Profile of the Health Care Consumer Steven P. Wallace, Ph.D. Professor of Community Health Sciences Assoc. Director Center for Health Policy Research UCLA School of Public Health

Key Points Most people visit a doctor during the year Insurance status varies by race,income, and region of Los AngelesMost uninsured persons are in employed families Most uninsured persons are in employed families Communty clinics are particularly important for those with low-incomes and no insurance

Elderly & Kids, Women & those with Health Insurance most likely to see a doctor in past year *All ages ** Ages 0-64 Source: 2003 California Health Interview Survey

Insurance by Race/Ethnic Group Los Angeles County Source: 2003 California Health Interview Survey

Insurance by Household Income Los Angeles County Source: 2003 California Health Interview Survey

Insurance by SPA Los Angeles County Source: 2003 California Health Interview Survey

Uninsured Rates in Assembly Districts, Los Angeles County, 2002 Estimated based on CHIS 2001 data Uninsured rates vary by legislative district

Uninsurance problem is worse in California and LA than nationally Over 6.5 million California children and adults uninsured all or part of year –1 in 5 of state’s nonelderly population –Nearly 1 in 6 of nation’s uninsured lives in California LA is epicenter of national problem –over 2 million uninsured –1 in 4 of county’s nonelderly residents Parts of LA have even more uninsured residents –33% in Metro and South areas (SPAs 4 and 6) Source: 2003 California Health Interview Survey and 2004 Current Population Survey Percent Uninsured All or Part of Year, Nonelderly Adults and Children

Uninsured are overwhelmingly in working families Source: 2003 California Health Interview Survey Over 1.2 million uninsured children and adults live in a household headed by a full-time working employee. Only one-fourth of the uninsured are in non-working families. –Many non-working families are headed by a single or disabled adult.

Low rate of employers offering coverage drives low job-based insurance rate 818,000 Los Angeles County workers are employed by firms that don’t offer coverage Offer, Eligibility, and Take-up Rates for Own Job-based Health Insurance, Employees Ages 19-64, California, 2003 Source: 2003 California Health Interview Survey

Providing outpatient care can improve the health of the uninsured Asthma, hypertension, and poor self-assessed health are ambulatory sensitive conditions

25.3% 2.6% 28.5% 2.7% 15.4% 82.% 8.1% 8.7% Safety-net providers are important to uninsured adults and those on Medi-Cal California safety-net providers are usual source of care for 1 in 4 uninsured adults and 1 in 4 adult Medi-Cal beneficiaries Source: 2003 California Health Interview Survey 85.8% 58.6% 25.9% 7.1% 28.8% 28.3% 6.8% 11.6% 44.7% Uninsured All or Part Year Medi-Cal or Healthy Families All Year Employer-Based Insurance All Year Doctor's Office/HMO/Kaiser Community or Government Clinic, Community Hospital No Usual Source of Care Adults, Ages 19-64

31.2% 40.3% 1.1% 37.9% 5.9% 85.3% 10.2% 0.5% 3.6% Safety-net providers are important to uninsured children and those on Medi-Cal and Healthy Families Safety-net clinics and hospitals are usual source of care for: 4 in 10 uninsured children and 4 in 10 children with Medi-Cal or Healthy Families coverage The longer people are uninsured, the more they rely on safety net clinics and hospitals Source: 2003 California Health Interview Survey 74.2% 46.3% 37.5% 14.7% 41.5% 37.2% 10.1% 11.5% 24.8% Uninsured All or Part Year Medi-Cal or Healthy Families All Year Employer-Based Insurance All Year Doctor's Office/HMO/Kaiser Community or Government Clinic, Community Hospital No Usual Source of Care Children, Ages 0-18

Conclusions Access of medical care is essential for everyone The uninsured are less likely to see the doctor, but still need medical care Uninsured persons exist across all groups and regions, but not equally Safety net providers are key to the health of low income and uninsured persons