Future Problem Solving Program of CT Healthcare Access Seminar

ACCESS TO HEALTHCARE:BARRIERS TO COVERAGE AND CARE

IN CONNECTICUT

Susan Cole & Marybeth BonadiesMarch 21, 2006

Office of Health Care Access (OHCA)

Connecticut state agencypredecessor agency was established by the General Assembly in 1973Website: http://www.ct.gov/ohca

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 citizensConnecticut has 169 towns94% of Connecticut residents have health insurance coverage, leaving 6% uninsuredConnecticut has 31 hospitals

Connecticut Hospitals

Factors that influence access:

Resource availabilityResource availability Health insurance statusIncome Race/ethnicityEmployment status

What is Certificate of Need? (CON)

State mandated programRegulates services offered by health care facilitiesRegulates major capital expenditures by health care facilitiesRegulates 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 basisOrderly introduction of new technologies and services to ConnecticutGuarantee 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 statusHealth insurance status

Income

Race/ethnicityEmployment status

Most Connecticut residents have health insurance coverage

But an estimated 196,000 uninsured out of 3.4 million people do not

Insured

94.2%Uninsured

5.8%

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

11.3%

2.1%0.7%

18.5%20.6%

11.3%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Emergency

Care

Illness Prescription

Insured

Uninsured

Perc

ent n

ot g

ettin

g ca

re

Source: OHCA 2004 Household Survey

Who are Connecticut’s uninsured?

Working

adults

58% Seniors/

retirees

4%Children

10%

Adult

students

3%

Unemployed

25%

Source: 2004 Household Survey

Factors that influence access:

Resource availability Health insurance statusIncome Income

Race/ethnicityEmployment status

Low income families more likely uninsured

Source: 2004 Household Survey

9% 8%

2%6% 6%

20%

0%

10%

20%

30%

<$12,000 $12,000 to$21,999

$22,000 to$44,999

$45,000+ Notspecific

All

Perc

ent U

nins

ured

Factors that influence access:

Resource availability Health insurance statusIncome Race/ethnicityRace/ethnicity

Employment status

Hispanics are over-represented among the uninsured

White46%

Hispanic40%Black

10%

Other4%

Factors that influence access:

Resource availability Health insurance statusIncome Race/ethnicityEmployment statusEmployment status

Connecticut’s Health Insurance SystemEmployer

Based

64%

HUSKY/

SAGA

12%

Medicare/

Other

Federal

14%

Uninsured

6%

Self-

purchase

4%

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 barriersto 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 creditsPremium AssistanceConsumer-directed careUniversal 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

For further information please visit:

http://www.ct.gov/ohca