household member and other members of his or her family who were residing in the household.

In order to ensure that the survey covered nearly all residents of Massachusetts, a dual sample frame was employed, combining a random-digit-dial (RDD) sample with an address-based sample. The survey was conducted between June and August 2008 via telephone, web, and mail by International Communications Research (ICR). It was available in English, Spanish, and Portuguese and took, on average, about 19 minutes to complete.

Surveys were completed with 4,910 Massachusetts households. The margin of error was +/-1 percentage point for estimates based on the full sample. The response rate was 42% for the RDD-sample and 28% for the address-based sample, for a combined response rate of 32%. A lack of standardization in calculating response rates makes it difficult to compare response rates across surveys and likely explains much of the difference in the response rate for the RDD-sample in the 2008 HIS and those reported for prior years of the survey. (Prior years of the HIS relied on RDD-samples.) Further, unlike earlier years of the HIS, the 2008 HIS has very little missing data, with item nonresponse generally less than 2% for most key questions and only 6% for the primary income question. Additional information on the 2008 HIS is available at www.mass.gov/dhcfp.

For these charts, we define children as age 0 to 18, non-elderly adults as age 19 to 64, and elderly adults as age 65 and older.

Survey Methodology

5Massachusetts Division of Health Care Finance and Policy

All Residents


Residents with a Usual Source of Care by Age Group

The majority of children, non-elderly adults, and elderly adults in Massachu-setts have a usual source of care, with non-elderly adults least likely (89%) and children most likely (97%) to have a usual source of care.

All Residents

Source: 2008 Massachusetts Health Insurance Survey

92%97%

89%95%

0%

20%

40%

60%

80%

100%

TotalPopulation

Children Non-ElderlyAdults

Elderly Adults


Residents with a Doctor Visit in Past 12 Months by Age Group

High shares of both children and elderly adults had a doctor visit and a preventive care visit. Among non-elderly adults, 85% had a doctor visit and 72% had a preventive care visit.

All Residents


88%94%

85%

95%

78%

89%

72%

87%

0%

20%

40%

60%

80%

100%

TotalPopulation


Elderly Adults

Any doctor visit Visit for preventive care


Residents Not Getting Needed Care Due to Cost in Past 12 Months by Age Group

Non-elderly adults were most likely to have gone without needed health care because of cost. Some 26% skipped needed health care, compared with 12% of children and 13% of elderly adults.

All Residents


21%

12%

26%

13%

0%

10%

20%

30%

40%

TotalPopulation


Elderly Adults


Residents with Difficulty Obtaining Care in Past 12 Months by Age Group

Non-elderly adults were the most likely to report difficulty obtaining health care, at 28%.

All Residents


24%

17%

28%

15%

0%

10%

20%

30%

40%

TotalPopulation


Elderly Adults


Residents with an ER Visit in the Past 12 Months by Age Group

Children and elderly adults were more likely to have an ER visit than were non-elderly adults. Children were about twice as likely as adults to have had a non-emergency visit as their most recent ER visit.

All Residents

*A non-emergency ER visit is one that the respondent says could have been treated by a regular doctor if one had been available.Source: 2008 Massachusetts Health Insurance Survey

26%

32%

23%

31%

9%

13%

7% 7%

0%

10%

20%

30%

40%

50%

TotalPopulation


Elderly Adults

Any ER visit Most recent visit was a non-emergency ER visit*


Residents in Families with Problems Paying Medical Bills in Past 12 Months by Age Group Non-elderly adults and

children were more than twice as likely to be in families with difficulties paying medical bills than were elderly residents (17% versus 8%).

All Residents

16%

17% 17%

8%

0%

5%

10%

15%

20%

TotalPopulation


Elderly Adults



Non-Elderly Adults(Ages 19 through 64)


Non-Elderly Adults with a Usual Source of Care by Income

Most non-elderly adults have a usual source of care. Those with higher family incomes were more likely to have a usual source of care than those with lower incomes

Non-Elderly Adults


89%84% 86%

90% 92%

0%

20%

40%

60%

80%

100%

TotalPopulation

<150%FPL

150-299%FPL

300-499%FPL

500% FPLand higher


Non-Elderly Adults with a Usual Source of Care by Race/Ethnicity

Other, non-Hispanic adults were less likely to have a usual source of care than white adults and adults reporting other race/ethnicities.

Non-Elderly Adults


89% 90% 93%

85% 86%

0%

20%

40%

60%

80%

100%

TotalPopulation

White,non-

Hispanic

Black,non-

Hispanic

Other,non-

Hispanic

Hispanic


Non-Elderly Adults with a Usual Source of Care by Health Status

Most Massachusetts adults, regardless of health status, have a usual source of care.

Non-Elderly Adults


89% 89% 89%

0%

20%

40%

60%

80%

100%

Total Population Good, very good,or excellent health

Fair or poor health


Non-Elderly Adults with a Usual Source of Care by Disability Status

Disabled and non-disabled non-elderly adults are equally likely to have a usual source of care (89%).

Non-Elderly Adults


89% 89% 89%

0%

20%

40%

60%

80%

100%

Total Population No activitylimitations due tohealth problems

Activities limitedby health problems


Non-Elderly Adults with a Usual Source of Care by Insurance Status

Compared with the insured, uninsured non-elderly adults were much less likely to have a usual source of care (42% versus 91%).

Non-Elderly Adults


89% 91%

42%

0%

20%

40%

60%

80%

100%

Total Population Insured Uninsured


Non-Elderly Adults with a Doctor Visit in Past 12 Months by Income

Non-elderly adults with family income between 150% and 299% of FPL were the least likely to have had any doctor visit or a visit for preventive care in the past 12 months.

Non-Elderly Adults


85%80% 79%

84%

90%

72%67% 66%

73%77%

0%

20%

40%

60%

80%

100%

TotalPopulation

Less than150% of

FPL

150-299%of FPL

300-499%of FPL

500% ofFPL orhigher



Non-Elderly Adults with a Doctor Visit in Past 12 Months by Race/Ethnicity

Among non-elderly adults, those who reported other, non-Hispanic race/ethni-cities were less likely than white, non-Hispanic or Hispanic adults to have had any doctor visits or a preventive care visit.

Non-Elderly Adults


85% 86% 84%

76%

87%

72% 73% 73%68%

73%

0%

20%

40%

60%

80%

100%

TotalPopulation

White,non-

Hispanic

Black,non-

Hispanic

Other,non-

Hispanic

Hispanic



Non-Elderly Adults with a Doctor Visit in Past 12 Months by Health Status

Non-elderly adults in fair or poor health were more likely than those in better health to have had any doctor visits (91% versus 84%) or a preventive care visit (77% versus 72%).

Non-Elderly Adults


85% 84%

91%

72% 72%77%

0%

20%

40%

60%

80%

100%


Fair or poor health



Non-Elderly Adults with a Doctor Visit in Past 12 Months by Disability Status

Non-elderly adults with a disability were more likely than those without a disability to have had any doctor visits (91% versus 83%) or a preventive care visit (78% versus 71%).

Non-Elderly Adults


85% 83%

91%

72% 71%

78%

0%

20%

40%

60%

80%

100%


Activity limitationsdue to health

problems



Non-Elderly Adults with a Doctor Visit in Past 12 Months by Insurance Status

Uninsured non-elderly adults were much less likely than those with insurance to have had any doctor visits (45% versus 86%) or a preventive care visit (31% versus 74%).

Non-Elderly Adults


85% 86%

45%

72% 74%

31%

0%

20%

40%

60%

80%

100%




Non-Elderly Adults Not Getting Needed Care Due to Cost in Past 12 Months by Income Unmet need for care

because of cost was highest among non-elderly adults with family income between 150% and 299% FPL. Some 40% of residents in this income group skipped needed health care in the past 12 months, compared with 15% of those with family income at or above 500% FPL.

Non-Elderly Adults


26%

34%

40%

29%

15%

0%

10%

20%

30%

40%

50%

TotalPopulation

<150% FPL 150-299%FPL

300-499%FPL

500% FPLand higher


Non-Elderly Adults Not Getting Needed Care Due to Cost in Past 12 Months by Race/Ethnicity Among non-elderly

adults, one-quarter of white, non-Hispanic adults skipped needed health care due to cost, compared with 29% of other, non-Hispanic adults and 35% of Hispanic adults.

Non-Elderly Adults


26% 25%

31%29%

35%

0%

10%

20%

30%

40%

50%

TotalPopulation

White,non-

Hispanic

Black, non-Hispanic

Other, non-Hispanic

Hispanic


Non-Elderly Adults Not Getting Needed Care Due to Cost in Past 12 Months by Health Status Non-elderly adults in

fair or poor health were more likely than those in better health to have gone without needed health care because of cost (43% versus 24%).

Non-Elderly Adults


26%24%

43%

0%

10%

20%

30%

40%

50%


Fair or poor health


Non-Elderly Adults Not Getting Needed Care Due to Cost in Past 12 Months by Disability Status Non-elderly adults with

a disability were more likely than those without a disability to have gone without needed health care because of cost (38% versus 23%).

Non-Elderly Adults


26%23%

38%

0%

10%

20%

30%

40%

50%


Activities limited byhealth problems


Non-Elderly Adults Not Getting Needed Care Due to Cost in Past 12 Months by Insurance Status Non-elderly adults

without insurance were much more likely than those with insurance to have gone without needed health care because of cost (64% versus 24%).

Non-Elderly Adults


26% 24%

64%

0%

10%

20%

30%

40%

50%

60%

70%



Non-Elderly Adults With Difficulty Obtaining Care in Past 12 Months by Income More than a quarter of

non-elderly adults at all income levels reported difficulty obtaining health care in the past 12 months, with close to a third of those with the lowest family incomes reporting problems.

Non-Elderly Adults


28%

31%

28%27% 27%

0%

10%

20%

30%

40%

TotalPopulation

Less than150% of

FPL

150-299%of FPL

300-499%of FPL

500% ofFPL orhigher


Non-Elderly Adults With Difficulty Obtaining Care in Past 12 Months by Race/Ethnicity Hispanic non-elderly

adults were most likely to report problems obtaining care, compared to other race/ethnicity groups.

Non-Elderly Adults


28% 28%

22%

29%

33%

0%

10%

20%

30%

40%

TotalPopulation

White,non-

Hispanic

Black, non-Hispanic

Other, non-Hispanic

Hispanic


Non-Elderly Adults with Difficulty Obtaining Care in Past 12 Months by Health Status Non-elderly adults in

fair or poor health were more likely to report difficulty obtaining health care than those in better health (40% versus 27%).

Non-Elderly Adults


28%27%

40%

0%

10%

20%

30%

40%

50%


Fair or poor health


Non-Elderly Adults With Difficulty Obtaining Care in Past 12 Months by Disability Status Non-elderly adults with

a disability were more likely to report difficulty obtaining health care than those without a disability (38% versus 26%).

Non-Elderly Adults


28%26%

38%

0%

10%

20%

30%

40%

50%


Activities limiteddue to health

problems


Non-Elderly Adults with Difficulty Obtaining Care in Past 12 Months by Insurance Status

Non-elderly adults with insurance were more likely to report difficulties obtaining health care than those without insurance (28% versus 15%).

Note: Uninsured adults were less likely to use care and more likely to report skipping needed health care because of cost.

Non-Elderly Adults


28% 28%

15%

0%

10%

20%

30%

40%



Non-Elderly Adults with an ER Visit in the Past 12 Months by Income

Low-income non-elderly adults were more likely to have had an ER visit than higher income adults. Some 36% of those with family income below 150% FPL had an ER visit, compared with 19%-24% of those at higher income levels.

Non-Elderly Adults


23%

36%

24%21%

19%

7%

12%9%

7%5%

0%

10%

20%

30%

40%

50%

TotalPopulation

Less than150% of

FPL

150-299%of FPL

300-499%of FPL

500% ofFPL orhigher

Any ER visit Most recent ER visit was a non-emergency ER visit*


Non-Elderly Adults with an ER Visit in the Past 12 Months by Race/Ethnicity

Among non-elderly adults, Hispanics were much more likely to have had an ER visit overall and an ER visit for a non-emergency than other race/ethnicity groups.

Non-Elderly Adults


23% 22%

25%

20%

45%

7% 7% 7% 8%

18%

0%

10%

20%

30%

40%

50%

TotalPopulation

White,non-

Hispanic

Black, non-Hispanic

Other, non-Hispanic

Hispanic



Non-Elderly Adults with an ER Visit in the Past 12 Months by Health Status

Among non-elderly adults, those in fair or poor health were much more likely to have had an ER visit and an ER visit for a non-emergency than those in better health.

Non-Elderly Adults


23%21%

45%

7% 7%

14%

0%

10%

20%

30%

40%

50%


Fair or poor health



Non-Elderly Adults with an ER Visit in the Past 12 Months by Disability Status

Among non-elderly adults, those with a disability were much more likely to have had an ER visit and an ER visit for a non-emergency than those without a disability.

Non-Elderly Adults


23%

20%

39%

7% 6%

12%

0%

10%

20%

30%

40%

50%



problems



Non-Elderly Adults with an ER Visit in the Past 12 Months by Insurance Status

Among non-elderly adults, those without insurance were more likely to have an ER visit and an ER visit for a non-emergency than those with insurance.

Non-Elderly Adults


23% 23%

29%

7% 7%

12%

0%

10%

20%

30%

40%

50%




Non-Elderly Adults in Families with Problems Paying Medical Bills in Past 12 Months by Income Non-elderly adults with

family income between 150% and 299% FPL were most likely to have problems paying medical bills (32%), while adults with family incomes at or above 500% FPL were the least likely (9%).

Non-Elderly Adults


17%

22%

32%

17%

9%

0%

10%

20%

30%

40%

TotalPopulation

<150% FPL 150-299%FPL

300-499%FPL

500% FPLand higher


Non-Elderly Adults in Families with Problems Paying Medical Bills in Past 12 Months by Race/Ethnicity Among non-elderly

adults, black, non-Hispanics were more likely to report problems paying medical bills than were white, non-Hispanic adults.

Non-Elderly Adults


17%16%

25%

20% 20%

0%

10%

20%

30%

40%

TotalPopulation

White,non-

Hispanic

Black, non-Hispanic

Other, non-Hispanic

Hispanic


Non-Elderly Adults in Families with Problems Paying Medical Bills in Past 12 Months by Health Status Non-elderly adults in

fair or poor health were twice as likely to have had trouble paying medical bills than adults in better health (31% versus 15%).

Non-Elderly Adults


17%15%

31%

0%

10%

20%

30%

40%


Fair or poor health


Non-Elderly Adults in Families with Problems Paying Medical Bills in Past 12 Months by Disability Status Non-elderly adults with

a disability were more than twice as likely to have had trouble paying medical bills as adults without a disability (30% versus 14%).

Non-Elderly Adults


17%

14%

30%

0%

10%

20%

30%

40%




Non-Elderly Adults in Families with Problems Paying Medical Bills in Past 12 Months by Insurance Status Uninsured non-elderly

adults were more than twice as likely to have had trouble paying medical bills as insured adults (34% versus 16%).

Non-Elderly Adults


17% 16%

34%

0%

10%

20%

30%

40%



Children(Ages 0 through 18)


Children with a Usual Source of Careby Income

While nearly all children had a usual source of care, those with family income less than 150% FPL were least likely to have a usual source of care (93%).

Children


97%93%

98% 100% 98%

0%

20%

40%

60%

80%

100%

TotalPopulation

<150%FPL

150-299%FPL

300-499%FPL

500% FPLand higher


Children with a Usual Source of Care by Race/Ethnicity

Hispanic children were least likely to have a usual source of care, compared to other race/ethnicity groups.

Children


97% 98% 98%93%

0%

20%

40%

60%

80%

100%

TotalPopulation

White, non-Hispanic

Other, non-Hispanic

Hispanic


Children with a Usual Source of Care by Health and Disability Status

Children who are in fair or poor health or are disabled are less likely to have a usual source of care than children in better health and without a disability (94% versus 98%).

Children


97% 98%94%

0%

20%

40%

60%

80%

100%


AND no activitylimitations due tohealth problems

Fair or poor healthOR activity

limitations due tohealth problems


Children with a Doctor Visit in Past 12 Months by Income

Nearly all children with family income above 300% FPL had a doctor visit in the past 12 months, compared with 89 to 92% of poorer children. Poorer children were also less likely to have had a preventive care visit.

Children


94%89% 92%

97% 96%

89%85% 86%

90%93%

0%

20%

40%

60%

80%

100%

TotalPopulation

Less than150% of

FPL

150-299%of FPL

300-499%of FPL

500% ofFPL orhigher



Children with a Doctor Visit in Past 12 Months by Race/Ethnicity

Hispanic and other, non-Hispanic children were less likely than white, non-Hispanic children to have had any doctor visit or a preventive care visit in the past 12 months.

Children


94% 95%91% 92%

89% 90%86% 86%

0%

20%

40%

60%

80%

100%

TotalPopulation

White, non-Hispanic

Other, non-Hispanic

Hispanic



Children with a Doctor Visit in Past 12 Months by Health and Disability Status

Children in good health and with no activity limitations were more likely than those in fair or poor health or with an activity limitation to have had a doctor visit in the past 12 months.

Children


94% 94% 91%89% 89% 87%

0%

20%

40%

60%

80%

100%







Children Not Getting Needed Care Due to Cost in Past 12 Months by Income

Unmet need for health care because of cost was greater among lower-income children. Of children with family income less than 300% FPL, 17%-19% went without needed care, compared with 3% of children at the highest income level.

Children


12%

17%19%

11%

3%

0%

10%

20%

30%

40%

TotalPopulation

<150% FPL 150-299%FPL

300-499%FPL

500% FPLand higher


Children Not Getting Needed Care Due to Cost in Past 12 Months by Race/Ethnicity Unmet need for health

care due to cost was highest for Hispanic children, at 22%.

Children


12%10%

11%

22%

0%

10%

20%

30%

40%

TotalPopulation

White, non-Hispanic

Other, non-Hispanic

Hispanic


Children Not Getting Needed Care Due to Cost in Past 12 Months by Health and Disability Status Children in fair or poor

health or with a disability were more than twice as likely to have unmet need for health care as children in better health and without a disability (22% versus 10%).

Children


12%10%

22%

0%

10%

20%

30%

40%






Children with Difficulty Obtaining Care in Past 12 Months by Income

Children with family income less than 150% FPL were most likely to face difficulties getting health care, at 24%.

Children


17%

24%

17%18%

13%

0%

10%

20%

30%

40%

TotalPopulation

Less than150% of

FPL

150-299%of FPL

300-499%of FPL

500% ofFPL orhigher


Children with Difficulty Obtaining Care in Past 12 Months by Race/Ethnicity

While Hispanic children were most likely to face difficulties obtaining health care, 17% of all children faced barriers to getting care.

Children


17% 17%18%

19%

0%

10%

20%

30%

40%

TotalPopulation

White, non-Hispanic

Non-white,non-Hispanic

Hispanic


Children With Difficulty Obtaining Care in Past 12 Months by Health and Disability Status Children in fair or poor

health or with a disability were more likely to face difficulties obtaining care than children in better health and without a disability (27% versus 16%).

Children


17%16%

27%

0%

10%

20%

30%

40%






Children with an ER Visit in the Past 12 Months by Income

Lower-income children were more likely to have had an ER visit, with 41% of those with family income less than 150% FPL visiting the ER.

Children


32%

41%

35% 36%

22%

13%

17%18%

15%

6%

0%

10%

20%

30%

40%

50%

TotalPopulation

Less than150% of

FPL

150-299%of FPL

300-499%of FPL

500% ofFPL orhigher



Children with an ER Visit in the Past 12 Months by Race/Ethnicity

Hispanic children were much more likely than non-Hispanic children to have had an emergency or non-emergency ER visit.

Children


32% 31%

28%

44%

13%11% 12%

24%

0%

10%

20%

30%

40%

50%

TotalPopulation

White, non-Hispanic

Other, non-Hispanic

Hispanic



Children with an ER Visit in the Past 12 Months by Health and Disability Status

Over half of children in fair or poor health or with a disability had an ER visit (55%), compared with nearly three out of ten children in better health and without a disability (29%). Rates of non-emergency ER visits were also higher among children in poorer health or with a disability (20% versus 12%).

Children


32%29%

55%

13% 12%

20%

0%

10%

20%

30%

40%

50%

60%







Children in Families with Problems Paying Medical Bills in Past 12 Months by Income Problems paying

medical bills were most common in the families of lower-income children, particularly those with family income between 150 and 299% FPL.

Children


17%

23%25%

20%

7%

0%

10%

20%

30%

40%

TotalPopulation

<150% FPL 150-299%FPL

300-499%FPL

500% FPLand higher


Children in Families with Problems Paying Medical Bills in Past 12 Months by Race/Ethnicity Other, non-Hispanic

and Hispanic children were most likely to live in families that had trouble paying medical bills (22%).

Children


17%15%

22% 22%

0%

10%

20%

30%

40%

TotalPopulation

White, non-Hispanic

Other, non-Hispanic

Hispanic


Children in Families with Problems Paying Medical Bills in Past 12 Months by Health and Disability Status Children in fair or poor

health or with a disability were twice as likely to live in families with difficulty paying medical bills than were other children (31% versus 15%).

Children


17%15%

31%

0%

10%

20%

30%

40%






Elderly Adults(Ages 65 and Older)


Elderly Adults with a Usual Source of Care by Income

Nearly all elderly adults had a usual source of care, although those with lower family incomes were less likely to have a usual source of care.

Elderly Adults


95%

89%94%

97% 98%

0%

20%

40%

60%

80%

100%

TotalPopulation

<150%FPL

150-299%FPL

300-499%FPL

500% FPLand higher


Elderly Adults with a Usual Source of Care by Race/Ethnicity

Among elderly adults, white, non-Hispanic adults were more likely to have a usual source of care than other adults (96% versus 88%).

Elderly Adults


95% 96%

88%

0%

20%

40%

60%

80%

100%

Total Population White, non-Hispanic

Other


Elderly Adults with a Usual Source of Care by Health Status

Elderly adults in fair or poor health were less likely than those in better health to have a usual source of care (92% versus 96%).

Elderly Adults


95% 96%92%

0%

20%

40%

60%

80%

100%


Fair or poor health


Elderly Adults with a Usual Source of Care by Disability Status

Nearly all elderly adults had a usual source of care, regardless of disability status.

Elderly Adults


95% 96% 94%

0%

20%

40%

60%

80%

100%


Activities limitedby health problems


Elderly Adults with a Doctor Visit in Past 12 Months by Income

Nearly all elderly adults had a doctor visit over the prior year and most had a preventive care visit. However, elderly adults with family income less than 150% FPL were less likely than higher-income elderly adults to have had a doctor visit or a preventive care visit.

Elderly Adults


95%90%

95% 96% 97%

87%82%

87% 89% 90%

0%

20%

40%

60%

80%

100%

TotalPopulation

Less than150% of

FPL

150-299%of FPL

300-499%of FPL

500% ofFPL orhigher



Elderly Adults with a Doctor Visit in Past 12 Months by Race/Ethnicity

Among elderly adults, white, non-Hispanic adults were more likely to have a doctor visit and a preventive care visit than adults of other races/ethnicities.

Elderly Adults


95% 95%

88%87% 88%85%

0%

20%

40%

60%

80%

100%


Other



Elderly Adults with a Doctor Visit in Past 12 Months by Health Status

Nearly all elderly adults, regardless of health status, had a doctor visit. Those in fair or poor health were less likely than other elderly adults to have had a preventive care visit.

Elderly Adults


95% 95% 95%

87% 88%84%

0%

20%

40%

60%

80%

100%


Fair or poor health



Elderly Adults with a Doctor Visit in Past 12 Months by Disability Status

Nearly all elderly adults, regardless of disability status, had a doctor visit and most had a preventive care visit.

Elderly Adults


95% 94% 96%

87% 87% 87%

0%

20%

40%

60%

80%

100%



problems



Elderly Adults Not Getting Needed Care Due to Cost in Past 12 Months by Income Unmet need for care

because of cost was highest among elderly adults with family income below 150% FPL. Some 22% of those adults skipped needed health care compared with 8% of those with family income at 500% FPL or higher.

Elderly Adults


13%

22%

17%

10%8%

0%

20%

40%

60%

80%

TotalPopulation

<150% FPL 150-299%FPL

300-499%FPL

500% FPLand higher


Elderly Adults Not Getting Needed Care Due to Cost in Past 12 Months by Race/Ethnicity White, non-Hispanic

elderly adults were much less likely to have unmet need for care because of cost than were other elderly adults (11% versus 31%).

Elderly Adults


13%11%

31%

0%

20%

40%

60%

80%


Other


Elderly Adults Not Getting Needed Care Due to Cost in Past 12 Months by Health Status Among elderly adults,

those in fair or poor health were more likely to have unmet need for care because of cost than were those in better health (20% versus 11%).

Elderly Adults


13%11%

20%

0%

20%

40%

60%

80%


Fair or poor health


Elderly Adults Not Getting Needed Care Due to Cost in Past 12 Months by Disability Status Among elderly adults,

those who were disabled were more likely to have unmet need for care because of cost than were those without a disability (20% versus 10%).

Elderly Adults


13%10%

20%

0%

20%

40%

60%

80%




Elderly Adults With Difficulty Obtaining Care in Past 12 Months by Income

About 1 in 7 elderly adults at all family income levels reported difficulty obtaining care in the past 12 months.

Elderly Adults


15% 13%15% 15% 15%

0%

20%

40%

60%

80%

TotalPopulation

Less than150% of

FPL

150-299%of FPL

300-499%of FPL

500% ofFPL orhigher


Elderly Adults With Difficulty Obtaining Care in Past 12 Months by Race/Ethnicity White, non-Hispanic

elderly adults were less likely to have had difficulty obtaining care than were other elderly adults (14% versus 18%).

Elderly Adults


15% 14%

18%

0%

10%

20%

30%

40%


Other


Elderly Adults With Difficulty Obtaining Care in Past 12 Months by Health Status

About 1 in 7 elderly adults, regardless of health status, reported difficulty obtaining health care.

Elderly Adults


15% 14%16%

0%

10%

20%

30%

40%


Fair or poor health


Elderly Adults With Difficulty Obtaining Care in Past 12 Months by Disability Status Elderly adults with a

disability were more likely to have had difficulty obtaining health care than those without a disability (17% versus 13%).

Elderly Adults


15%13%

17%

0%

10%

20%

30%

40%



problems


Elderly Adults with an ER Visit in the Past 12 Months by Income

Elderly adults with family incomes below 300% FPL were more likely to have had an ER visit in the past 12 months than higher-income adults.

Elderly Adults

31%

44%

35%

24% 24%

7%9% 9%

5% 6%

0%

10%

20%

30%

40%

50%

TotalPopulation

Less than150% of

FPL

150-299%of FPL

300-499%of FPL

500% ofFPL orhigher




Elderly Adults with an ER Visit in the Past 12 Months by Race/Ethnicity

About 3 in 10 elderly adults, regardless of race or ethnicity, had an ER visit in the past 12 months. White, non-Hispanic elderly adults were half as likely to visit the ER for a non-emergency as elderly adults in other race/ethnicity groups.

Elderly Adults

31% 31% 32%

7% 6%

12%

0%

10%

20%

30%

40%

50%


Other




Elderly Adults with an ER Visit in the Past 12 Months by Health Status

Elderly adults in fair or poor health were much more likely than those in better health to have had an ER visit (46% versus 26%).

Elderly Adults

31%

26%

46%

7% 7%9%

0%

10%

20%

30%

40%

50%


Fair or poor health




Elderly Adults with an ER Visit in the Past 12 Months by Disability Status

Nearly 4 in 10 (38%) elderly adults with an activity limitation had an ER visit in the past 12 months, compared with close to 3 in 10 (27%) non-disabled residents.

Elderly Adults

31%

27%

38%

7%9%

3%

0%

10%

20%

30%

40%

50%



problems




Elderly Adults in Families with Problems Paying Medical Bills in Past 12 Months by Income Elderly adults with

family incomes below 300% FPL were most likely to live in families that had had problems paying medical bills in the past 12 months.

Elderly Adults


8%

14%

11%

4%

2%

0%

10%

20%

30%

TotalPopulation

<150% FPL 150-299%FPL

300-499%FPL

500% FPLand higher


Elderly Adults in Families with Problems Paying Medical Bills in Past 12 Months by Race/Ethnicity Compared with white,

non-Hispanic elderly adults, other elderly adults were three times as likely to live in families that had problems paying medical bills (6% versus 18%).

Elderly Adults


8%6%

18%

0%

10%

20%

30%


Other


Elderly Adults in Families with Problems Paying Medical Bills in Past 12 Months by Health Status Elderly adults in fair or

poor health were more than 4 times as likely than those in better health to live in families that had problems paying medical bills (17% versus 4%).

Elderly Adults


8%

4%

17%

0%

10%

20%

30%


Fair or poor health


Elderly Adults in Families with Problems Paying Medical Bills in Past 12 Months by Disability Status Elderly adults with a

disability were much more likely than those without a disability to live in families that had problems paying medical bills (14% versus 4%).

Elderly Adults


8%

4%

14%

0%

10%

20%

30%



Division of Health Care Finance and Policy

Two Boylston Street

Boston, MA 02116

Phone: (627) 988-3100

Fax: (617) 727-7662

Website: www.mass.gov/dhcfp

Publication Number: 12-345-02 HCF

mass health insurance survey

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