pamela behan, phd., assistant professor of sociology university of houston-downtown
DESCRIPTION
"The Effects of Health Care Financing Arrangements on Consumer Utilization Decisions in Harris County." . Pamela Behan, PhD., Assistant Professor of Sociology University of Houston-Downtown Patrice Williams, Graduate Research Assistant University of Texas School of Public Health. - PowerPoint PPT PresentationTRANSCRIPT
"The Effects of Health Care Financing Arrangements on Consumer UtilizationDecisions in Harris County."
Presented at the Healthcare Safety Net Initiatives Conference: Policy and Performance on February 9, 2007
Pamela Behan, PhD., Assistant Professor of Sociology University of Houston-Downtown
Patrice Williams, Graduate Research AssistantUniversity of Texas School of Public Health
Project DescriptionTelephone Survey with telephone numbers from a random-digit-dialed list from University of Houston Center for Public Policy.
Inclusion criteria
Harris County resident
At least 18 yrs of age
Comprehensive knowledge of a time in the past year when someone in Harris County needed medical care
Exclusion criteria
Business telephone numbers
Less than 18 years of age
The study budget
Houston Health Services Collaborative
University of Houston Center for Public Policy
Spanish Survey Experience
• Finding translators
• Translation of survey
• Delivery of the survey
What terms used Healthcare changed to medical care issues The introductory statement
When to callMorningsAfternoonsEvenings Weekends
Where to conduct the surveyU of H survey labHome Office
How to conduct the surveys Pen and paper surveys Computer assisted Internet
Flexibility
Thank you for your time
The Effects of The Effects of Health Care Financing Health Care Financing
Arrangements on Consumer Arrangements on Consumer Utilization Decisions in Harris Utilization Decisions in Harris
County:County:
Preliminary ResultsPreliminary Results
OROR
Does our safety net
(and system)
work the way we think it does?
The Problem:The Problem:
A lack of timely care leads to:
▫ preventable health care problems▫ pain, stress, grief, poverty ▫ wasted human potential▫ the need for more expensive care ▫ wasted safety net resources
Why do people not get timely Why do people not get timely care?care?
One explanation:
Lack of insurance or funds ->
Refusal by providers
Another explanation:
Inadequate insurance or funds, or confusion about either ->
Fear of costs or fear of refusal ->
Delay or avoidance by consumers
Is it only the uninsured that don’t Is it only the uninsured that don’t get timely care?get timely care?
One answer:
Yes. Insurance takes care of access & costs.
Another possibility:
No. All insurance is not equal. Some requires cash to get care and covers very little, while other insurance requires no cash and covers a lot.
Also, insurance is changing:Also, insurance is changing:
Increasing health care costs ->
Decreasing coverage by employment-related and government insurance programs ->
Increased likelihood of less timely care among the insured
Which answers are correct? Which answers are correct? How can we find out?How can we find out?
Which answers are correct? Which answers are correct? How can we find out?How can we find out?
Ask consumers!
How?How?
Our Research Format:
Telephone Survey
Random Sample of 500 Harris County residents
Questions about:
▫ a recent episode of need for medical care
▫ the patient’s insurance coverage
▫ the patient and decision-Maker (if different)
Preliminary ResultsPreliminary Resultsbased on:based on:
• 403 cases• 82% insured; 18% uninsured• Patient ages: 1 to 99; average 51years old• Patient race/ethnicity: 51% white, 27% African-
American, 20% Hispanic, 2% Other• Patient gender: 62% female; 38% male• Household Incomes: 15% < $10,000 per year; 32% > $75,000 per year; average $35-50,000
First, we look at decisions which First, we look at decisions which involved insurance or financial involved insurance or financial
considerations:considerations:
• Total: 270
• Positive only: 182 (67%)
• Negative only: 69 (26%)
• Mixed: 19 (7%)
Types of decisions affected by Types of decisions affected by insurance or financial insurance or financial
considerations:considerations:
• To seek care right away (98)• To wait before seeking care (61)• To not seek care (22)• To have all recommended tests and
treatments done right away (121)• To wait on some or all tests & treatments (5)• To not have all tests & treatments done (20)
Now, we look at decisions to delay Now, we look at decisions to delay or avoid care:or avoid care:
• Total (188) • For non-financial reasons (91)• For financial or insurance-related reasons (98)
Now let’s add in insurance status:Now let’s add in insurance status:
Delayed or avoided care, tests or treatments:• Insured (136 / 327) 42%• Uninsured (52 / 73) 71%
Considered insurance or finances in making that decision:
• Insured (47 / 327) 14%• Uninsured (51 / 73) 70%
Other factors that appear to affect care Other factors that appear to affect care avoidance or delay for financial or avoidance or delay for financial or
insurance-related reasons:insurance-related reasons:
• Insurance source• Race• Income• Age• Whether the patient
makes their own care decisions
• Whether the patient has a regular provider
• Whether the patient has ever been refused care
• Whether the patient has avoided care in the last year
Decisions are made differently when a Decisions are made differently when a situation is perceived as an emergency.situation is perceived as an emergency.
• Insurance and financial considerations are ignored (73)
• Care is sought “in spite of” financial or insurance concerns (40)
Possible ImplicationsPossible Implications
• About the same number (not percent) of insured as uninsured citizens are discouraged by financial concerns from getting care in a timely manner.
• Any insurance is not necessarily better than no insurance in its consequences for timely care.
• Current arrangements ignore many user concerns and decision-making patterns, leading to less timely care.
• These concerns and patterns must be clarified and used in policy planning if resource waste is to be minimized and program results maximized.