Trends and Indicators in the Changing Health Care Marketplace Section 7: Implications of Health Market Trends for Consumers and the Safety Net
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Trends and Indicators in the Changing Health Care Marketplace
Exhibit 7.1: Number of the Nonelderly Uninsured, 1994-2004
The number of the nonelderly (under age 65) uninsured in the United States increased in 2004 to 45.5 million, an increase of 800,000 over 2003. Health insurance affects people’s access to health care, their health status, their job decisions, and their financial security. Health insurance makes a difference in whether people get necessary medical care, where they get their care, and, ultimately, how healthy they are. About two-thirds of the nonelderly uninsured are low income (see Exhibit 7.4), so medical bills can cause financial burdens for individuals and families. Uncompensated care to uninsured and underinsured individuals and the safety net of public hospitals and community clinics do not fully substitute for health insurance.
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Notes: Changes in the Current Population Survey’s (CPS) sample and questionnaire have been made over the years, which hamper the ability to trend data across years. Health insurance estimates for 1999 and later years that use the revised questionnaire cannot be compared with CPS estimates from earlier years. *Revised method estimates for 1999 shown in this exhibit are comparable to later years, except they are based on a smaller sample.
Source: Kaiser Family Foundation, Health Insurance Coverage in America, 2004 Data Update, November 2005, Figure 1, p.9, at http://www.kff.org/uninsured/7415.cfm prepared by the Kaiser Commission on Medicaid and the Uninsured, and the Urban Institute using data from the Census Bureau’s March Supplements to the Current Population Survey.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 03/15/06
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 7.2: Changes in Health Insurance Coverage Rates, Children and Nonelderly Adults, (Percentage Point Differences), 2002-2003
From 2002 to 2003, employer coverage of both children and adults declined, with a greater decline for children than for nonelderly adults. Increases in Medicaid coverage helped to offset the losses in employer coverage for children, but only partially offset such losses for nonelderly adults.
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Notes: Medicaid/Other Public also includes the State Children’s Health Insurance Program, other state programs, Medicare, and military-related coverage.
Source: Kaiser Family Foundation, Health Insurance Coverage in America, 2003 Data Update, November 2004, Figure 22, Table 2 and Table 3, at http://www.kff.org/uninsured/7153.cfm, prepared by the Kaiser Commission on Medicaid and the Uninsured, and the Urban Institute using data from the Census Bureau’s March 2004 Supplement to the Current Population Survey.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 02/02/05
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 7.3: Health Insurance Coverage of the Nonelderly by Poverty Level, 2004
As income decreases, the likelihood of being uninsured increases (18.3% of those with moderate incomes vs. 36.5% of the poor were uninsured in 2004) and the likelihood of having employer-sponsored coverage decreases (65.9% of those with moderate incomes vs. 15.0% of the poor had such coverage in 2004). Because the Near Poor are less likely to qualify for public insurance and have decreased access to employer-sponsored insurance, almost a third (28.5%) of this group was uninsured in 2004.
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Notes: Percentages may not total 100% due to rounding. The federal poverty level was $19,307 for a family of four in 2004. Medicaid also includes the State Children’s Health Insurance Program (SCHIP). Other Public includes Medicare, military-related coverage, and state programs other than Medicaid and SCHIP.
Source: Kaiser Family Foundation, Health Insurance Coverage in America, 2004 Data Update, November 2005, Table 1, p. 26, at http://www.kff.org/uninsured/7415.cfm, supplemented with data prepared by the Kaiser Commission on Medicaid and the Uninsured, and the Urban Institute using data from the Census Bureau’s March 2005 Supplement to the Current Population Survey.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 03/15/06
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 7.4: The Nonelderly Uninsured by Poverty Level, 2004
In 2004, almost two-thirds (64.3%) of the uninsured were from families with incomes below 200% of the federal poverty level (or FPL, which was $19,307 for a family of four in 2004). More than one-third (36.8%) of the uninsured had incomes below poverty, and an additional 27.5% had incomes below twice poverty.
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Notes: The federal poverty level was defined as $19,307 for a family of four in 2004.
Source: Kaiser Family Foundation, Health Insurance Coverage in America, 2004 Data Update, November 2005, Table 10, p. 36, at http://www.kff.org/uninsured/7415.cfm, prepared by the Kaiser Commission on Medicaid and the Uninsured, and the Urban Institute using data from the Census Bureau’s March 2005 Supplement to the Current Population Survey.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 03/15/06
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 7.5: Health Status Within Health Insurance Coverage Types, 2004
The uninsured are more likely than those with employer or other private coverage to be in fair or poor health (9% vs. 5% in 2004). The Medicaid population is the least healthy, with one in five (20%) being in fair or poor health.
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Notes: Medicaid also includes the State Children’s Health Insurance Program, other state programs, Medicare, and military-related coverage. May not total 100% due to rounding.
Source: Kaiser Family Foundation, Health Insurance Coverage in America, 2004 Data Update, November 2005, Figure 18, p. 18, at http://www.kff.org/uninsured/7415.cfm, prepared by the Kaiser Commission on Medicaid and the Uninsured, and the Urban Institute using data from the Census Bureau’s March 2005 Supplement to the Current Population Survey.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 03/15/06
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 7.6: Barriers to Health Care by Insurance Status, 2003
Lacking insurance has serious consequences for the uninsured. Without insurance, the cost of care becomes a barrier preventing the uninsured from obtaining recommended health care services and treatment. Nearly half (47%) of the uninsured reported in 2003 that they postponed seeking care because of costs, and about a third did not fill a prescription (37%) or skipped recommended treatment (35%) because of cost. The uninsured were 3-4 times more likely than the insured to say they had experienced these problems.
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Notes: Insured includes those covered by public or private health insurance. *Experienced by the respondent or a member of their family.
Source: Kaiser Family Foundation, Kaiser Commission on Medicaid and the Uninsured, Access to Care for the Uninsured: An Update, September 2003, Chart 2, p. 3, at http://www.kff.org/uninsured/4142.cfm, using unpublished data from the Kaiser 2003 Health Insurance Survey.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 4/01/04
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 7.7: Consequences of Not Getting Care, by Insurance Status, 2003
Both the uninsured and insured experience serious consequences when they don’t get medical care. In 2003, about half reported that they suffered painful temporary disability (57% uninsured, 52% insured) or loss of time at important activities (50% uninsured, 42% insured). About one-fifth suffered a long-term disability (19% uninsured, 15% insured).
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Notes: No significant difference between groups for any of these measures. Insured includes those covered by public or private health insurance. *Experienced by the respondent or a member of their family.
Source: Kaiser Family Foundation, Kaiser Commission on Medicaid and the Uninsured, Access to Care for the Uninsured: An Update, September 2003, Chart 3, p. 4, at http://www.kff.org/uninsured/4142.cfm, using unpublished data from the Kaiser 2003 Health Insurance Survey.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 4/01/04
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 7.8: Financial Burden of Medical Bills, by Insurance Status, 2003
Over a third (36%) of the uninsured in 2003 had problems paying medical bills in the past 12 months. Almost a quarter (23%) of the uninsured had to change their way of life significantly to pay medical bills or were contacted by collection agencies about medical bills. The uninsured were 2-3 times more likely to say they experienced these problems than the insured.
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Notes: Insured includes those covered by public or private health insurance.
Source: Kaiser Family Foundation, Kaiser Commission on Medicaid and the Uninsured, Access to Care for the Uninsured: An Update, September 2003, Chart 4, p. 5, at http://www.kff.org/uninsured/4142.cfm, using unpublished data from the Kaiser 2003 Health Insurance Survey.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 4/01/04
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 7.9: Funding of Uncompensated Care to the Uninsured
Federal spending is the largest and most important component of funding for the health care safety net, which is the informal network of hospitals, clinics, community health centers, and other community-based providers that provide most of the uncompensated care received by the uninsured. Federal health care safety net spending rose from $19.8 billion in 2001 to $22.8 billion in 2004, an increase of 15.4%. However, in inflation-adjusted terms, the increase was only 1.3% (from $22.5 billion to $22.8 billion). Since the number of uninsured increased 11.2% during this period (from 41,207,000 to 45,820,000), Federal spending per uninsured person actually declined 8.9% (from $546 in 2001 to $498 in 2004).
Total Sources of Funding Available for Uncompensated Care to the Uninsured, 2001
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Federal Spending on the Health Care Safety Net ($ billions), 2001-2004
2001
2002
2003
2004
% Change 2001-2004
Federal Spending, Current Dollars
$19.8
$20.5
$21.9
$22.8
15.4%
Inflation-Adjusted Federal Spending
$22.5
$22.3
$22.9
$22.8
1.3%
Number of Uninsured (000's)
41,207
43,574
44,961
45,820
11.2%
Inflation-Adjusted Federal Spending per Uninsured Person
$546
$512
$509
$498
-8.9%
Notes: Inflation adjustment using the medical care component of the consumer price index (almost 14% increase between 2001 and 2004) and shown in constant 2004 dollars.
Source: Jack Hadley et al., Kaiser Commission on Medicaid and the Uninsured, Federal Spending on the Health Care Safety Net from 2001-2004: Has Spending Kept Pace with the Growth in the Uninsured?, November 2005, pp. 5, 26, and 27, at http://www.kff.org/uninsured/7425.cfm.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 4/26/06
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 7.10: Number of Public Community Hospitals, 1990-2003
The number of public (i.e., state and local government) community hospitals has declined by about one-fifth (22%) over the past decade, from 1,444 in 1990 to 1,121 hospitals in 2003. Facility consolidation, mergers, and privatization have all contributed to this decline. Public community hospitals typically provide more care to uninsured and low-income patients than do other types of hospitals. The number of admissions to public community hospitals has also declined, from 5.2 million in 1990 to 4.6 million in 2003 (a 12% decrease).
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Notes: Includes state and local government community hospitals. Community hospitals represent 85% of all hospitals. Federal hospitals, long term care hospitals, psychiatric hospitals, institutions for the mentally retarded, and alcoholism and other chemical dependency hospitals are not included.
Source: Health Forum LLC, an affiliate of the American Hospital Association: Hospital Statistics, 2002, Table 1 (1990-2000 data); American Hospital Association Annual Surveys (2000-2003 data) at www.hospitalconnect.com.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 4/11/05
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 7.11: Health Center Medicaid and Uninsured Patients and Revenues by Payer Source, 1985 and 2004
Community health centers (CHCs) are an important source of primary care (and to a lesser extent specialty care) for low-income populations. As more poor children and adults became eligible for Medicaid during the 1980s and 1990s, the share of CHC patients and funding attributable to Medicaid has grown, while the shares attributable to the uninsured have fallen.
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Notes: No data on privately insured patients provided for 1985.
Source: Kaiser Commission on Medicaid and the Uninsured, Health Centers Reauthorization -- An Overview of Achievements and Challenges, prepared by Sarah Rosenbaum and Peter Shin, March 2006, Fig. 9, Pg. 12, at http://www.kff.org/uninsured/7471.cfm, using 2004 Uniform Data System (UDS) data and 1985 estimates by the National Association of Community Health Centers using Bureau of Community Health Service's Common Reporting Requirements (BCRR).
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 04/26/06
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 7.12: Insured Adults' Views of Their Health Plans, 1998-2004
About two-thirds (67%) of adults with health insurance gave their current health plan an “A” or a “B” in 2004, with only about 2% giving their plan an “F.” These results have been fairly consistent over the last 6 years. A greater proportion of insured adults gave an “A” to their Medicare plan (36%) than did those enrolled in other types of plans (employer, Medicaid, and privately bought).
Rating Of Own Health Plan: 1998-2004 “I want to know how you rate your current health plan, thinking about all your experiences with that plan, would you give it a grade of A, B, C, D, or F?” Base: Insured Adults
1998
1999
2000
2001
2002
2004
A
33%
30%
34%
29%
31%
28%
B
39
39
35
38
35
39
C
18
22
19
23
20
18
D
5
5
6
4
8
8
F
3
2
2
4
4
2
Not sure/refused
2
2
4
2
2
4
Rating Of Those With Different Types Of Plans: 2004 “I want to know how you rate your current health plan, thinking about all your experiences with that plan, would give it a grade of A, B, C, D, or F?” Base: Insured Adults
Employer-Provided
Medicare
Medicaid
Privately Bought
A
25%
36%
22%
26%
B
42
31
40
40
C
19
15
18
19
D
10
11
16
9
F
2
4
2
2
Not sure/refused
2
5
3
3
Source: Harris Interactive, "Satisfaction with Own Health Insurance Remarkably Stable," Health Care News, March 29, 2004, Volume 4, Issue 5, Tables 1-A and 1-B, at http://www.harrisinteractive.com/news/newsletters_healthcare.asp. Survey was conducted February 9-16, 2004.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 4/11/05
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 7.13: Views About Managed Care’s Impact, 1997-2004
The share of the public expressing negative views about managed care’s impact has remained fairly steady since 1997, though the share saying that managed care has not made much difference in health care costs has increased from 55% in 1997 to 63% in 2004. The share saying that managed care has made it easier to get preventive services has declined from 46% in 1997 to 32% in 2004.
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Aug-97
Aug-98
Apr-99
Jul-01
Aug-04
Not made much difference in health care costs
55%
59%
55%
59%
63%
Decreased time doctors spend with patients
61
64
61
67
60
Made it harder for people who are sick to see medicine specialists
59
62
63
59
56
Decreased the quality of health care for people who are sick
51
50
50
54
49
Made it easier to get preventive services
46
40
38
39
32
Source: Kaiser Family Foundation, Health Poll Report, July/August 2004 Edition, at http://www.kff.org/healthpollreport/archive_aug2004/2b.cfm, using surveys conducted by the Kaiser Family Foundation and the Harvard School of Public Health, with fieldwork conducted by Princeton Survey Research Associates.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 4/11/05
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 7.14: Worries About Health Care, 1999-2003
The share of the public that reports it is very worried about health care has changed somewhat over time. Health care worries reached a peak in June 2001, but fell following the events of September 11, 2001, when the public's concerns seemed to shift away from health care toward other matters. Worries about health care rose again between December 2001 and June 2002 and since then have declined slightly. About 3 in 10 are very worried that the amount they pay for health services or insurance would increase (32%) or that their health plan would be more concerned about saving money than about the best treatment (29%).
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Source: Kaiser Family Foundation, Health Poll Report, Health Security Watch, November/December 2003 Edition.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 4/01/04
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 7.15: Worries About Employer-Sponsored Health Insurance, 1999-2003
About one in six people with health insurance said they were very worried about losing their health insurance coverage. A smaller percentage reported staying in their current job because they feared they would lose health coverage if they changed jobs.
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Source: Kaiser Family Foundation, Health Poll Report, Health Security Watch, November/December 2003 Edition.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 4/01/04
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 7.16: Worries About Affording Health Care, 1996-2004
In 2004, about 3 in 4 Americans said they were very concerned about being unable to afford necessary health care when a family member gets sick.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 4/11/05
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 7.17: Personal Experience with Medical Errors, Public (2004) and Physicians (2002)
A 1999 Institute of Medicine report, To Err Is Human: Building A Safer Health System, estimated that between 44,000 and 98,000 die each year in this country from preventable medical errors in hospitals. Although other studies have estimated fewer preventable deaths, the issues of safety and quality in medical care have been a major focus in recent years. About a third of the public (34%) in 2004 and about a third of physicians (35%) in 2002 said that they had been personally involved in a situation where a preventable medical error was made in their own medical care or the care of a family member. The surveys defined medical errors as mistakes that are made when people are ill and receive medical care that results in serious harm, such as death, disability, or additional or prolonged treatment. Some errors are preventable, while others may not be. Nearly a quarter of the public (21%) in 2004 and one-fifth of physicians (18%) in 2002 said that the medical error they experienced resulted in serious health consequences, including loss of time from important life activities such as work or school (16% public/12% physicians), severe pain (16%/11%), temporary disability (12%/8%), long-term disability (11%/6%), and death (8%/7%). In addition, almost a third (29%) of physicians said in 2002 that the past year in their role as a physician, they had seen a medical error that resulted in serious harm to a patient.
Personal Experience with Medical Errors, Public (2004) and Physicians (2002)
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Source: 2004 public data from Kaiser Family Foundation/Agency for Healthcare Research and Quality/Harvard School of Public Health, National Survey on Consumers’ Experiences with Patient Safety and Quality Information, November 2004, Chart 16 and Chart 17 (conducted July 7-September 5, 2004) at http://www.kff.org/kaiserpolls/7209.cfm. 2002 physician data from Kaiser Family Foundation/Harvard School of Public Health, Medical Errors: Practicing Physician and Public Views, December 2002, Chartpack, Charts 1-3, at http://www.kff.org/kaiserpolls/20021211a-index.cfm.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 04/11/05
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 7.18: Exposure To and Use of Quality Information, 2000 and 2004
One suggested method for improving quality of care is to rate or rank health plans and health care providers and then publish this information to help consumers make choices. Two important aspects of this approach are whether consumers have access to the information and whether they use the information in making decisions about their health care. People were slightly more likely to say they had seen and used health care quality information in 2004 compared to 2000 (35% said they saw any quality information in 2004 vs. 27% in 2000). In 2004, they were more likely to say they had seen information comparing the quality of health insurance plans (28%) than hospitals (22%) or doctors (11%). The share that said they saw and used quality information to make health care decisions increased from 12% in 2000 to 19% in 2004.
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Source: Kaiser Family Foundation/Agency for Healthcare Research and Quality/ Harvard School of Public Health, National Survey on Consumers’ Experiences with Patient Safety and Quality Information, November 2004, Chart 10 (conducted July 7-September 5, 2004) at http://www.kff.org/kaiserpolls/7209.cfm.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 04/11/05
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 7.19: Why People Did Not Use Quality Information, 2004
Those who saw health quality information about hospitals and health plans but did not use it were most likely to say they did not use it because they did not need to make a decision about their care at the time (68% for hospital information/64% for health plan information), or the information they saw was not specific to their personal health conditions or concerns (53% for hospital information/40% for health plan information).
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Source: Kaiser Family Foundation/Agency for Healthcare Research and Quality/ Harvard School of Public Health, National Survey on Consumers’ Experiences with Patient Safety and Quality Information, November 2004, Chart 11 (conducted July 7-September 5, 2004) at http://www.kff.org/kaiserpolls/7209.cfm.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 04/11/05
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number: 7031
