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

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

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

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

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

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

Uninsured Rates in Assembly Districts, Los Angeles County, 2002

Estimated based on CHIS 2001 data

Uninsured rates vary by legislative district

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

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.

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

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%

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

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

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