Taking the Pulse of Health in Ohio. Results of the 2008 Ohio Family Health Survey

Transcription

1 Taking the Pulse of Health in Ohio Results of the 2008 Ohio Family Health Survey

2 History and Study Design The 2008 OFHS is the third survey, also done in 2004 and 1998 Survey data between years are not fully comparable because of changes in design and questions to improve the quality of the results The 2008 OFHS contains responses from almost 51,000 adults, one per household This survey contains proxy responses for over 13,000 children, one per household This survey is a complex design that requires using special statistical techniques and software to analyze 2

3 3 Topics Addressed In The 2008 Ohio Family Health Survey Include: Employment characteristics Income Health status Access to care Health care utilization Health outcomes & selected disease estimates Health coverage status Coverage for supplemental services (vision, dental, prescriptions, & mental health) Unmet needs Health risk factors

4 Types of Analysis Possible Rates by race (White, Black, and Asian), and ethnicity (Hispanic) Rates by region: Appalachia, Metropolitan, Rural non-appalachia, and Suburban Rates by county on many variables, depending on sample size Rates by income Rates by type of coverage Rates by uninsured and insured 4

5 5 For the 2008 Ohio Family Health Survey Mahoning, Trumbull, and Ashtabula Counties are not counted in the Appalachian Region because that change by the Board of Demographers took place after the project started

6 6 Caveats and Reminders The income reported is the annual family income for the 2007 calendar year; it does not reflect current reality The insurance status and working status reference the week prior to being surveyed; the rates are likely different currently because of changes in the economy Survey results should not be considered reliable or reported when the confidence intervals associated with a proportion cover zero (e.g., -2.1, 0, 2.1) The survey results include upper and lower counts based on the confidence intervals. Traditionally, the middle point count associated with a variable s proportion should be reported caution should be used when considering how to report the upper and lower confidence limits.

7 Key Findings Ohio's child uninsured rate was 4.0% in 2008, down from 5.4% in 2004 Ohio's uninsured rate had increased from 15.0% in 2004 to 17.0% in % of the uninsured had incomes below 300% of poverty (88.0% for children) Appalachia and Rural Ohio regions had large increases in the uninsured group (17.8% to 21.9% and 13.3% to 17%); Suburban Ohio region had improvement in uninsured rates 7

8 Key Findings Hispanics children were 3.25 times more likely to be uninsured, 2.57 times for Hispanics Blacks were 1.79 times more likely to be uninsured than Whites, while Black and White children had a similar uninsured rate The percent of Ohioans who got coverage through job-based coverage fell from 63.5% in 2004 to 61.7% in 2008 The uninsured reported greater issues with access to care, unmet need, and paying for care than the insured (e.g., uninsured and children were 2.68 and 5.1 times more likely to not have a usual source of care) 8

9 Key Findings The uninsured reported poorer health status and more ER use, but a lower use of hospitalizations Some insured reported issues with access to care and paying medical bills (e.g., 23.5% reported difficulty paying bills) More Ohioans reported lacking coverage for dental, vision, mental health, or prescription drug services than being uninsured Medicare Part D had lowered the percent of seniors reporting no drug coverage by almost 60%, though 12% still reported not having prescription drug coverage 9

10 Key Findings A key reason for an increase in the uninsured rate was a large increase in the number of those who were not working, up from 30.6% in 2004 to 35.1% in 2008 Most of the uninsured children (77,023) had incomes below 201% of poverty, suggesting that they are income eligible for Medicaid/SCHIP 10

11 Profile Of Ohio s Uninsured and Insured Populations: Children (< 18), Working Age Adults (18 64), and Seniors ( 65) 11

12 Ohio s Child Uninsured Declined; Uninsured Rate Increased 18.0% 16.0% 17.0% % 15.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% 5.4% 4.0% 1.1% 0.7% child seniors 12 Between 2004 and 2008 the number of uninsured Ohio children fell from 155,973 to 111,255, while the number of uninsured Ohioans increased from 1,055,651 to 1,220,895

13 Child uninsured rate varied by region; 7.0% highest in rural counties in % 6.3% % 5.4% 4.8% 5.5% 5.1% 4.9% 4.8% 4.0% 4.0% 3.9% 3.0% 3.3% 2.0% 1.0% 0.0% Ohio Appalachia Metropolitan Rural Suburban 13

14 Uninsured Rate for Children Varied Among Metro Counties Sum mit Stark Richland Montgomery Mahoning Lucas Lorain Ham ilton Franklin Cuyahoga Butler Allen 2008 Uninsured Children By Metro County 3.0% 3.0% 2.2% 4.1% 3.7% 4.3% 4.5% 3.4% 2.8% 2.2% 5.7% 6.1% 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 14 Differences in the uninsured rate between some counties may not be statistically significant

15 18-64 Uninsured Rate Varied by Region; Significant Increase in Appalachia and Rural Regions since % 20.0% 21.9% % 10.0% 15.0% 17.0% 17.8% 15.2% 17.4% 17.0% 13.3% 14.1% 12.3% 5.0% 0.0% Ohio Appalachia Metropolitan Rural Suburban 15

16 18 64 Uninsured Varied Across Metro Counties Summit 19.80% Stark 15.40% Richland Montgomery 18.20% 17.90% Mahoning 15.10% Lucas 19.50% Lorain Hamilton 15.90% 16.40% Franklin Cuyahoga 17.60% 18.90% Butler 12.40% Allen 18.90% 0.00% 5.00% 10.00% 15.00% 20.00% ,247 or 56.2% of Ohio s 1,220, uninsured lived in metropolitan counties

17 Uninsured Rate was Higher in Younger Age Adult Population 35.0% % uninsured within age group 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 29.4% 20.8% 14.8% 13.2% 10.8% 0.0% age groups 17

18 Uninsured Rate was Significantly Higher for People with Lower Educational Levels 35.0% 30.0% 33.0% 25.0% 20.0% % 21.0% % % 5.0% 6.5% 0.0% less t han high high school some college college graduate school graduat e 18

19 Hispanics Experienced Significantly Higher Uninsured Rates for All Age Groups; Blacks for Age Group 45.0% 40.0% 35.0% Children Seniors 39.0% 30.0% 25.0% 27.1% 20.0% 15.0% 10.0% 15.2% 12.4% 12.3% 5.0% 0.0% 3.8% 4.5% 3.4% 1.8% 2.3% 0.6% White Black Hispanic Asian 19

20 Being Uninsured Was Not a Short Term Experience: 63.9% Uninsured > 1 year, 47.3% for Children 70.0% 60.0% 50.0% child % 40.0% 48.4% 47.3% 41.5% 30.0% 20.0% 32.4% 28.1% 10.0% 0.0% < 1 year > 1 year > 3 years 20

21 Fewer Ohioans Got Coverage Through Their Employer, Children's Rate Dropped Even More Than Rate 90.0% 80.0% % 60.0% 50.0% 40.0% 63.5% 61.7% 53.6% 48.9% 68.1% 60.1% 77.3% 72.2% 59.5% 53.3% 30.0% 20.0% 10.0% 0.0% % FPL % FPL % FPL children 21 The categories shown have statistically significant changes between 2004 and There were not significant changes in income groups below 151% FPL and above 300% FPL

22 6.2 Percentage Point Decrease in Children on Job-based Coverage; Drop Highest in Appalachia and Rural Regions 70.0% 60.0% 50.0% 59.5% 53.3% % 57.8% 52.1% 65.4% 65.8% 55.4% 64.4% 40.0% 40.3% 30.0% 20.0% 10.0% 0.0% Ohio Appalachian Metropolitan Rural Non- Appalachian Suburban 22

23 Independent Workers and Workers in Small Firms had Highest Uninsured Rates; Rates Highest in Appalachian Region All Workers Independent 2-49 Employees Employees Employees 1,000 Employees 4.2% 3.9% 17.0% 5.4% 10.6% 10.7% 13.8% 7.3% 6.6% 4.3% 5.2% 4.3% 6.0% 9.1% 12.3% 12.5% 16.3% 20.1% 27.7% 27.3% 22.1% 23.6% 27.0% Suburban Rural Metropolitan Appalachian 34.1% 0% 5% 10% 15% 20% 25% 30% 35% 40% 23 Independent worker refers to people who are selfemployed with no employees

24 Independent workers and workers in small firms had highest uninsured rates; rates highest for Blacks and Hispanics 11.0% All Workers 20.7% 33.4% Independent 25.2% 43.6% 40.5% 2-49 Employees 20.5% 39.2% 46.9% Employees 8.2% 20.2% 38.4% Employees 5.4% 10.2% 18.7% White Black 1,000 Employees 3.9% 10.0% 7.9% Hispanic 24 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Independent worker refers to people who are selfemployed with no employees

25 Uninsured Rates were Higher for Those with Lower Incomes: 69.2% of Uninsured Children and 65.2% of Uninsured had Incomes Below 201% FPL (88% and 84.2% at 300% FPL) Category by population and income Percent Uninsured Count Proportion of Total All uninsured children 4.0% 111, % Uninsured below 101% FPL 5.0% 32, % Uninsured below 201% FPL 6.2% 77, % Uninsured below 301% FPL 5.7% 97, % Uninsured above 300% FPL 1.3% 13, % All uninsured years 17.0% 1,220, % Uninsured below 101% FPL 33.5% 390, % Uninsured below 201% FPL 32.7% 795, % Uninsured below 301% FPL 27.7% 1,027, % Uninsured above 300% FPL 5.6% 193, % 25

26 2007 FEDERAL POVERTY GUIDELINES Annual Gross Income Family Size % FPL 200% FPL 300% FPL $10,212 ($851 monthly) $13,692 ($1,141 monthly) $17,172 ($1,431 monthly) $20,652 ($1,721 monthly) $20,424 ($1,702 monthly) $27,384 ($2,282 monthly) $34,344 ($2,862 monthly) $41,304 ($3,442 monthly) $30,636 ($2,553 monthly) $41,706 ($3,423 monthly) $51,516 ($4,293 monthly) $61,956 ($5,163 monthly) $14,560 - annual income for someone working full time (2080 hours per year) at $7.00 per hour (Ohio minimum wage, as of 1/1/08) $22,880 - annual income for someone working full time at $11 per hour $731 and $3, average worker annual premium cost for single and for family coverage** 26 Source: * Federal Register; effective April 2007 April ** Employer Health Benefits 2008: Summary of Findings, Kaiser Family Foundation

27 Greater Percent of Uninsured Reported Being in Poor to Fair Health 30.0% 25.0% 20.0% 24.5% 27.1% 15.0% 10.0% 14.8% 5.0% 0.0% 4.0% 3.6% uninsured child insured child uninsured insured seniors 27

28 Uninsured Reported Higher Prevalence of Smoking and Binge Drinking, Lower for Drinking, Similar for Obesity 70.0% 60.0% 50.0% 40.0% 45.6% 50.7% 57.2% uninsured insured 30.0% 20.0% 10.0% 24.1% 26.4% 20.4% 28.2% 29.4% 0.0% regular smoker drinking in past 30 days binge drinking Obese BMI 30 28

29 More Ohioans Reported Lack of Coverage for Dental, Prescription, & Vision than Being Uninsured 60.0% 60.1% child 50.0% senior 45.3% 40.0% 39.9% 36.4% 30.0% 20.0% 18.3% 22.3% 20.8% 10.0% 0.0% 6.9% 11.8% no dental coverage no vision coverage no prescription drugs 29

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38 Factors Affecting Having Health Insurance Coverage 38

39 Factors Affecting Coverage Fewer people in workforce reduces opportunity to get job-based coverage The employed uninsured more likely to work at firms that do not offer coverage than the employed insured Not all people at firms that offer coverage meet the eligibility requirements for that coverage People with lower incomes less able to afford private coverage Older people and people with existing health issues face high premiums on the individual market A small percentage report choosing to not be insured because they do not see a need for it 39

40 Significantly More Ohioans Were Not Working; Less Access to Job-based Coverage 80.0% 70.0% 60.0% 69.4% 65.0% working not working 50.0% 40.0% 30.0% 20.0% 30.6% 35.1% 10.0% 0.0% Not working refers to anyone who is not being paid by an employer. They may be retired, unemployed looking for work, choosing to stay at home, or unable to work.

41 Not All Jobs Offered Coverage, Not All Workers were Eligible for Coverage Offered 12.0% 10.0% 8.0% 10.2% 9.8% 6.0% 7.1% 4.0% 2.0% 3.8% 0.0% firm does not offer coverage employee not eligible for firms coverage firm offers, employee uninsured employee eligible for offer, but uninsured 41

42 Employment status affected health coverage status; variation existed for both employed and not employed by race/ethnicity 25.8% % uninsured not employed Asian 8.6% 20.6% uninsured employed Hispanic 33.4% 47.4% Black 20.7% 34.7% White 11.0% 23.5% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 42

43 Employment status affected health coverage status; variation existed for both employed and not employed by region 19.3% Suburban 9.1% uninsured not employed uninsured employed Rural 12.3% 25.7% Metro 12.5% 26.5% Appalachia 16.3% 30.1% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 43

44 45% of Ohio Children and Seniors Lived in Families with Incomes Below 201% FPL; Rate was Higher in Appalachia and for Black and Hispanic families Ohio Appalachia Metro Rural Suburban White Black Hispanic < 100% FPL child 23.7% 33.8% 25.1% 19.3% 15.5% 18.6% 48.6% 43.8% < 200% FPL child 45.4% 59.6% 46.0% 44.6% 33.9% 39.6% 75.5% 66.4% < 300% FPL child 62.8% 75.1% 66.7% 64.7% 52.4% 58.3% 86.5% 79.9% < 100% FPL % 20.7% 17.4% 14.2% 11.2% 13.3% 34.8% 39.2% < 200% FPL % 43.7% 34.4% 33.6% 26.5% 30.2% 58.5% 60.3% < 300% FPL % 63.5% 51.1% 54.1% 43.8% 48.5% 74.1% 73.9% < 100% senior 14.3% 18.2% 14.1% 14.9% 12.2% 12.6% 30.9% 33.1% < 200% senior 45.0% 56.5% 43.0% 47.8% 41.5% 43.2% 65.0% 62.4% < 300% senior 69.2% 80.2% 66.7% 73.9% 66.1% 68.1% 83.1% 80.7% 44

45 Access to Care, Use of Services, and Unmet Needs 45

46 Uninsured Reported Less Likely to Have a Usual Source of Care 35.0% 30.0% 33.8% 25.0% 20.0% Without a usual source of care uninsured insured 15.0 % 10.0 % 12.3 % % 5.0% 0.0% 2.4% children seniors 5.2% 46

47 ER Use Rates Similar For Uninsured and Insured Children, Significantly Different For Uninsured and Insured 30.0% 25.0% 28.5% 1 or more visits 3 or more visits 23.9% 20.0% 20.3% 19.8 % 20.7% 15.0% 10.0% 5.0% 7.0% 0.0% 3.7% 3.1% 3.5% 2.8% uninsured child insured child uninsured insured seniors 47 An estimated 1,230,621 insured Ohioans and 488,284 insured children reported using the ER at least once compared to 347,704 uninsured and 21,735 uninsured kids

48 Use Of Urgent Care Was Similar For All Uninsured and Insured; Urgent Care Use Was Much Lower For All Than Use of ER 16.0% 14.0% 1 or more visits 13.8% 14.4% 12.0% 3 or more visits 10.0% 8.0% 6.0% 8.3% 7.8% 4.0% 2.0% 0.0% 2.4% 1.8% uninsured insured seniors 48

49 Though Uninsured Had Worse Health Status, They Were Less Likely to Be Hospitalized 25.0% 20.0% 15.0% uninsured insured 21.3% 10.0% 10.7 % 12.8 % 5.0% 4.7% 6.4% 0.0% children seniors 49

50 Uninsured Reported Much Higher Amount of Unmet Need for and Children 40.0% dental health 35.0% 37.5% 35.1% prescription drugs 30.0% 25.0% 20.0% 15.0% 16.8% 10.0% 5.0% 0.0% 12.8% uninsured child 4.0% 2.7% insured child uninsured % 9.2% insured % 7.5% seniors 50

51 Uninsured Reported Health Care Harder to Get than 3 Years Ago 60.0% 50.0% 40.0% 52.0% 30.0% 20.0% 10.0% 0.0% 19.5% 11.1% uninsured insured seniors 51

52 Uninsured Reported Greater Difficulty Paying Medical Bills 60.0% 50.0% 56.4% Had difficulty paying medical bills in past 12 months 40.0% 30.0% 20.0% 23.5% 10.0% 11.9% 0.0% uninsured insured seniors 52

53 For Those with Difficulties Paying Bills, Many Had to Not Pay for Other Needs, Used Savings, and/or Took Loans and Debt seniors insured % 32.1% 38.3% 34.1% 63.8% used loan or debt used saving s unable to pay other bills 60.2% uninsured % 46.8% 64.0% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 53

54 Some Insured Faced Access and Financial Challenges Access to care and health cost dimensions insured count health care harder to get than three years ago 19.5% 1,157,265 unmet dental health need 10.3% 612,241 unmet prescription drug need 13.1% 777,606 difficulty paying medical bills 23.5% 1,398,009 if difficulty, unable to pay other bills 34.1% 476,434 if difficulty, used savings 60.1% 840,483 if difficulty, took out loan or debt 32.1% 448,814 54

55 Implications for Potentially Eligible for Policy Options** Potentially Population group of potential interest eligible count uninsured < 18 < 201% FPL (Medicaid/SCHIP $ eligible) 77,023 uninsured < 18 > 200% <301% FPL (SCHIP expansion) 20,875 uninsured < 101% FPL 390,910 uninsured 18-64> 100% and < 201% FPL 405,026 uninsured > 200% and < 301% FPL 231,713 uninsured and employed (125 plan) 441,414 uninsured ages ,864 uninsured poor to fair health status 299,647 ** These counts are estimates that DO NOT account for factors that might make someone not eligible for a policy option, such as income or other eligibility requirements. For example, the 125 plan proposal does not apply to workers in firms with less than 10 employees. USE WITH CAUTION ; It is also best to review the upper and load bounds of the confidence intervals before using. 55

56 56 Now What?

57 How to Access Materials Presentation materials and OFHS County Tables can be downloaded from the OFHS collaboration web site: Click on Enter as a Guest Download from public documents 57

58 Special Reports A series of special reports are being prepared on various topics: Medicaid, obesity, family violence, mental health, children s health, health disparities, etc. (see handout in packet) These reports will be released at the OFHS Sponsored Research Forum on June 1 Additional analysis and reports will continue to be released on a periodic basis 58

59 Regional Forums The Health Policy Institute of Ohio intends to do a series of regional forums in May and June on the OFHS findings and reform activities taking place in Ohio 59

60 Access to the survey dataset Public use file made available in April on OFHS website Research dataset (restricted use) available with signed data use agreement Contact Lorin Ranbom at the GRC 60

61 Information and Requests All media requests for interviews and information should be made through Paul Quinn at HPIO Organizations or individuals interested in specific analysis of the data can contact Barry Jamieson at the GRC Organizations wanting special briefings or presentations at meetings can contact Barry Jamieson at the GRC 61

62 Future Surveys Development of the Ohio Employer Health Survey (OEHS) is underway and is expected to be in the field this summer Development plans are underway to conduct a follow up Ohio Family Health Survey starting in the fall of 2009 the emphasis will be tracking major changes to the Ohio s health and health system given the recent economic downturn Both the OEHS and the 2009 OFHS depend on securing funding support. Interested funding partners are encourage to contact Bill Hayes at the Health Policy Institute of Ohio 62

63 Contact Information Ohio Colleges of Medicine Government Resource Center Lorin Ranbom, Director (614) Barry Jamieson, Project Manager (614) The Health Policy Institute of Ohio Bill Hayes, President (614) x305 Paul Quinn, Communications Director (614) x316 Tim Sahr, Director of Research x308 63

64 2008 Ohio Family Health Survey Results