Priority Area: Access to Quality Health Care

The Burden of Insufficient Access to Quality Health Care

In its 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine defined quality as "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." Access to quality care is important to eliminate health disparities and increase the quality and years of healthy life for all New Yorkers. Patients who are women, older, members of racial and ethnic minorities, poorer, less educated, or uninsured are less likely to receive needed care, primarily because they lack access to care. These disparities seem to be increasing. Although having insurance increases access to the health care system, it is not sufficient to ensure appropriate use of services or care that is of high quality. This priority area addresses two key components of a well functioning health care system that ensures access to quality health care for New Yorkers: enrollment in health insurance and access to and delivery of preventive health services and primary care that are shown to improve overall health.

Objectives

  • By the year 2013, increase the percentage of adult New Yorkers with health care coverage to 100%.* [Baseline: 86.5%, BRFSS, 2006]
  • By the year 2013, increase the percentage of adult New Yorkers who have a regular health care provider to 96%.* [Baseline: 85.0%, BRFSS, 2006]
  • By the year 2013, increase the percentage of adult New Yorkers who have seen a dentist in the past year to 83%.* [Baseline: 71.8%, BRFSS, 2006]
  • By the year 2013, increase the percentage of cancer cases diagnosed at an early stage of disease in New York residents to at least:
    • 80% for breast cancer. [Baseline: 64%, NYS Cancer Registry, 2000-2004]
    • 65% for cervical cancer. [Baseline: 52%, NYS Cancer Registry, 2000-2004]
    • 50% for colorectal cancer. [Baseline: 40%, NYS Cancer Registry, 2000-2004]

    * Healthy People 2010 Objective

In addition to the Prevention Agenda objectives, the DOH’s Office of Health Insurance Programs has established the following three objectives to increase access to quality health care:

  • By year 2013, increase the percentage of managed care enrollees who have controlled their high blood pressure to:
    • 70% for commercial enrollees. [Baseline: 58 percent, 2007 Managed Care Plan Performance]
    • 70% for Medicaid enrollees. [Baseline: 60 percent, 2007 Managed Care Plan Performance]
  • By year 2013, increase the percentage of diabetic managed care enrollees whose blood sugar levels are in good control to:
    • 50% for commercial enrollees. [Baseline: 44 percent, 2007 QARR data]
    • 45% for Medicaid enrollees. [Baseline: 38 percent, 2007 QARR data]
  • By year 2013, increase the percentage of adult managed care enrollees who were not prescribed an inappropriate antibiotic for bronchitis to:
    • 30% for commercial enrollees. [Baseline: 24 percent, 2008 eQARR]
    • 35% for Medicaid enrollees. [Baseline: 28 percent, 2008 eQARR]

Indicators for Tracking Public Health Priority Areas

Each community's progress towards reaching these Prevention Agenda Objectives will be tracked so members can see how close each community is to meeting the objectives.

Data and Statistics

Access to Quality Health Care

Health Insurance

The number and percent of New York State residents without health insurance are presented in a DOH report, entitled, Profile of the Uninsured in New York State in 2007 and highlighted below. This profile is based on data from the 2008 Annual Social and Economic Supplement to the Current Population Survey (CPS), released by the US Census Bureau on August 26, 2008 and analyzed by NYSDOH staff, except as noted in the final section.

Basic Rates and Counts

  • In 2007, 13.2% of the state’s population was uninsured, about 2,519,000 people.
  • The rate for children under 19 was 9.2%, with 434,000 uninsured.
  • The rate for adults 19 to 64 was 17.2%, with 2,030,000 uninsured.
  • These rates are below the comparable values for the nation at large, which were 15.3% for all, 11.3% for children under 19, and 19.7% for adults 19-64.
  • The 2007 estimate of uninsured NYS residents is about 143,000 lower than 2006.

New York City

  • Most (54%) of the state’s uninsured live in New York City, with 1,368,000 uninsured in 2007.
  • The uninsured rate in NYC was 16.6%, compared to a rate of 10.6% for the rest of the state.
  • The NYC rate for children was 10.1%, compared to 8.4% for the rest of the state, and the NYC rate for non-elderly adults was 21.7%, compared to 13.6% the rest of the state.
  • The 2007 estimated uninsured population in NYC is about 58,000 less than 2006, accounting for about 40% of the 143,000 statewide decrease.
  • The 2007 estimate for NYC was 4% lower than in 2006, compared to a 7% decrease in the rest of the state.

Demographics and Disparities

  • Half of the uninsured are aged 19 to 39, with 31% in the 19 to 29 age group.
  • The rest are roughly evenly divided among children (17%), those aged 40 to 49 (19%), and those aged 50 and older (19%).
  • Racial/ethnic “minorities” are about 61% of uninsured, but only about 40% of population.
  • The uninsured rate for the state’s non-Hispanic Whites was 8.5%; for African-Americans, 20.7%; for persons of Hispanic origin, 22.0%; and 16.5% for others.
  • About 23% of NYS uninsured are poor (using the Census Bureau’s poverty definition).
  • The 2007 uninsured rate for the poor (20.7%) was lower than 2006 (24.5%).
  • About 26% of NYS uninsured are not U.S. citizens; 31.5% of noncitizens were uninsured.

Eligibility for Publicly Funded Coverage

  • The NYSDOH estimates that 89% of the state’s 434,000 uninsured children under 19 are eligible for publicly subsidized health insurance: 385,000 children
    • About two-thirds (62%) of those eligible children qualify for Medicaid and the remaining for Child Health Plus (CHPlus).
    • About 60,000 of those children are eligible because of the recent expansion of CHPlus eligibility to 400% of Federal Poverty Level (FPL).
    • The 2007 data show about a quarter (25%) of the state’s uninsured children is above 250% of FPL, compared to an estimated one-third in the 2006 data.
  • The NYSDOH estimates that 39% of the state’s 2.0 million uninsured adults are eligible for public health insurance programs: 794,000 adults
    • About two-thirds of those eligible adults qualify for Medicaid and the rest for Family Health Plus.

Eligibility for Employment-Based Coverage

  • The CPS does not provide data on the availability of private insurance, only on coverage. It shows that private insurance coverage in general and employment-based coverage specifically declined between 2006 and 2007. The CPS estimates that 58.6% of NYS residents were insured through employment-based programs in 2007, compared to 60.6% in 2006. Employment-based coverage of children and the elderly accounted for this decline.
  • Another federal survey (MEPS-IC) estimates the availability of employment-based coverage in 2006. It shows that such employment-based coverage was available to 70% of the estimated 7.1 million private-sector workers in NYS in 2006.
  • The remaining 30% worked in firms that have no health insurance program (12% of workers) or were not eligible for their company’s program (18% of workers).
  • More than three-fourths (78%) of workers in NYS who were offered employment-based health insurance enrolled in their company’s program, according to the MEPS-IC.
  • In smaller firms (under 60 employees), about 55% of workers had the opportunity to enroll and about 77% of those given the opportunity did enroll in the company’s plan.

Allocation of Uninsured by County

Every summer, the Census Bureau estimates each state’s uninsured population in the previous calendar year using the Current Population Survey (CPS). The CPS estimates are the most widely cited reference for healthcare policy analysis and program administration, in part because they provide a consistent basis for comparison across states or over time. However, because the CPS does not produce county-level estimates, the Census Bureau developed a statistical model to estimate the uninsured population of the nation’s counties in 2000 and 2005.

The NYSDOH uses results from the Census Bureau’s model to allocate each year’s Census Bureau Current Population Survey - CPS estimate among the state’s 62 counties. The following are tables for calendar year 2007 by age population grouping.

New York State Department of Health Programs

Enrollment in New York’s Public Health Insurance Programs

New York State provides comprehensive health insurance coverage to more than 4.5 million children and adults through Child Health Plus, Medicaid and Family Health Plus. Nearly two million of those who New York covers are children and teens with approximately 1.6 million enrolled in Medicaid and nearly 400,000 in Child Health Plus.

Enrollment by program and county can be found at the links below.

New York’s Public Health Insurance Programs

New York State provides free and low-cost health insurance for children and adults through Child Health Plus, Medicaid and Family Health Plus. These programs provide New Yorkers with coverage for a wide range of medical services, including regular check-ups, hospital care, outpatient care, prescription drugs, emergency care, lab tests, x-rays, mental health services and much more. For details on each of these health insurance programs and where to sign up, visit the links below.

Enrollment

Access to and receipt of clinical preventive services and primary care

Managed care plans that serve the publicly insured focus on arranging preventive health care for their members. They provide members with a medical home for themselves and their families. A new initiative in the Medicaid program will reward providers with increased reimbursement if they meet DOH medical home standards which are designed to build greater accountability into physician practices. Achieving medical home certification should also benefit other (non-Medicaid) patients in physician practices as it would allow for better tracking and follow-up.

To ensure the quality of care being provided throughout the state adheres to current clinical standards the Office of Health Insurance Programs measures and publishes information on health plan performance including rates for breast cancer, cervical cancer and colorectal cancer screening. In addition the DOH has new initiatives designed to have patients with certain conditions such as breast cancer or obesity receive surgical treatment at high volume providers who have better outcomes. The DOH also works with health plans that conduct annual Performance Improvement Projects (PIPs); many of which have focused on improving rates of preventive health screenings among their members. The PIPs are small scale research projects designed to test various system changes as a way of improving care.

Strategies - The Evidence Base for Effective Interventions

The Evidence Base for Effective Interventions

  • Evidence-based and promising strategies to increase access to quality care are summarized in the following reports:
  • Doroshow JH, Croyle RT, Niederhuber JE. Five strategies for accelerating the war on cancer in an era of budget deficits. Oncologist 2009 Jan 15:110-6
  • Carcaise-Edinboro P, Bradley JJ. Influence of patient-provider communication on colorectal cancer screening. Med Care 2008 Jul; 46(7):738-45.
  • Schoen C, Davis K, Collins SR. Building blocks for reform: achieving universal coverage with private and public group health insurance. Health Affairs (Millwood) 2008 May-June; 27(3):646-57.
  • Sarpel U, Vladeck BC, Divino CM, Klotman PE. Fact and fiction: debunking myths in the US healthcare system. Ann Surg 2008 Apr; 247(4):563-9.
  • Greene, SB; Reiter, KL.; Kilpatrick, KE.; Leatherman, Sheila; Somers, Stephen A.; Hamblin, Allison. Demonstrating the business case for quality in Medicaid: challenges and opportunities. Health Care Management Review October-December 2008:33(4);350-360.

Evidence Based Strategies for Helping People Get Enrolled

The organizations and websites listed below feature some of the most recent research and literature on the issue of the uninsured and health care coverage.

Reports

The resources listed below are important sources of information about both health care coverage and access to care.

Return on Investment

Making the Case for the Importance of Health Insurance

Health insurance can make a difference for a lifetime. Health insurance affects how individuals receive necessary medical care, where they go for care, and their overall health. In addition, health insurance impacts a person’s financial well-being. There are a number of resources documenting the impact of health insurance on access to care for children and adults as well as the financial implications of not having health insurance. Below are highlights from current research about the consequences of not having health insurance:

Partners

More Information

Office of Health Insurance Programs
Corning Tower, Room 1955
Empire State Plaza
Albany, NY 12237
Email: bhp03@health.state.ny.us
Voice: 518-486-9012