Monitoring health care access and utilization following implementation of the Affordable Care Act using the National Health Interview Survey
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1 Monitoring health care access and utilization following implementation of the Affordable Care Act using the National Health Interview Survey Renee M. Gindi, Robin A. Cohen, and Whitney K. Kirzinger National Center for Health Statistics Presented on June 21, 2012 DC-AAPOR/WSS Summer Conference Preview National Center for Health Statistics Centers for Disease Control and Prevention 1
2 Outline Using NHIS to monitor Affordable Care Act (ACA): Existing questions provide baseline and trend data New questions address targeted issues Larger sample allows for more state-level estimates Highlighted topics Financial burden of medical care Coverage for young adults aged Emergency room use State-level estimates of insurance coverage 2
3 FINANCIAL BURDEN OF MEDICAL CARE 3
4 Financial Burden of Medical Care New questions added to NHIS: Problems paying medical bills in past 12 months Currently have medical bills that are being paid over time Currently have medical bills that they are unable to pay at all Any financial burden of medical care (summary) 4
5 Percent 40 Percentages of persons in families with selected financial burdens of medical care: U.S., Jan Jun Problems paying medical bills in the past 12 months Currently have medical bills paid over time Currently have medical bills unable to pay at all Any financial burden of medical care Source: Cohen RA, Gindi RM, Kirzinger WK. Burden of medical care cost: Early release of estimates from the National Health Interview Survey, January June National Center for Health Statistics. March
6 Percent Percentages of persons in families with any financial burden of medical care, by age group: U.S., Jan-Jun years years years 75 years and over Adapted from: Cohen RA, Gindi RM, Kirzinger WK. Burden of medical care cost: Early release of estimates from the National Health Interview Survey, January June National Center for Health Statistics. March
7 Future research: Financial Burden of Medical Care Associations with use of health care services, prescription drug costs Unmet needs due to cost Trends 7
8 HEALTH INSURANCE COVERAGE FOR ADULTS AGED
9 Health Insurance Coverage for Adults Aged Using existing NHIS questions: Insurance coverage at time of interview, by age Access and utilization: Usual place for health care, doctor s visit in past 12 months, emergency room use 9
10 Percent Percentage of adults aged with health insurance, by coverage type, and percentage uninsured at time of interview: U.S., Private 40 Uninsured Public 10 0 Q Q2 Q3 Q4 Q Q2 Q3 Q4 Q Q2 Q3 Q4 Source: Cohen RA, Martinez ME. Health insurance coverage: Early release of estimates from the National Health Interview Survey, National Center for Health Statistics. June 19,
11 Percent Percentages of adults aged with selected access measures, by insurance coverage status: U.S., Jan-Sep Uninsured Private insurance Public coverage Has usual place for health care Doctor visit in past 12 months Emergency room visit in past 12 months Source: Kirzinger WK, Cohen RA, Gindi RM. Health care access and utilization among young adults aged 19 25: Early release of estimates from the National Health Interview Survey, January September National Center for Health Statistics. May
12 Health Insurance Coverage for Adults Aged Future research: Obtain more detail on insured young adults: Source of coverage (policyholder) Employment Previous coverage / gaps in coverage 12
13 REASONS FOR EMERGENCY ROOM USE 13
14 Reasons for Emergency Room Use Using existing and new questions: Number of ER visits in the past 12 months Hospital admission for last ER visit If not admitted, reason for last ER visit Can select more than one Adults aged 18-64: 20% visited ER 73% not admitted 14
15 Percentage with reason for last ER visit, among adults aged whose last visit in past 12 months did not result in hospital admission: U.S., Jan Jun 2011 Seriousness of medical problem 66.0 Only hospital could help 54.5 Problem too serious for doctor's office 42.5 Health provider said to go 20.1 Arrived by ambulence 8.9 Lack of access to other providers 79.7 Doctor's office not open No other place to go Emergency room is closest provider Most care is at emergency room Source: Gindi RM, Cohen RA, Kirzinger WK. Emergency room use among adults aged 18 64: Early release of estimates from the National Health Interview Survey, January June National Center for Health Statistics. May
16 Percent Percentage with reason for last ER visit, among adults aged whose last visit in past 12 months did not result in hospital admission, by insurance coverage status: U.S., Jan Jun Uninsured Private insurance Public coverage No other place to go Doctor's office or clinic was not open Only hospital could help Source: Gindi RM, Cohen RA, Kirzinger WK. Emergency room use among adults aged 18 64: Early release of estimates from the National Health Interview Survey, January June National Center for Health Statistics. May
17 Reasons for Emergency Room Use Future research: Reasons for ER visits among children, older adults Timing of use (nights / weekends) State-level estimates of ER use 17
18 STATE-LEVEL HEALTH INSURANCE ESTIMATES 18
19 State-Level Health Insurance Estimates Using existing NHIS questions: Insurance coverage at time of interview, by state of residence and age 19
20 Percentage of persons aged who were uninsured at the time of interview, by state: U.S., 2011 HI Percentage significantly lower than U.S. overall (21.3%) Percentage not significantly different from U.S. overall Percentage significantly higher than U.S. overall Estimate does not meet NCHS standard for precision Source: Cohen RA, Martinez ME. Health insurance coverage: Early release of estimates from the National Health Interview Survey, National Center for Health Statistics. June 19,
21 State-Level Health Insurance Estimates Future research: Covariates for state-level health insurance estimation Additional topics for state-level estimation 21
22 Conclusions NHIS data can be used to monitor outcomes related to ACA provisions and important health correlates Useful for national, subgroup, state estimates Can establish baselines and indicate trends 22
23 For more information please contact National Center for Health Statistics Division of Health Interview Statistics, National Center for Health Statistics 3311 Toledo Rd, Room 2217 Hyattsville, MD Web: Telephone: (301)
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