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					            Access to Health Care in Massachusetts:
                      Estimates from the
          2008 Massachusetts Health Insurance Survey

                      Sharon K. Long, Allison Cook, and Karen Stockley
                                      Urban Institute

                                         March 2009




Deval L. Patrick, Governor                                                  JudyAnn Bigby, Secretary
Commonwealth of Massachusetts                          Executive Office of Health and Human Services
Timothy P. Murray                                                         Sarah Iselin, Commissioner
Lieutenant Governor                                        Division of Health Care Finance and Policy
                                                                                                   Executive Summary
Access to Health Care in Massachusetts

 In 2008, Massachusetts residents reported relatively good          Barriers to Care
 access to health care across a number of key measures.             Despite relatively high use of health care services among
 However, access to affordable health care remains an issue         residents, nearly one quarter (24%) reported having
 for many residents, especially for the uninsured, lower-           difficulty obtaining health care in 2008. The disabled and
 income, the disabled, and those in fair or poor health.            those in fair or poor health were most likely to report
                                                                    difficulties. Some 27% of children with an activity limitation
 Source of Care                                                     or in fair or poor health reported difficulties obtaining care,
 In 2008, the vast majority of Massachusetts residents (92%)        compared with 16% of healthy, non-disabled children.
 had a usual place they went to seek health care. A smaller         Similarly, some 40% of non-elderly adults in fair or poor
 share of non-elderly adults (89%) had a usual source of care       health reported difficulties, compared with 27% of other
 compared with children (97%) and elderly adults (95%).             non-elderly adults.

 Doctor Visits                                                      Unmet Need
 In the 12 months prior to the survey, most residents (88%)         More than one-fifth (21%) of residents did not get the care
 had at least one doctor visit, and 78% had a preventive care       they needed due to cost in the 12 months prior to the
 visit. The uninsured were much less likely to have had any         survey. Uninsured residents had an especially high degree
 type of doctor visit or a visit for preventive care. Only 45% of   of unmet need, with 64% of uninsured non-elderly adults
 uninsured non-elderly adults visited a doctor and only 31%         forgoing needed care due to cost. Among children and non-
 had a visit for preventive care.                                   elderly adults, those in families with incomes between 150-
                                                                    299% of the federal poverty level (FPL) were more likely
 Emergency Care                                                     than any other income groups to forgo necessary care due
 Across all residents, 26% made at least one visit to the           to cost (19% and 40% for children and adults,
 emergency room (ER) in the previous year. Some 9% of all           respectively). Among elderly adults, those in families with
 residents reported that their most recent ER visit was for a       income less than 150% FPL reported more unmet need due
 non-emergency condition, suggesting that these residents           to cost (22%) than did higher income adults.
 may be seeking care in the ER that could be obtained in the
 community.




Massachusetts Division of Health Care Finance and Policy                                                                          1
                                                                                            Executive Summary
Access to Health Care in Massachusetts
                                                                                                Table of Contents
 Medical Bills
                                                                                             Methodology                  3
 Some 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     All Residents                 4
 paying for health care within all age groups. Again, among children and non-elderly          Usual Source of Care         5
 adults, those with family incomes between 150-299% FPL were the income groups                Doctor Visits                6
 most likely to experience problems paying medical bills (25% and 32%, respectively).         Not Getting Needed Care      7
                                                                                              Difficulty Obtaining Care    8
 Among elderly adults, those in families with incomes below 150% FPL had the most             Emergency Room Visits        9
 difficulties (14%).                                                                          Medical Bills               10

 Access for Different Population Groups                                                      Non-Elderly Adults           11
                                                                                              Usual Source of Care        12
 Not surprisingly, lower-income residents had lower access to care across all measures        Doctor Visits               17
 compared with higher-income groups. Across age groups, non-elderly adults (19-64)            Not Getting Needed Care     22
 consistently reported lower access compared with children and elderly adults. Among          Difficulty Obtaining Care   27
 race/ethnicity groups, Hispanics were more likely to experience lower access to care         Emergency Room Visits       32
                                                                                              Medical Bills               37
 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          Children                     42
 experienced greater barriers to care and had more unmet need due to cost compared            Usual Source of Care        43
 with non-disabled residents and those in better health. Although a lower share of            Doctor Visits               46
                                                                                              Not Getting Needed Care     49
 uninsured non-elderly adults reported difficulties obtaining care compared with insured
                                                                                              Difficulty Obtaining Care   52
 residents, this most likely reflects the reluctance of uninsured residents to seek care      Emergency Room Visits       55
 they can not afford, as unmet need is much higher for this group.                            Medical Bills               58

                                                                                             Elderly Adults               61
                                                                                              Usual Source of Care        62
                                                                                              Doctor Visits               66
                                                                                              Not Getting Needed Care     70
                                                                                              Difficulty Obtaining Care   74
                                                                                              Emergency Room Visits       78
                                                                                              Medical Bills               82




Massachusetts Division of Health Care Finance and Policy                                                                       2
                                                                                                           Methodology
Survey Methodology

 The 2008 Massachusetts Health Insurance Survey (HIS)             Surveys were completed with 4,910 Massachusetts
 provides information on health insurance coverage and            households. The margin of error was +/-1 percentage point
 access to and use of health care for the non-institutionalized   for estimates based on the full sample. The response rate
 population in Massachusetts. In the survey, an adult member      was 42% for the RDD-sample and 28% for the address-
 of the household responded to questions about health             based sample, for a combined response rate of 32%. A lack
 insurance coverage and demographic information for all           of standardization in calculating response rates makes it
 members of the household. More detailed socioeconomic            difficult to compare response rates across surveys and
 characteristics and health care information were collected for   likely explains much of the difference in the response rate
 one randomly selected household member and other                 for the RDD-sample in the 2008 HIS and those reported for
 members of his or her family who were residing in the            prior years of the survey. (Prior years of the HIS relied on
 household.                                                       RDD-samples.) Further, unlike earlier years of the HIS, the
                                                                  2008 HIS has very little missing data, with item
 In order to ensure that the survey covered nearly all            nonresponse generally less than 2% for most key questions
 residents of Massachusetts, a dual sample frame was              and only 6% for the primary income question. Additional
 employed, combining a random-digit-dial (RDD) sample with        information on the 2008 HIS is available at
 an address-based sample. The survey was conducted                www.mass.gov/dhcfp.
 between June and August 2008 via telephone, web, and mail
 by International Communications Research (ICR). It was           For these charts, we define children as age 0 to 18, non-
 available in English, Spanish, and Portuguese and took, on       elderly adults as age 19 to 64, and elderly adults as age 65
 average, about 19 minutes to complete.                           and older.




Massachusetts Division of Health Care Finance and Policy                                                                     3
                                                           All Residents




Massachusetts Division of Health Care Finance and Policy                   4
                                                                                                      All Residents
Residents with a Usual Source of Care
by Age Group
                                                                                               The majority of
                                                                                               children, non-elderly
                                                                                               adults, and elderly
     100%                                             97%                         95%          adults in Massachu-
                                92%                                                            setts have a usual
                                                                   89%                         source of care, with
                                                                                               non-elderly adults
                                                                                               least likely (89%) and
       80%                                                                                     children most likely
                                                                                               (97%) to have a usual
                                                                                               source of care.

       60%



       40%



       20%



          0%
                            Total                    Children   Non-Elderly   Elderly Adults
                          Population                              Adults


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                5
                                                                                                           All Residents
Residents with a Doctor Visit in Past 12
Months by Age Group
                                                                                                    High shares of both
                                                                                                    children and elderly
                                                                                                    adults had a doctor
     100%                                                                                           visit and a preventive
                                                     94%                              95%
                                                                                                    care visit. Among non-
                            88%                            89%                               87%    elderly adults, 85%
                                                                      85%
                                                                                                    had a doctor visit and
                                      78%                                                           72% had a preventive
       80%
                                                                            72%                     care visit.


       60%



       40%



       20%



          0%
                            Total                    Children       Non-Elderly    Elderly Adults
                          Population                                  Adults

                                          Any doctor visit       Visit for preventive care


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                     6
                                                                                                     All Residents
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
     40%                                                                                       because of cost. Some
                                                                                               26% skipped needed
                                                                                               health care, compared
                                                                                               with 12% of children
                                                                                               and 13% of elderly
                                                                                               adults.
     30%
                                                                   26%

                              21%
     20%

                                                                                  13%
                                                      12%

     10%




       0%
                         Total                       Children   Non-Elderly   Elderly Adults
                       Population                                 Adults


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                               7
                                                                                                      All Residents
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,
     40%                                                                                       at 28%.




     30%                                                           28%

                              24%


     20%
                                                      17%
                                                                                  15%


     10%




       0%
                         Total                       Children   Non-Elderly   Elderly Adults
                       Population                                 Adults


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                 8
                                                                                                                                                           All Residents
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
     50%                                                                                                                                            adults. Children were
                                                                                                                                                    about twice as likely as
                                                                                                                                                    adults to have had a
                                                                                                                                                    non-emergency visit as
     40%                                                                                                                                            their most recent ER
                                                                                                                                                    visit.
                                                               32%                                                                   31%
     30%
                           26%
                                                                                                   23%

     20%

                                                                         13%

     10%                               9%
                                                                                                              7%                           7%



        0%
                           Total                               Children                        Non-Elderly                         Elderly Adults
                         Population                                                              Adults

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

*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


Massachusetts Division of Health Care Finance and Policy                                                                                                                       9
                                                                                                      All Residents
Residents in Families with Problems
Paying Medical Bills in Past 12 Months
                                                                                               Non-elderly adults and
by Age Group                                                                                   children were more
                                                                                               than twice as likely to
                                                                                               be in families with
     20%                                                                                       difficulties paying
                                                                                               medical bills than were
                                                      17%                                      elderly residents (17%
                                                                   17%                         versus 8%).
                              16%
     15%




     10%
                                                                                   8%


       5%




       0%
                         Total                       Children   Non-Elderly   Elderly Adults
                       Population                                 Adults


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                 10
                                                 Non-Elderly Adults
                                                 (Ages 19 through 64)




Massachusetts Division of Health Care Finance and Policy                11
                                                                                            Non-Elderly Adults
Non-Elderly Adults with a Usual Source
of Care by Income
                                                                                            Most non-elderly
                                                                                            adults have a usual
     100%                                                                                   source of care.
                                                                                  92%       Those with higher
                             89%                                         90%
                                                               86%                          family incomes were
                                                     84%                                    more likely to have a
                                                                                            usual source of care
       80%                                                                                  than those with lower
                                                                                            incomes


       60%



       40%



       20%



          0%
                        Total                        <150%   150-299% 300-499% 500% FPL
                      Population                      FPL       FPL      FPL   and higher



Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                            12
                                                                                                 Non-Elderly Adults
Non-Elderly Adults with a Usual Source
of Care by Race/Ethnicity
                                                                                                 Other, non-Hispanic
                                                                                                 adults were less likely
     100%                                                                                        to have a usual source
                                                                 93%                             of care than white
                             89%                      90%
                                                                                       86%       adults and adults
                                                                            85%                  reporting other
                                                                                                 race/ethnicities.
       80%



       60%



       40%



       20%



          0%
                        Total                         White,     Black,     Other,    Hispanic
                      Population                       non-       non-       non-
                                                     Hispanic   Hispanic   Hispanic



Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                   13
                                                                                            Non-Elderly Adults
Non-Elderly Adults with a Usual Source
of Care by Health Status
                                                                                            Most Massachusetts
                                                                                            adults, regardless of
     100%                                                                                   health status, have a
                                                                                            usual source of care.
                                     89%                   89%                89%

       80%



       60%



       40%



       20%



          0%
                         Total Population            Good, very good, Fair or poor health
                                                     or excellent health



Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                            14
                                                                                              Non-Elderly Adults
Non-Elderly Adults with a Usual Source
of Care by Disability Status
                                                                                              Disabled and non-
                                                                                              disabled non-elderly
     100%                                                                                     adults are equally
                                                                                              likely to have a usual
                                     89%                   89%                 89%            source of care (89%).

       80%



       60%



       40%



       20%



          0%
                         Total Population                No activity     Activities limited
                                                     limitations due to by health problems
                                                      health problems



Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                               15
                                                                             Non-Elderly Adults
Non-Elderly Adults with a Usual Source
of Care by Insurance Status
                                                                             Compared with the
                                                                             insured, uninsured
     100%                                                                    non-elderly adults
                                                                             were much less likely
                                     89%                   91%
                                                                             to have a usual source
                                                                             of care (42% versus
                                                                             91%).
       80%



       60%


                                                                   42%
       40%



       20%



          0%
                         Total Population              Insured   Uninsured



Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                              16
                                                                                                     Non-Elderly Adults
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
     100%                                                                                            likely to have had any
                                                                                          90%        doctor visit or a visit
                          85%                                                                        for preventive care in
                                                                             84%
                                                     80%          79%                                the past 12 months.
       80%                                                                                     77%
                                 72%                                             73%
                                                         67%        66%

       60%


       40%


       20%


          0%
                        Total                        Less than   150-299% 300-499%       500% of
                      Population                     150% of       of FPL   of FPL        FPL or
                                                        FPL                               higher

                                          Any doctor visit         Visit for preventive care

Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                   17
                                                                                                    Non-Elderly Adults
Non-Elderly Adults with a Doctor Visit in
Past 12 Months by Race/Ethnicity
                                                                                                    Among non-elderly
                                                                                                    adults, those who
     100%                                                                                           reported other, non-
                                                                                                    Hispanic race/ethni-
                                                     86%                                 87%        cities were less likely
                          85%                                   84%
                                                                                                    than white, non-
       80%                                                                  76%
                                                                                              73%
                                                                                                    Hispanic or Hispanic
                                 72%                    73%        73%                              adults to have had any
                                                                                68%                 doctor visits or a
                                                                                                    preventive care visit.
       60%


       40%


       20%


          0%
                        Total                         White,     Black,      Other,     Hispanic
                      Population                       non-       non-        non-
                                                     Hispanic   Hispanic    Hispanic

                                          Any doctor visit        Visit for preventive care



Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                      18
                                                                                            Non-Elderly Adults
Non-Elderly Adults with a Doctor Visit in
Past 12 Months by Health Status
                                                                                            Non-elderly adults in
                                                                                            fair or poor health
     100%                                                                                   were more likely than
                                                                              91%           those in better health
                                                                                            to have had any doctor
                                85%                      84%                                visits (91% versus
       80%                                                                          77%     84%) or a preventive
                                             72%               72%                          care visit (77% versus
                                                                                            72%).

       60%



       40%



       20%



          0%
                         Total Population            Good, very good, Fair or poor health
                                                     or excellent health

                                          Any doctor visit   Visit for preventive care



Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                         19
                                                                                                 Non-Elderly Adults
Non-Elderly Adults with a Doctor Visit in
Past 12 Months by Disability Status
                                                                                                 Non-elderly adults with
                                                                                                 a disability were more
     100%                                                                                        likely than those
                                                                              91%                without a disability to
                                85%                                                              have had any doctor
                                                         83%                                     visits (91% versus
                                                                                    78%
       80%                                                                                       83%) or a preventive
                                             72%               71%                               care visit (78% versus
                                                                                                 71%).

       60%


       40%


       20%


          0%
                         Total Population                No activity      Activity limitations
                                                     limitations due to     due to health
                                                      health problems          problems

                                          Any doctor visit   Visit for preventive care



Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                               20
                                                                                           Non-Elderly Adults
Non-Elderly Adults with a Doctor Visit in
Past 12 Months by Insurance Status
                                                                                           Uninsured non-elderly
                                                                                           adults were much less
     100%                                                                                  likely than those with
                                                                                           insurance to have had
                                                                                           any doctor visits (45%
                                85%                      86%
                                                                                           versus 86%) or a
                                                                                           preventive care visit
       80%                                                       74%                       (31% versus 74%).
                                             72%



       60%

                                                                               45%

       40%
                                                                                     31%


       20%



          0%
                         Total Population                    Insured           Uninsured

                                          Any doctor visit    Visit for preventive care



Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                            21
                                                                             Non-Elderly Adults
Non-Elderly Adults Not Getting Needed
Care Due to Cost in Past 12 Months
                                                                             Unmet need for care
by Income                                                                    because of cost was
                                                                             highest among non-
                                                                             elderly adults with
     50%                                                                     family income between
                                                                             150% and 299% FPL.
                                                                             Some 40% of
                                                                             residents in this
                                                           40%               income group skipped
     40%
                                                                             needed health care in
                                                     34%                     the past 12 months,
                                                                             compared with 15% of
                                                                             those with family
     30%                                                         29%
                                                                             income at or above
                          26%                                                500% FPL.


     20%
                                                                       15%


     10%



       0%
                      Total    <150% FPL 150-299% 300-499% 500% FPL
                    Population              FPL      FPL   and higher


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                             22
                                                                                                 Non-Elderly Adults
Non-Elderly Adults Not Getting Needed
Care Due to Cost in Past 12 Months by
                                                                                                 Among non-elderly
Race/Ethnicity                                                                                   adults, one-quarter of
                                                                                                 white, non-Hispanic
                                                                                                 adults skipped needed
     50%                                                                                         health care due to
                                                                                                 cost, compared with
                                                                                                 29% of other, non-
                                                                                                 Hispanic adults and
     40%                                                                                         35% of Hispanic
                                                                                       35%       adults.

                                                               31%
     30%                                                                   29%
                          26%
                                                     25%

     20%



     10%



       0%
                      Total                       White,    Black, non- Other, non-   Hispanic
                    Population                     non-      Hispanic    Hispanic
                                                 Hispanic


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                  23
                                                                                            Non-Elderly Adults
Non-Elderly Adults Not Getting Needed
Care Due to Cost in Past 12 Months by
                                                                                            Non-elderly adults in
Health Status                                                                               fair or poor health
                                                                                            were more likely than
                                                                                            those in better health
     50%                                                                                    to have gone without
                                                                                            needed health care
                                                                              43%           because of cost (43%
                                                                                            versus 24%).
     40%



     30%
                                   26%
                                                           24%

     20%



     10%



       0%
                      Total Population               Good, very good, Fair or poor health
                                                     or excellent health


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                             24
                                                                                                Non-Elderly Adults
Non-Elderly Adults Not Getting Needed
Care Due to Cost in Past 12 Months by
                                                                                                Non-elderly adults with
Disability Status                                                                               a disability were more
                                                                                                likely than those
                                                                                                without a disability to
     50%                                                                                        have gone without
                                                                                                needed health care
                                                                                                because of cost (38%
                                                                                                versus 23%).
     40%                                                                        38%



     30%
                                   26%
                                                           23%

     20%



     10%



       0%
                      Total Population                   No activity    Activities limited by
                                                     limitations due to   health problems
                                                      health problems


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                              25
                                                                             Non-Elderly Adults
Non-Elderly Adults Not Getting Needed
Care Due to Cost in Past 12 Months by
                                                                             Non-elderly adults
Insurance Status                                                             without insurance were
                                                                             much more likely than
                                                                             those with insurance to
     70%                                                                     have gone without
                                                                   64%       needed health care
                                                                             because of cost (64%
     60%                                                                     versus 24%).



     50%


     40%


     30%                           26%
                                                           24%

     20%


     10%


       0%
                      Total Population                Insured    Uninsured


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                           26
                                                                                          Non-Elderly Adults
Non-Elderly Adults With Difficulty
Obtaining Care in Past 12 Months by
                                                                                          More than a quarter of
Income                                                                                    non-elderly adults at
                                                                                          all income levels
                                                                                          reported difficulty
     40%                                                                                  obtaining health care
                                                                                          in the past 12 months,
                                                                                          with close to a third of
                                                                                          those with the lowest
                                                     31%                                  family incomes
     30%                                                                                  reporting problems.
                           28%                                28%
                                                                       27%       27%




     20%




     10%




       0%
                      Total                     Less than   150-299% 300-499%   500% of
                    Population                  150% of       of FPL   of FPL    FPL or
                                                   FPL                           higher


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                             27
                                                                                                 Non-Elderly Adults
Non-Elderly Adults With Difficulty
Obtaining Care in Past 12 Months by
                                                                                                 Hispanic non-elderly
Race/Ethnicity                                                                                   adults were most likely
                                                                                                 to report problems
                                                                                                 obtaining care,
     40%                                                                                         compared to other
                                                                                                 race/ethnicity groups.

                                                                                        33%

     30%                                                                   29%
                           28%                       28%


                                                               22%

     20%




     10%




       0%
                      Total                       White,    Black, non- Other, non-   Hispanic
                    Population                     non-      Hispanic    Hispanic
                                                 Hispanic


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                   28
                                                                                            Non-Elderly Adults
Non-Elderly Adults with Difficulty
Obtaining Care in Past 12 Months by
                                                                                            Non-elderly adults in
Health Status                                                                               fair or poor health
                                                                                            were more likely to
                                                                                            report difficulty
     50%                                                                                    obtaining health care
                                                                                            than those in better
                                                                                            health (40% versus
                                                                                            27%).
                                                                              40%
     40%



     30%                            28%
                                                           27%



     20%



     10%



       0%
                       Total Population              Good, very good, Fair or poor health
                                                     or excellent health


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                            29
                                                                                               Non-Elderly Adults
Non-Elderly Adults With Difficulty
Obtaining Care in Past 12 Months by
                                                                                               Non-elderly adults with
Disability Status                                                                              a disability were more
                                                                                               likely to report
                                                                                               difficulty obtaining
     50%                                                                                       health care than those
                                                                                               without a disability
                                                                                               (38% versus 26%).

     40%                                                                        38%



     30%                           28%
                                                           26%


     20%



     10%



       0%
                      Total Population                   No activity      Activities limited
                                                     limitations due to    due to health
                                                      health problems         problems


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                             30
                                                                             Non-Elderly Adults
Non-Elderly Adults with Difficulty
Obtaining Care in Past 12 Months by
                                                                             Non-elderly adults with
Insurance Status                                                             insurance were more
                                                                             likely to report
                                                                             difficulties obtaining
                                                                             health care than those
     40%                                                                     without insurance
                                                                             (28% versus 15%).




     30%                           28%                     28%




     20%

                                                                   15%

                                                                             Note: Uninsured adults were less
     10%                                                                     likely to use care and more likely
                                                                             to report skipping needed health
                                                                             care because of cost.




       0%
                      Total Population                Insured    Uninsured


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                          31
                                                                                                                                              Non-Elderly Adults
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
     50%                                                                                                                                      higher income adults.
                                                                                                                                              Some 36% of those
                                                                                                                                              with family income
                                                                                                                                              below 150% FPL had
     40%                                                                                                                                      an ER visit, compared
                                                     36%                                                                                      with 19%-24% of
                                                                                                                                              those at higher income
                                                                                                                                              levels.
     30%
                         23%                                                      24%
                                                                                                              21%
     20%                                                                                                                           19%


                                                             12%
     10%                                                                                   9%
                                  7%                                                                                    7%
                                                                                                                                         5%


        0%
                       Total                       Less than                  150-299% 300-499%                                    500% of
                     Population                    150% of                      of FPL   of FPL                                     FPL or
                                                      FPL                                                                           higher

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


Massachusetts Division of Health Care Finance and Policy                                                                                                               32
                                                                                                                                              Non-Elderly Adults
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
     50%                                                                                                                                      overall and an ER visit
                                                                                                                                   45%        for a non-emergency
                                                                                                                                              than other
                                                                                                                                              race/ethnicity groups.
     40%


     30%
                                                                                  25%
                         23%
                                                     22%
                                                                                                              20%
     20%                                                                                                                              18%



     10%                          7%                                                       7%                           8%
                                                               7%


        0%
                       Total                         White,                  Black, non- Other, non-                               Hispanic
                     Population                       non-                    Hispanic    Hispanic
                                                    Hispanic

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


Massachusetts Division of Health Care Finance and Policy                                                                                                                33
                                                                                                                                           Non-Elderly Adults
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
     50%                                                                                                                                   had an ER visit and an
                                                                                                                               45%         ER visit for a non-
                                                                                                                                           emergency than those
                                                                                                                                           in better health.
     40%



     30%

                                23%
                                                                               21%
     20%
                                                                                                                                     14%

     10%                                       7%                                             7%



        0%
                        Total Population                             Good, very good, Fair or poor health
                                                                     or excellent health

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


Massachusetts Division of Health Care Finance and Policy                                                                                                          34
                                                                                                                                           Non-Elderly Adults
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
     50%                                                                                                                                   had an ER visit and an
                                                                                                                                           ER visit for a non-
                                                                                                                                           emergency than those
                                                                                                                                           without a disability.
     40%                                                                                                                       39%




     30%
                                23%
                                                                               20%
     20%

                                                                                                                                     12%
     10%                                       7%                                             6%


        0%
                        Total Population                                  No activity                               Activity limitations
                                                                      limitations due to                              due to health
                                                                       health problems                                   problems

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


Massachusetts Division of Health Care Finance and Policy                                                                                                            35
                                                                                                                                           Non-Elderly Adults
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
     50%                                                                                                                                   visit and an ER visit for
                                                                                                                                           a non-emergency than
                                                                                                                                           those with insurance.

     40%



     30%                                                                                                                       29%

                                23%                                            23%

     20%

                                                                                                                                     12%
     10%                                       7%                                             7%



        0%
                        Total Population                                          Insured                                     Uninsured

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


Massachusetts Division of Health Care Finance and Policy                                                                                                           36
                                                                            Non-Elderly Adults
Non-Elderly Adults in Families with
Problems Paying Medical Bills in Past 12
                                                                            Non-elderly adults with
Months by Income                                                            family income between
                                                                            150% and 299% FPL
                                                                            were most likely to
     40%                                                                    have problems paying
                                                                            medical bills (32%),
                                                                            while adults with
                                                                            family incomes at or
                                                           32%              above 500% FPL were
                                                                            the least likely (9%).
     30%


                                                     22%

     20%
                           17%                                   17%




     10%                                                               9%




       0%
                      Total    <150% FPL 150-299% 300-499% 500% FPL
                    Population              FPL      FPL   and higher


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                          37
                                                                                                 Non-Elderly Adults
Non-Elderly Adults in Families with
Problems Paying Medical Bills in Past 12
                                                                                                 Among non-elderly
Months by Race/Ethnicity                                                                         adults, black, non-
                                                                                                 Hispanics were more
                                                                                                 likely to report
     40%                                                                                         problems paying
                                                                                                 medical bills than were
                                                                                                 white, non-Hispanic
                                                                                                 adults.

     30%

                                                               25%

                                                                           20%          20%
     20%
                           17%
                                                     16%



     10%




       0%
                      Total                       White,    Black, non- Other, non-   Hispanic
                    Population                     non-      Hispanic    Hispanic
                                                 Hispanic


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                   38
                                                                                            Non-Elderly Adults
Non-Elderly Adults in Families with
Problems Paying Medical Bills in Past 12
                                                                                            Non-elderly adults in
Months by Health Status                                                                     fair or poor health
                                                                                            were twice as likely to
                                                                                            have had trouble
     40%                                                                                    paying medical bills
                                                                                            than adults in better
                                                                                            health (31% versus
                                                                                            15%).
                                                                              31%
     30%




     20%
                                    17%
                                                           15%



     10%




       0%
                      Total Population               Good, very good, Fair or poor health
                                                     or excellent health


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                              39
                                                                                                Non-Elderly Adults
Non-Elderly Adults in Families with
Problems Paying Medical Bills in Past 12
                                                                                                Non-elderly adults with
Months by Disability Status                                                                     a disability were more
                                                                                                than twice as likely to
                                                                                                have had trouble
     40%                                                                                        paying medical bills as
                                                                                                adults without a
                                                                                                disability (30% versus
                                                                                                14%).
                                                                                30%
     30%




     20%
                                    17%
                                                            14%


     10%




       0%
                      Total Population                   No activity    Activities limited by
                                                     limitations due to  health problems
                                                      health problems


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                              40
                                                                             Non-Elderly Adults
Non-Elderly Adults in Families with
Problems Paying Medical Bills in Past 12
                                                                             Uninsured non-elderly
Months by Insurance Status                                                   adults were more than
                                                                             twice as likely to have
                                                                             had trouble paying
     40%                                                                     medical bills as insured
                                                                             adults (34% versus
                                                                             16%).
                                                                   34%


     30%




     20%
                                    17%
                                                           16%




     10%




       0%
                      Total Population                Insured    Uninsured


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                            41
                                                       Children
                                                  (Ages 0 through 18)




Massachusetts Division of Health Care Finance and Policy                42
                                                                                                          Children
Children with a Usual Source of Care
by Income
                                                                                            While nearly all
                                                                                            children had a usual
                                                                                            source of care, those
                                                                                            with family income less
                                                               98%      100%
     100%                     97%                                                  98%      than 150% FPL were
                                                      93%                                   least likely to have a
                                                                                            usual source of care
                                                                                            (93%).
       80%



       60%



       40%



       20%



          0%
                        Total                        <150%   150-299% 300-499% 500% FPL
                      Population                      FPL       FPL      FPL   and higher


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                          43
                                                                                                          Children
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
     100%                        97%                    98%           98%                   race/ethnicity groups.
                                                                                   93%



       80%



       60%



       40%



       20%



          0%
                            Total                    White, non-   Other, non-   Hispanic
                          Population                  Hispanic      Hispanic


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                             44
                                                                                                            Children
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
     100%                             97%                   98%                               source of care than
                                                                               94%
                                                                                              children in better
                                                                                              health and without a
                                                                                              disability (94% versus
       80%                                                                                    98%).


       60%


       40%


       20%


          0%
                         Total Population            Good, very good, Fair or poor health
                                                     or excellent health    OR activity
                                                       AND no activity   limitations due to
                                                     limitations due to   health problems
                                                      health problems


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                               45
                                                                                                                        Children
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
     100%                 94%
                                                                                97%             96%       months, compared
                                                                   92%                             93%    with 89 to 92% of
                             89%                     89%                            90%
                                                        85%           86%                                 poorer children. Poorer
                                                                                                          children were also less
       80%                                                                                                likely to have had a
                                                                                                          preventive care visit.


       60%


       40%


       20%


          0%
                        Total    Less than                    150-299% 300-499%                 500% of
                      Population 150% of                        of FPL   of FPL                  FPL or
                                    FPL                                                          higher
                                                Any doctor visit    Visit for preventive care

Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                         46
                                                                                                                      Children
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
     100%                   94%                        95%                                             children to have had
                                                             90%         91%               92%         any doctor visit or a
                                      89%                                                              preventive care visit in
                                                                               86%               86%
                                                                                                       the past 12 months.
       80%



       60%



       40%



       20%



          0%
                            Total                    White, non-       Other, non-         Hispanic
                          Population                  Hispanic          Hispanic
                                                Any doctor visit   Visit for preventive care

Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                          47
                                                                                                                    Children
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
     100%                       94%                            94%                                   or poor health or with
                                             89%                      89%              91%           an activity limitation to
                                                                                               87%
                                                                                                     have had a doctor visit
       80%                                                                                           in the past 12 months.



       60%


       40%


       20%


          0%
                         Total Population                Good, very good, Fair or poor health
                                                         or excellent health    OR activity
                                                           AND no activity   limitations due to
                                                         limitations due to   health problems
                                                          health problems
                                                Any doctor visit   Visit for preventive care

Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                     48
                                                                                          Children
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.
     40%                                                                    Of children with family
                                                                            income less than
                                                                            300% FPL, 17%-19%
                                                                            went without needed
                                                                            care, compared with
                                                                            3% of children at the
     30%                                                                    highest income level.




     20%                                                   19%
                                                     17%


                           12%                                   11%
     10%


                                                                       3%

       0%
                      Total    <150% FPL 150-299% 300-499% 500% FPL
                    Population              FPL      FPL   and higher


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                              49
                                                                                                         Children
Children Not Getting Needed Care Due
to Cost in Past 12 Months by
                                                                                            Unmet need for health
Race/Ethnicity                                                                              care due to cost was
                                                                                            highest for Hispanic
                                                                                            children, at 22%.
     40%




     30%


                                                                                   22%

     20%


                               12%                                    11%
                                                        10%
     10%




       0%
                         Total                       White, non-   Other, non-   Hispanic
                       Population                     Hispanic      Hispanic


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                            50
                                                                                                             Children
Children Not Getting Needed Care Due
to Cost in Past 12 Months by Health and
                                                                                              Children in fair or poor
Disability Status                                                                             health or with a
                                                                                              disability were more
                                                                                              than twice as likely to
     40%                                                                                      have unmet need for
                                                                                              health care as children
                                                                                              in better health and
                                                                                              without a disability
                                                                                              (22% versus 10%).
     30%


                                                                               22%
     20%


                                    12%
                                                            10%
     10%



       0%
                      Total Population               Good, very good, Fair or poor health
                                                     or excellent health    OR activity
                                                       AND no activity   limitations due to
                                                     limitations due to   health problems
                                                      health problems


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                 51
                                                                                                       Children
Children with Difficulty Obtaining Care
in Past 12 Months by Income
                                                                                          Children with family
                                                                                          income less than
                                                                                          150% FPL were most
                                                                                          likely to face
     40%                                                                                  difficulties getting
                                                                                          health care, at 24%.




     30%

                                                     24%


     20%                                                               18%
                           17%                                17%

                                                                                 13%

     10%




       0%
                      Total                     Less than   150-299% 300-499%   500% of
                    Population                  150% of       of FPL   of FPL    FPL or
                                                   FPL                           higher


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                         52
                                                                                                           Children
Children with Difficulty Obtaining Care
in Past 12 Months by Race/Ethnicity
                                                                                             While Hispanic children
                                                                                             were most likely to
                                                                                             face difficulties
                                                                                             obtaining health care,
     40%                                                                                     17% of all children
                                                                                             faced barriers to
                                                                                             getting care.



     30%




                                                                                    19%
     20%                                                               18%
                               17%                      17%




     10%




       0%
                         Total                       White, non-    Non-white,    Hispanic
                       Population                     Hispanic     non-Hispanic


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                               53
                                                                                                             Children
Children With Difficulty Obtaining Care
in Past 12 Months by Health and
                                                                                              Children in fair or poor
Disability Status                                                                             health or with a
                                                                                              disability were more
                                                                                              likely to face
     40%                                                                                      difficulties obtaining
                                                                                              care than children in
                                                                                              better health and
                                                                                              without a disability
                                                                                              (27% versus 16%).
     30%
                                                                               27%



     20%                            17%
                                                            16%



     10%



       0%
                      Total Population               Good, very good, Fair or poor health
                                                     or excellent health    OR activity
                                                       AND no activity   limitations due to
                                                     limitations due to   health problems
                                                      health problems


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                 54
                                                                                                                                                           Children
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
     50%                                                                                                                                      family income less
                                                                                                                                              than 150% FPL visiting
                                                                                                                                              the ER.
                                                     41%
     40%
                                                                                  35%                         36%
                         32%
     30%

                                                                                                                                   22%
     20%                                                                                  18%
                                                             17%
                                                                                                                      15%
                                 13%

     10%
                                                                                                                                         6%


        0%
                       Total                       Less than                  150-299% 300-499%                                    500% of
                     Population                    150% of                      of FPL   of FPL                                     FPL or
                                                      FPL                                                                           higher
                          Any ER visit                 Most recent ER visit was a non-emergency ER visit*

*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


Massachusetts Division of Health Care Finance and Policy                                                                                                           55
                                                                                                                                                             Children
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
     50%                                                                                                                                       emergency or non-
                                                                                                                                               emergency ER visit.
                                                                                                                                   44%

     40%

                           32%                                 31%
     30%                                                                                           28%
                                                                                                                                         24%


     20%

                                      13%
                                                                         11%                                 12%
     10%



        0%
                           Total                           White, non-                         Other, non-                         Hispanic
                         Population                         Hispanic                            Hispanic
                          Any ER visit                 Most recent ER visit was a non-emergency ER visit*

*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


Massachusetts Division of Health Care Finance and Policy                                                                                                                56
                                                                                                                                                         Children
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%),
     60%                                                                                                                                   compared with nearly
                                                                                                                               55%         three out of ten
                                                                                                                                           children in better
     50%                                                                                                                                   health and without a
                                                                                                                                           disability (29%). Rates
                                                                                                                                           of non-emergency ER
     40%                                                                                                                                   visits were also higher
                                32%                                                                                                        among children in
     30%                                                                       29%                                                         poorer health or with a
                                                                                                                                           disability (20% versus
                                                                                                                                     20%   12%).
     20%
                                             13%                                             12%
     10%

        0%
                        Total Population                             Good, very good, Fair or poor health
                                                                     or excellent health    OR activity
                                                                       AND no activity   limitations due to
                                                                     limitations due to   health problems
                                                                      health problems
                          Any ER visit                 Most recent ER visit was a non-emergency ER visit*

*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


Massachusetts Division of Health Care Finance and Policy                                                                                                          57
                                                                                          Children
Children in Families with Problems
Paying Medical Bills in Past 12 Months
                                                                            Problems paying
by Income                                                                   medical bills were
                                                                            most common in the
                                                                            families of lower-
     40%                                                                    income children,
                                                                            particularly those with
                                                                            family income between
                                                                            150 and 299% FPL.


     30%

                                                           25%
                                                     23%

                                                                 20%
     20%
                           17%




     10%
                                                                       7%




       0%
                      Total    <150% FPL 150-299% 300-499% 500% FPL
                    Population              FPL      FPL   and higher


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                              58
                                                                                                          Children
Children in Families with Problems
Paying Medical Bills in Past 12 Months
                                                                                            Other, non-Hispanic
by Race/Ethnicity                                                                           and Hispanic children
                                                                                            were most likely to live
                                                                                            in families that had
     40%                                                                                    trouble paying medical
                                                                                            bills (22%).




     30%


                                                                      22%          22%

     20%
                               17%
                                                        15%



     10%




       0%
                         Total                       White, non-   Other, non-   Hispanic
                       Population                     Hispanic      Hispanic


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                           59
                                                                                                              Children
Children in Families with Problems
Paying Medical Bills in Past 12 Months
                                                                                              Children in fair or poor
by Health and Disability Status                                                               health or with a
                                                                                              disability were twice as
                                                                                              likely to live in families
     40%                                                                                      with difficulty paying
                                                                                              medical bills than were
                                                                                              other children (31%
                                                                               31%            versus 15%).
     30%



     20%                            17%
                                                            15%


     10%



       0%
                      Total Population               Good, very good, Fair or poor health
                                                     or excellent health    OR activity
                                                       AND no activity   limitations due to
                                                     limitations due to   health problems
                                                      health problems


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                               60
                                                     Elderly Adults
                                                   (Ages 65 and Older)




Massachusetts Division of Health Care Finance and Policy                 61
                                                                                                  Elderly Adults
Elderly Adults with a Usual Source of
Care by Income
                                                                                            Nearly all elderly
                                                                                            adults had a usual
                                                                                            source of care,
                                                                                            although those with
     100%                                                                97%       98%      lower family incomes
                              95%                              94%                          were less likely to have
                                                      89%                                   a usual source of care.

       80%



       60%



       40%



       20%



          0%
                        Total                        <150%   150-299% 300-499% 500% FPL
                      Population                      FPL       FPL      FPL   and higher


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                           62
                                                                                 Elderly Adults
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
     100%                             95%                  96%             of care than other
                                                                           adults (96% versus
                                                                   88%     88%).

       80%



       60%



       40%



       20%



          0%
                         Total Population            White, non-   Other
                                                      Hispanic


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                         63
                                                                                                  Elderly Adults
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
     100%                             95%                  96%                              usual source of care
                                                                              92%           (92% versus 96%).



       80%



       60%



       40%



       20%



          0%
                         Total Population            Good, very good, Fair or poor health
                                                     or excellent health


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                64
                                                                                                    Elderly Adults
Elderly Adults with a Usual Source of
Care by Disability Status
                                                                                              Nearly all elderly
                                                                                              adults had a usual
                                                                                              source of care,
                                                                                              regardless of disability
     100%                             95%                  96%                 94%
                                                                                              status.




       80%



       60%



       40%



       20%



          0%
                         Total Population                No activity     Activities limited
                                                     limitations due to by health problems
                                                      health problems


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                 65
                                                                                                                Elderly Adults
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
     100%                 95%                                      95%          96%             97%       preventive care visit.
                                                     90%                            89%            90%    However, elderly
                                 87%                                 87%                                  adults with family
                                                       82%                                                income less than
       80%                                                                                                150% FPL were less
                                                                                                          likely than higher-
                                                                                                          income elderly adults
                                                                                                          to have had a doctor
       60%                                                                                                visit or a preventive
                                                                                                          care visit.


       40%


       20%


          0%
                        Total    Less than                    150-299% 300-499%                 500% of
                      Population 150% of                        of FPL   of FPL                  FPL or
                                    FPL                                                          higher

                                                Any doctor visit    Visit for preventive care

Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                           66
                                                                                                           Elderly Adults
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
     100%                       95%                            95%                                   and a preventive care
                                                                                                     visit than adults of
                                             87%                      88%              88%           other races/ethnicities.
                                                                                               85%

       80%



       60%



       40%



       20%



          0%
                         Total Population                    White, non-                  Other
                                                              Hispanic

                                                Any doctor visit   Visit for preventive care

Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                    67
                                                                                                           Elderly Adults
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
     100%                       95%                            95%                     95%
                                                                                                     fair or poor health
                                                                                                     were less likely than
                                             87%                      88%                            other elderly adults to
                                                                                               84%
                                                                                                     have had a preventive
       80%                                                                                           care visit.




       60%



       40%



       20%



          0%
                         Total Population                Good, very good, Fair or poor health
                                                         or excellent health

                                                Any doctor visit   Visit for preventive care

Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                       68
                                                                                                               Elderly Adults
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
     100%                       95%                            94%                     96%               had a preventive care
                                                                                                         visit.
                                             87%                      87%                      87%

       80%


       60%


       40%


       20%


          0%
                         Total Population                     No activity         Activity limitations
                                                          limitations due to        due to health
                                                           health problems             problems

                                                Any doctor visit   Visit for preventive care

Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                            69
                                                                                 Elderly Adults
Elderly Adults Not Getting Needed Care
Due to Cost in Past 12 Months by
                                                                            Unmet need for care
Income                                                                      because of cost was
                                                                            highest among elderly
                                                                            adults with family
     80%                                                                    income below 150%
                                                                            FPL. Some 22% of
                                                                            those adults skipped
                                                                            needed health care
                                                                            compared with 8% of
                                                                            those with family
     60%                                                                    income at 500% FPL or
                                                                            higher.



     40%



                                                     22%
     20%                                                   17%
                           13%
                                                                 10%
                                                                       8%


       0%
                      Total    <150% FPL 150-299% 300-499% 500% FPL
                    Population              FPL      FPL   and higher


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                        70
                                                                                Elderly Adults
Elderly Adults Not Getting Needed Care
Due to Cost in Past 12 Months by
                                                                           White, non-Hispanic
Race/Ethnicity                                                             elderly adults were
                                                                           much less likely to
                                                                           have unmet need for
     80%                                                                   care because of cost
                                                                           than were other
                                                                           elderly adults (11%
                                                                           versus 31%).


     60%




     40%
                                                                   31%



     20%
                                    13%
                                                           11%



       0%
                      Total Population               White, non-   Other
                                                      Hispanic


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                          71
                                                                                                  Elderly Adults
Elderly Adults Not Getting Needed Care
Due to Cost in Past 12 Months by Health
                                                                                            Among elderly adults,
Status                                                                                      those in fair or poor
                                                                                            health were more
                                                                                            likely to have unmet
     80%                                                                                    need for care because
                                                                                            of cost than were
                                                                                            those in better health
                                                                                            (20% versus 11%).


     60%




     40%



                                                                              20%
     20%
                                    13%
                                                           11%



       0%
                      Total Population               Good, very good, Fair or poor health
                                                     or excellent health


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                             72
                                                                                                      Elderly Adults
Elderly Adults Not Getting Needed Care
Due to Cost in Past 12 Months by
                                                                                                Among elderly adults,
Disability Status                                                                               those who were
                                                                                                disabled were more
                                                                                                likely to have unmet
     80%                                                                                        need for care because
                                                                                                of cost than were
                                                                                                those without a
                                                                                                disability (20% versus
                                                                                                10%).
     60%




     40%



                                                                                20%
     20%
                                    13%
                                                            10%



       0%
                      Total Population                   No activity    Activities limited by
                                                     limitations due to  health problems
                                                      health problems


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                 73
                                                                                               Elderly Adults
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
     80%                                                                                  care in the past 12
                                                                                          months.




     60%




     40%




     20%
                           15%                                15%      15%       15%
                                                     13%



       0%
                      Total                     Less than   150-299% 300-499%   500% of
                    Population                  150% of       of FPL   of FPL    FPL or
                                                   FPL                           higher


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                           74
                                                                                 Elderly Adults
Elderly Adults With Difficulty Obtaining
Care in Past 12 Months by
                                                                           White, non-Hispanic
Race/Ethnicity                                                             elderly adults were
                                                                           less likely to have had
                                                                           difficulty obtaining
     40%                                                                   care than were other
                                                                           elderly adults (14%
                                                                           versus 18%).



     30%




     20%
                                                                   18%
                                    15%                    14%


     10%




       0%
                      Total Population               White, non-   Other
                                                      Hispanic


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                             75
                                                                                                  Elderly Adults
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
     40%                                                                                    health care.




     30%




     20%
                                                                              16%
                                    15%                    14%


     10%




       0%
                      Total Population               Good, very good, Fair or poor health
                                                     or excellent health


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                              76
                                                                                                      Elderly Adults
Elderly Adults With Difficulty Obtaining
Care in Past 12 Months by Disability
                                                                                                 Elderly adults with a
Status                                                                                           disability were more
                                                                                                 likely to have had
                                                                                                 difficulty obtaining
     40%                                                                                         health care than those
                                                                                                 without a disability
                                                                                                 (17% versus 13%).


     30%




     20%
                                                                                 17%
                                    15%
                                                            13%

     10%




       0%
                      Total Population                   No activity      Activity limitations
                                                     limitations due to     due to health
                                                      health problems          problems


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                  77
                                                                                                                                                    Elderly Adults
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
     50%                                                                                                                                      ER visit in the past 12
                                                                                                                                              months than higher-
                                                     44%                                                                                      income adults.

     40%
                                                                                  35%
                         31%
     30%
                                                                                                              24%                  24%

     20%


     10%                                                       9%                          9%
                                  7%
                                                                                                                        5%               6%


        0%
                       Total                       Less than                  150-299% 300-499%                                    500% of
                     Population                    150% of                      of FPL   of FPL                                     FPL or
                                                      FPL                                                                           higher

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

*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


Massachusetts Division of Health Care Finance and Policy                                                                                                                78
                                                                                                                                                  Elderly Adults
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
     50%                                                                                                                                    12 months. White,
                                                                                                                                            non-Hispanic elderly
                                                                                                                                            adults were half as
                                                                                                                                            likely to visit the ER for
     40%                                                                                                                                    a non-emergency as
                                                                                                                                            elderly adults in other
                                                                                                                                            race/ethnicity groups.
                                31%                                            31%                                             32%
     30%



     20%

                                                                                                                                      12%
     10%                                       7%                                             6%



        0%
                        Total Population                                     White, non-                                           Other
                                                                              Hispanic

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

*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


Massachusetts Division of Health Care Finance and Policy                                                                                                             79
                                                                                                                                                Elderly Adults
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
     50%                                                                                                                                  have had an ER visit
                                                                                                                               46%        (46% versus 26%).


     40%

                                31%
     30%
                                                                               26%


     20%



     10%                                                                                                                             9%
                                               7%                                             7%



        0%
                        Total Population                             Good, very good, Fair or poor health
                                                                     or excellent health

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

*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


Massachusetts Division of Health Care Finance and Policy                                                                                                          80
                                                                                                                                                 Elderly Adults
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
     50%                                                                                                                                   12 months, compared
                                                                                                                                           with close to 3 in 10
                                                                                                                                           (27%) non-disabled
                                                                                                                                           residents.
     40%                                                                                                                       38%


                                31%
     30%                                                                       27%



     20%


     10%                                                                                      9%
                                               7%
                                                                                                                                     3%

        0%
                        Total Population                                  No activity                               Activity limitations
                                                                      limitations due to                              due to health
                                                                       health problems                                   problems

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

*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


Massachusetts Division of Health Care Finance and Policy                                                                                                             81
                                                                                 Elderly Adults
Elderly Adults in Families with Problems
Paying Medical Bills in Past 12 Months
                                                                           Elderly adults with
by Income                                                                  family incomes below
                                                                           300% FPL were most
                                                                           likely to live in families
     30%                                                                   that had had problems
                                                                           paying medical bills in
                                                                           the past 12 months.




     20%


                                                     14%
                                                           11%

     10%
                            8%


                                                                 4%
                                                                      2%

       0%
                      Total    <150% FPL 150-299% 300-499% 500% FPL
                    Population              FPL      FPL   and higher


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                82
                                                                                 Elderly Adults
Elderly Adults in Families with Problems
Paying Medical Bills in Past 12 Months
                                                                           Compared with white,
by Race/Ethnicity                                                          non-Hispanic elderly
                                                                           adults, other elderly
                                                                           adults were three
     30%                                                                   times as likely to live
                                                                           in families that had
                                                                           problems paying
                                                                           medical bills (6%
                                                                           versus 18%).



     20%
                                                                   18%




     10%
                                     8%
                                                           6%




       0%
                      Total Population               White, non-   Other
                                                      Hispanic


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                             83
                                                                                                  Elderly Adults
Elderly Adults in Families with Problems
Paying Medical Bills in Past 12 Months
                                                                                            Elderly adults in fair or
by Health Status                                                                            poor health were more
                                                                                            than 4 times as likely
                                                                                            than those in better
     30%                                                                                    health to live in
                                                                                            families that had
                                                                                            problems paying
                                                                                            medical bills (17%
                                                                                            versus 4%).



     20%
                                                                              17%




     10%
                                     8%


                                                            4%



       0%
                      Total Population               Good, very good, Fair or poor health
                                                     or excellent health


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                84
                                                                                                      Elderly Adults
Elderly Adults in Families with Problems
Paying Medical Bills in Past 12 Months
                                                                                                Elderly adults with a
by Disability Status                                                                            disability were much
                                                                                                more likely than those
                                                                                                without a disability to
     30%                                                                                        live in families that
                                                                                                had problems paying
                                                                                                medical bills (14%
                                                                                                versus 4%).



     20%


                                                                                14%



     10%
                                     8%


                                                            4%



       0%
                      Total Population                   No activity    Activities limited by
                                                     limitations due to  health problems
                                                      health problems


Source: 2008 Massachusetts Health Insurance Survey


Massachusetts Division of Health Care Finance and Policy                                                                  85
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

				
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