Understanding Access and Barriers to Health Care

Understanding Access and Barriers To Health Care In Centre County In 2009, Public Health Management Corporation, through its Community Health Data Base (CHDB), conducted the Centre County Household Health Survey to examine the health status and needs of adults in Centre County, Pennsylvania. The survey was conducted in the summer of 2009 among 1,251 households1, and included questions regarding health status, utilization of health screenings, health behaviors and access to health care. This Data Brief examines findings of the survey, focusing on critical issues related to access to health care among adults 18 years of age and older residing in the county.

T

he Centre County Household Health Survey was modeled after

The Importance of Access to Health Care

CHDB’s Southeastern Pennsylvania Household Health Survey, the National Health Interview Survey, and the Behavioral Risk

Approximately 46 million Americans have no public or private health

Factor Surveillance System. CHDB’s Household Health Survey is

insurance. More than eight out of ten uninsured Americans are in

one of the largest and most comprehensive local health surveys

working families2. An extensive body of research has shown that

in the country. Due to the large sample size and local focus of

health insurance is integral to health and wellbeing, and that not

the 2009 Centre County Household Health Survey, the data can

having health insurance can have a negative impact on health. Many

be used in a variety of ways, including assessing health status

adults in Centre County face challenges receiving health care. This

among Centre County communities or demographic groups, for

Data Brief examines major access to care indicators including insur-

program development and marketing, and for establishing baseline

ance status, prescription and dental coverage, utilization of a regular

indicators to monitor future progress.

source of health care, and access to emergency and specialty care.

These indicators will be examined by demographic factors, including

FIGURE 1 Source of Insurance for Centre County Adults Ages 18-64, 2009

age, gender, and poverty status. Since Centre County has a large university population, student status is also examined.

Other Public 9%

Health Insurance and the Uninsured in Centre County

Uninsured 11% Private 70%

Medicaid 10%

While the majority of Centre County residents have some form of health insurance coverage, a significant number of non-elderly adults are uninsured (Figure 1). Slightly more than one in ten adults ages 18-643 in Centre County (11.3%) does not have any public or private health insurance, representing 9,400 uninsured adults across the

FIGURE 2 Uninsured Adults Ages 18-64 in Centre County

by Age, Gender and Poverty Status, 2009

county. Seven in ten adults ages 18-64 (69.7%) are insured through a private insurer, one in ten (10.1%) are insured through Medicaid and about 9% are insured through another public source of coverage, such

25

23.9%

as the Veterans Administration or Medicare. Nearly half of the currently uninsured adults in Centre County (47.8%) have been without

20

17.5%

health insurance for over two years 15

13.5%

Different demographic subgroups in Centre County are more likely to be uninsured than others (Figure 2). Similar to national and state-

10

9.3%

9.2%

8.3%

wide trends, younger adults are more likely to be uninsured than older adults. In Centre County, 17.5% of adults 18-34 years of age are un-

4.8%

5

insured, representing approximately 6,500 young adults. This is compared to 8.3% of adults 35-59 and 4.8% of adults 50-64. The Centre

0

18-34

35-49

50-64

Men

Women

Below At/Above Poverty Poverty

County Household Health Survey also found that:

In Centre County, women are more likely to be uninsured than men

FIGURE 3 Cost Barriers to Health Care and Prescription Drugs for Centre County Adults Ages 18-64 by Insurance Status, 2009

(13.5% and 9.2%, respectively).

50

12.3% of adult students (18-64) have no public or private health insurance.

Poverty is strongly associated with lack of health insurance. Nearly

44.6% 40.5%

40

30

one in four of those living below the Federal Poverty Level (23.9%) are uninsured, compared to fewer than one in ten of those living

20

14.2%

above the Federal Poverty Level (9.3%).

11.7%

10

Barriers to Obtaining Insurance According to the Centre County Household Health Survey, the most commonly cited reason for lack of insurance was affordability; 34.7% of uninsured Centre County residents indicated they could not afford health insurance. This is followed by 15.7% uninsured

Understanding Access and Barriers to Health Care in Centre County

0

Insured

Uninsured

No RX due to cost

Insured

Uninsured

No care due to cost

Source: PHMC’s Community Health Data Base, Centre County Household Health Survey, 2009.

due to job change or job loss. Although unemployment is a major

Adult students (18+) in Centre County have a particularly difficult

factor in lack of health insurance, the majority of those without

time; nearly a quarter of Centre County students (23.5%) find it dif-

health insurance in Centre County are employed either full-time

ficult to get an appointment with a specialist.

(43.2%) or part-time (22.8%).

Access to Emergency Care in Centre County Access to Prescription and Dental Coverage

Three in ten Centre County adults (30.8%) have visited a hospital

The majority of adults (18+) in Centre County report having both pre-

emergency room at least once during the past year. Uninsured adults

scription drug coverage and dental coverage. However, a sizable pro-

(36.4%) are slightly more likely to have made an emergency visit than

portion does not have access to these forms of health coverage. Nearly

are insured adults (30.7%). Among uninsured adults 18-64 who had

one in five (18.3%) have no prescription drug coverage, representing

been to an emergency room in the previous year, two-thirds (65.5%)

about 17,100 adults in Centre County. Slightly more than four in ten

reported that they had gone to the ER instead of a regular doctor’s of-

(41.9%) have no dental coverage, representing 41,300 individuals.

fice due to their lack of insurance. About one in twelve insured Centre County adults (8.3%) and one in seven uninsured adults (15.1%) find it somewhat or very difficult to get care in a medical emergency.

Access to Health Care in Centre County Cost Barriers to Health Care Regular Source of Care

Many Centre County residents experience financial barriers to receiving

One in ten (10.9% or approximately 10,900) Centre County adults has

the health care they need. For example, 14% of adults did not receive

no regular source of health care. Uninsured adults are less likely to

needed care in the previous year due to cost, representing over 13,400

have a regular source of care compared to insured adults; nearly one-

adults. Women were more likely than men to report they were sick but

third (32.5%) of uninsured Centre County adults ages 18-64 has no

did not seek care due to the cost (16.2% and 10.9%, respectively). The

regular source of health care.

uninsured were more likely to report an unmet need for care due to cost than those with health insurance (44.6% and 11.7%, respectively.)

Of those Centre County adults with a regular source of care, most (69.1%) go to a private doctor’s office for regular care. Uninsured

The out-of-pocket cost of prescription medication is a barrier for

adults are more likely to receive medical care in clinics, health cen-

some Centre County residents (Figure 3). About 15% of adults re-

ters, emergency rooms and other places than are insured adults.

port that they had not filled a prescription in the previous year due

Nearly four in ten uninsured Centre County adults (38.0%) go to a

to the cost. Centre County adults without health insurance coverage

community clinic or health center for regular care, compared to two in

are more likely to report this; four in ten uninsured adults age 18-64

ten insured Centre County adults (19.6%).

had not filled a prescription due to the cost (40.5%), compared to 14.2% of insured adults 18-64.

Students in Centre County are less likely to have a regular source of care than non-students. About one in six Centre County students (16.8%) do not have a regular place they go when they are sick or need advice

Conclusion  Many adults in Centre County face

about their health, compared to one in ten non-students (10.0%).

significant challenges accessing health care.

Access to Specialty Care in Centre County Nearly one in five (17.5%) Centre County adults find it somewhat or very difficult to get an appointment with a medical specialist, such

N

ot having a regular health care provider, cost of care, and dif-

as a cardiologist or dermatologist. Uninsured adults have greater dif-

ficulty seeing medical specialists are just a few of the barriers to

ficulty with specialty care than insured adults; about a quarter of un-

timely care faced by Centre County residents. The uninsured, adult

insured adults 18-64 in Centre County (24.0%) indicate it is somewhat

students, and Centre County residents living below the Federal Pov-

or very difficult to see a medical specialist, compared to 18.1% of

erty Line are at greater risk of the effects of unmet health care needs

insured adults in the same age range.

and delayed care.

www.CHDBdata.org

Notes 1 Adult respondents were interviewed using traditional random digit dialing landline

2 Robert Wood Johnson Foundation: http://covertheuninsured.org/the_issue, accessed 2/18/10.

techniques (n=1,051) as well as cell phone interviewing methodology (n= 200).

3 While the survey includes adults over age 64, because the majority of adults 65+ are covered

by Medicare, this report focuses on adults between the ages of 18 and 64.

ABOUT PHMC’S COMMUNITY HEALTH DATA BASE & THE CENTRE COUNTY HOUSEHOLD HEALTH SURVEY Public Health Management Corporation (PHMC) is a nonprofit, public health institute committed to improving community health through research, planning, technical assistance, outreach, education, and direct services. The Community Health Data Base (CHDB) has been an integral part of PHMC for more than 25 years. It is a cooperative planning resource for health and social service agencies. The goal of the CHDB is to enhance the capacity of local health and human service providers, planners and policymakers to improve the health and wellbeing of their communities. The CHDB achieves this goal by disseminating health and social service data, enabling policymakers and service providers to assess needs, target programming, allocate funding, and monitor changes over time for the communities they serve.

The Community Health Data Base has extensive experience conducting primary research on population health, and has developed a reputation for high quality data, exacting research methods, and expertise in the area of community health.

The Centre County Household Health Survey was conducted in the summer of 2009 in order to provide a unique information resource to Centre County health and social services organizations, policymakers, and academic institutions. The survey includes interviews with 1,251 adults age 18 and older. The large sample size of the Household Health Survey allows analysis by geographic sub-areas within Centre County, as well as by demographic breakdowns such as age, race/ethnicity, gender, student status, and poverty level.

The Centre County Household Health Survey includes a broad range of information on health and wellbeing. In addition to the access to care variables discussed in this Data Brief, key topic areas of the Survey include:

Health Status

Health Behaviors

Disease Prevention

Household

Demographic

Self reported health status

Tobacco use and

& Health Promotion

Household composition

Characteristics

Screening and exams

Exposure to tobacco smoke

Age

Chronic conditions

quit attempts

(e.g., asthma, diabetes,

Consumption of alcoholic

high blood pressure, high cholesterol, heart disease) Body Mass Index (e.g., for assessing obesity) Mental health conditions

beverages

(e.g., dental, blood

in the home

Race/ethnicity

pressure, mammography,

Firearms at home

Gender

Physical activity

prostate, HIV testing,

Unaffordable housing costs

Sexual orientation

Consumption of fast food

sigmoidoscopy)

Renting or owning home

Education level

Access to fresh

Poverty status

fruits & vegetables

Employment status

Hunger and food insecurity

Student status

The Southeastern Pennsylvania Household Health Survey, the largest local health survey in the country, is the centerpiece of PHMC’s Community Health Data Base (CHDB). The survey collects data from 10,000 households in Bucks, Chester, Delaware, Montgomery, and Philadelphia counties. It has been conducted 11 times since 1982, and is currently conducted every two years. In 2008, CHDB expanded the Household Health Survey’s geographic reach to include Berks, Lancaster, and Schuylkill Counties, and, in 2009, the survey was also fielded in Centre County.

For more information on CHDB go to www.CHDBdata.org or contact CHDB at 215.985.2548.

PHMC is a nonprofit public health institute that builds healthier communities through partnerships with government, foundations, businesses and other community-based organizations. For more information on PHMC, please visit PHMC.org.

The Centre County Household Health Survey and this Data Brief were made possible by the support of the Pennsylvania Department of Community and Economic Development.

PHMC is a United Way of Southeastern Pennsylvania community partner | Donor Code: 2050

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