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Profile of the Health Care Consumer
Steven P. Wallace, Ph.D.Professor of Community Health Sciences
Assoc. Director Center for Health Policy Research
UCLA School of Public Health
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Key Points
• Most people visit a doctor during the year• Insurance status varies by race,income, and
region of Los AngelesMost uninsured persons are in employed families
• Most uninsured persons are in employed families
• Communty clinics are particularly important for those with low-incomes and no insurance
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Elderly & Kids, Women & those with Health Insurance most likely to see a
doctor in past year
88%
78%
89%
79%
95%87%
64%
*All ages ** Ages 0-64
Source: 2003 California Health Interview Survey
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Insurance by Race/Ethnic Group Los Angeles County
13.4%4.6%
10.9%5.8% 8.5%
12.6%
34.9%
19.6% 19.1% 20.5%6.7%
27.4%
13.2%25.7%
16.4%
67.3%
33.2%
56.3%
49.4%54.5%
White Latino Asian Americanand Pacific
Islander
African American OtherSingle/Multiple
Race
Uninsured All/Part Year Medi-Cal/Healthy Families All YearEmployer-Based Ins. All Year Other Insurance All Year
Source: 2003 California Health Interview Survey
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Insurance by Household Income Los Angeles County
39.8%32.7%
24.3%
10.6%
45.2%
28.0%
10.0%
2.2%
9.3%
31.2%
57.3%
77.1%
5.8% 8.1% 8.4% 10.1%
0-99% of FPL 100-199% of FPL 200-299% of FPL 300% of FPL andAbove
Uninsured All or Part Year Medi-Cal or Healthy Families All Year
Employer-Based Insurance All Year Other Insurance All Year
Source: 2003 California Health Interview Survey
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Insurance by SPALos Angeles County
Uninsured All or Part Year
Medi-Cal or Healthy
Families All Year
Employer-Based
Insurance All Year
Other Insurance All Year Total
Antelope Valley 18.5% 21.5% 55.5% 4.5% 100.0%
San Fernando Valley 20.7% 15.3% 55.6% 8.5% 100.0%
San Gabriel Valley 22.5% 17.9% 50.5% 9.1% 100.0%
Metro 33.8% 22.3% 36.0% 7.8% 100.0%
West 17.3% 8.9% 55.4% 18.3% 100.0%
South 31.8% 32.8% 30.5% 4.9% 100.0%
East 23.2% 16.4% 53.7% 6.7% 100.0%
South Bay 21.4% 17.4% 53.1% 8.1% 100.0%
Source: 2003 California Health Interview Survey
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Uninsured Rates in Assembly Districts, Los Angeles County, 2002
Estimated based on CHIS 2001 data
Uninsured rates vary by legislative district
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Uninsurance problem is worse in California and LA than nationally
• Over 6.5 million California children and adults uninsured all or part of year
– 1 in 5 of state’s nonelderly population
– Nearly 1 in 6 of nation’s uninsured lives in California
• LA is epicenter of national problem
– over 2 million uninsured
– 1 in 4 of county’s nonelderly residents
• Parts of LA have even more uninsured residents
– 33% in Metro and South areas (SPAs 4 and 6)
Source: 2003 California Health Interview Survey and 2004 Current Population Survey
Percent Uninsured All or Part of Year, Nonelderly Adults and Children
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Uninsured are overwhelmingly in working families
At Least One Adult Works Part-time
101,0005%
At Least One Adult is Self-Employed
224,00011%
Non-working Family531,000
25%
At Least One Adult Works Full-time
1,235,00059%
Source: 2003 California Health Interview Survey
• Over 1.2 million uninsured children and adults live in a household headed by a full-time working employee.
• Only one-fourth of the uninsured are in non-working families.
– Many non-working families are headed by a single or disabled adult.
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Low rate of employers offering coverage drives low job-based insurance rate
818,000 Los Angeles County workers are employed by firms that don’t offer coverage
Offer Eligibility Take-up
All employees (5,933,000) 80.5% 90.5% 86.7%
Race/Ethnicity
White 88.6% 92.0% 89.9%
Latino 68.6% 87.8% 81.8%
Asian American & Pacific Islander 82.8% 93.1% 87.9%
African American 88.8% 90.8% 88.1%
Other & Multiple Race 85.0% 86.5% 82.2%
Citizenship Status
U.S.-born Citizen 88.2% 90.3% 87.8%
Naturalized Citizen 82.6% 94.1% 89.1%
Noncitizen With Green Card 66.4% 90.5% 84.1%
Noncitizen Without Green Card 50.8% 81.8% 72.4%
Offer, Eligibility, and Take-up Rates for Own Job-based Health Insurance, Employees Ages 19-64, California, 2003
Source: 2003 California Health Interview Survey
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Providing outpatient care can improve the health of the uninsured
• Asthma, hypertension, and poor self-assessed health are ambulatory sensitive conditions
6%
29%24%
0%5%
10%15%20%25%30%
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25.3%
2.6%
28.5%
2.7%
15.4%
82.%
8.1% 8.7%
Safety-net providers are important to uninsured adults and those on Medi-Cal
• California safety-net providers are usual source of care for 1 in 4 uninsured adults and 1 in 4 adult Medi-Cal beneficiaries
Source: 2003 California Health Interview Survey
85.8%
58.6%
25.9%
7.1%
28.8%28.3%
6.8%11.6%
44.7%
Uninsured All or Part Year
Medi-Cal or Healthy Families All Year
Employer-Based Insurance All Year
Doctor's Office/HMO/KaiserCommunity or Government Clinic, Community Hospital
No Usual Source of Care
Adults, Ages 19-64
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31.2%
40.3%
1.1%
37.9%
5.9%
85.3%
10.2%
0.5%3.6%
Safety-net providers are important to uninsured children and those on Medi-Cal and Healthy Families
• Safety-net clinics and hospitals are usual source of care for: 4 in 10 uninsured children and 4 in 10 children with Medi-Cal or Healthy Families coverage
• The longer people are uninsured, the more they rely on safety net clinics and hospitals
Source: 2003 California Health Interview Survey
74.2%
46.3%
37.5%
14.7%
41.5%
37.2%
10.1%11.5%
24.8%
Uninsured All or Part Year
Medi-Cal or Healthy Families All Year
Employer-Based Insurance All Year
Doctor's Office/HMO/Kaiser
Community or Government Clinic, Community Hospital
No Usual Source of Care
Children, Ages 0-18
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Conclusions
• Access of medical care is essential for everyone
• The uninsured are less likely to see the doctor, but still need medical care
• Uninsured persons exist across all groups and regions, but not equally
• Safety net providers are key to the health of low income and uninsured persons