1. Disparities in Access: a presentation to the Massachusetts Health Disparities Council Jarrett T. Barrios April 27, 2009

2. Overview The Foundation’s approach Overview of our research The critical access issues Where to from here?

3. The Foundation’s approach to disparities Emphasis on access and equity Broad definition of disparities

4. The Foundation’s disparities-related research agenda Monitoring impact of Chapter 58 Public polling on insurance and usage (Blendon, Globe) Survey of consumers (Urban) Research focused on access issues in immigrant communities Care Beyond Coverage

5. Data Issues Limited pre/post Chapter 58 data Proxies for race and ethnicity Oversamples to be able to comment on differences by R/E Difficultly distinguishing legal immigrants and unauthorized

6. Research Findings

7. Mixed Evidence on Impact of Health Reform on Disparities Coverage Access Unmet Need Affordability

8. Disparities in Uninsurance Rates by Income Source: Sharon Long, Massachusetts Health Reform Survey, 2008 Drop in uninsurance larger for low-income adults

9. Health Reform’s Impact on Access to Care for Low-income Individuals Source: Sharon Long, Massachusetts Health Reform Survey, 2008 Low-income adults more likely to have a regular health care provider and to have had health care visits over the prior year

10. Disparities in Unmet Need Source: Sharon Long, Massachusetts Health Reform Survey, 2008 Both low-income and higher-income adults less likely to have any unmet need for health care over the prior year

11. Disparities in Unmet Need Because of Difficulties Seeing a Provider Source: Sharon Long, Massachusetts Health Reform Survey, 2008 Low-income adults more likely have unmet need for health care over the prior year because of difficulties getting to see a provider

12. Recent Evidence on Health Disparities Personal Care Providers Emergency Department Use Health Status

13. Disparities in Having a Personal Care Provider Racial/ethnic disparities 79% of Hispanic respondents and 88% of non-Hispanic non-Whites report having a personal care provider, compared to 91% of non-Hispanic Whites. Citizenship disparities Non-US citizens are less likely to report having a personal care provider (85%) than citizens (91%). Geographical disparities The lowest rates of having a personal provider were found in Essex County (80%) and Western MA (84%). The highest rates were found in Suffolk/Norfolk Counties (95%) and Southeastern Massachusetts/Cape Cod/Islands (94%). Source: Massachusetts Health Care Access Survey, Fall 2008

14. Disparities in Emergency Dept Use for Non-emergency Conditions Racial/ethnic disparities Hispanics (26%) and non-Hispanic non-Whites (24%) are more likely to use the ED for conditions treatable by their PCP than non-Hispanic Whites (13%). Age disparities 18-34 year olds are more likely to use the ED for non-emergency conditions (22%) than older adults (35-49 yrs, 13%; 50-64 yrs, 15%). Education disparities Individuals with a high school degree or less are more likely to use the ED (23%) than individuals with college or postgraduate degrees (12%). Income disparities 24% of residents with household incomes ≤300% MA poverty level used the ED compared to 12% of higher income individuals. Source: Massachusetts Health Care Access Survey, 2008

15. Disparities Access by Health Status Individuals who self report being in poor/fair health are more likely than those with excellent/very good health to Forego needed medical care (19% vs. 4%) Use the ED for non-emergency conditions (31% vs. 10%) Have medical debt in the past year (26% vs. 9%) Avoid or postpone treatment because they owed money (18% vs. 7%) Avoid filling a prescription because of cost (29% vs. 13%) Source: Massachusetts Health Care Access Survey, 2008

16. Critical Takeaways Barriers to access are not new Disparities continue despite insurance coverage Issues outside the medical arena cannot be ignored

17. Much is Known; What’s the Action? Opportunity for Disparities Council to serve as a catalyst Foundation Disseminate findings Summit—May 28, 2009 Grantmaking—focus on community voice and broad understanding of disparities and SDOH Selected areas for continued study We can make a difference—we did with coverage