Future Problem Solving Program of CT Healthcare Access Seminar ACCESS TO HEALTHCARE: BARRIERS TO COVERAGE AND CARE IN CONNECTICUT Susan Cole & Marybeth Bonadies March 21, 2006

Office of Health Care Access (OHCA) Connecticut state agency predecessor agency was established by the General Assembly in 1973 Website:

OHCA’s Mission regulating health care system development through the Certificate of Need Program (CON) collecting and analyzing data used to advise policy makers on health care issues Ensure citizens of Connecticut have access to a quality health care delivery system by:

Connecticut Facts Connecticut has 3.4 million citizens Connecticut has 169 towns 94% of Connecticut residents have health insurance coverage, leaving 6% uninsured Connecticut has 31 hospitals

Connecticut Hospitals

Factors that influence access: Resource availability Health insurance status Income Race/ethnicity Employment status

What is Certificate of Need? (CON) State mandated program Regulates services offered by health care facilities Regulates major capital expenditures by health care facilities Regulates purchase of certain imaging equipment

Certificate of Need What is a healthcare facility? Hospitals, clinics, ambulatory surgery centers, cancer centers, etc. What imaging equipment requires CON authorization? CT scanner, MRI scanner, PET/CT scanner, linear accelerator, and cardiac cath lab

CON’s Contribution to Resource Availability Availability of therapeutic services in the community that need to be accessed on a frequent basis Orderly introduction of new technologies and services to Connecticut Guarantee that specialized services are available in a centralized location “center of excellence” Note: Access does not equal convenience

Factors that influence access: Resource availability Health insurance status Income Race/ethnicity Employment status

Most Connecticut residents have health insurance coverage But an estimated 196,000 uninsured out of 3.4 million people do not

Access and the Uninsured…… The uninsured are: less likely to have a regular source of care, make fewer physician visits, and more likely to forego medical care or a prescription when they have and illness or injury.

Uninsured more likely to forego necessary care or prescriptions Percent not getting care Source: OHCA 2004 Household Survey

Who are Connecticut’s uninsured? Source: 2004 Household Survey

Factors that influence access: Resource availability Health insurance statusIncome Race/ethnicity Employment status

Low income families more likely uninsured Source: 2004 Household Survey

Factors that influence access: Resource availability Health insurance status IncomeRace/ethnicity Employment status

Hispanics are over-represented among the uninsured

Factors that influence access: Resource availability Health insurance status Income Race/ethnicity Employment status

Connecticut’s Health Insurance System Source: 2004 Household Survey

“ There are no medical or pension benefits, but our employees’ lounge has excellent free coffee” Eroding Employer based coverage:

Implications of barriers to individuals and to society Individual delayed care – poorer health outcomes out of pocket health costs Health Care Providers overburdened hospital emergency departments uncompensated care costs Society higher health care costs strained public health facilities

Where does this leave us? Some current approaches: Build on current employer-based system Shift to individual responsibility –consumer directed care Expand public coverage –single payer/universal coverage

Many Options to Consider Employer mandates Tax credits Premium Assistance Consumer-directed care Universal coverage

A Connecticut health care system that offers a full continuum of high quality health care to all residents in an effective, affordable and accessible manner Access to coverage and care

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