Insurance status of Massachusetts residents

44 Pages·2000·1.8 MB·English

by  Massachusetts. Division of Health Care Finance and Policy

Massachusetts Division ofHealth Care Finance and Policy
Insurance Status
of Massachusetts Residents
Second Edition
GOVERNMENT DOCUMENTS
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Massachusetts
University of
Depository C.py
December 2000
Louis Freedman, Commissioner
I.
Argeo Paul Cellucci, Governor William D. O'Leary, Secretary
Commonwealth of Massachusetts Executive Office of Health and Human Services

Insurance Status
of Massachusetts Residents
Second Edition
December 2000
Louis Freedman, Commissioner
I.

Health Insurance Status of Massachusetts Residents
Summary
Executive
• The numberofuninsured peopleresiding
in lower income households has declined
more than any other income group. Unin-
surance rates for those living in households
with income between 134 through 150%
of the federal poverty level (FPL) declined
more than 55% between 1998 and 2000.
• Households with income between 151
through 200%oftheFPLdidnot experience
Section 25 of Chapter 203 of the Acts of any significant improvement in uninsur-
1996 required the Massachusetts Divi- ance rates. Within the five income groups
sion of Health Care Finance and Policy these households now show the highest
to file two reports on the findings of a uninsured rate at 14.3%.
comprehensive surveyofthe uninsured and
the underinsured in the Commonwealth. • Uninsurance rates have declined across
The first report, Health Insurance Status of all racial/ethnic groups between 1998 and
Massachusetts Residents, was completed in 2000. The Hispanic population has experi-
October of 1998. This second report con- enced the least improvement in uninsured
tains the findings from the second survey rates with a 10.5% decline in uninsured
on health insurance coverage which was rates compared to around 30% improve-
completed in the summer of 2000. ments for both the white and black popula-
tions.
Key Findings • Although nearly 32% of the uninsured
reside in the greater Boston area, of all
• The number ofuninsured people in Mas- Bostonarearesidents, lessthan6%areunin-
sachusetts has declined from an estimated sured. In comparison, about 24% of the
8.2% of the population in 1998 to 5.9% in uninsured reside in the Southeast region of
2000. the state, and of all Southeast region resi-
dents, about 8.2% are uninsured.
• The number of uninsured has declined
for both adults and children, with children • Nearly three times as many of uninsured
under age 19 showing the largest percent adultsareself-employedcomparedtoinsured
decline between 1998 and 2000 of more adults.
than 52%.
• Morethanthreequartersoftheuninsured
• Young adults ages 19 through 39 have work for small firms of 50 employees or less.
the largest proportion of uninsured at
11.3%, compared to children with the • Nearly three quarters of uninsured work-
smallestproportion ofuninsured ataround ing adults report they are ineligible for
3%. health insurance coverage through work.
iii
• For those working uninsured adults who • Uninsured adults report higher utiliza-
are eligible for health insurance coverage tion of emergency room services compared
through work, nearly 70% report cost as the to insured adults.
reason for being uninsured.
• Uninsured adults and children report
• Nearly86%oftheuninsuredreportbeing fewer physician office visits compared to
aware of the MassHealth program. insured adults.
iv Executive Summary
-
Health Insurance Status of Massachusetts Residents
Foreword
Satisfying the Need for
Health Care Information
The effectiveness of the health care
system depends in part upon the availabil-
ity of applicable information. In order for
this system to function properly, purchas-
ers must have accurate and useful infor-
mation about quality, pricing, supply and
available alternatives. Providers need infor-
The Division of Health Care Finance mation on the productivity and efficiency
and Policy collects, analyzes and dis- oftheir business operations to develop strat-
seminates information with the goal egies to improve the effectiveness ofthe ser-
of improving the quality, efficiency and vices they deliver. State policy makers need
effectiveness of the health care delivery to be advised of the present health care
system in Massachusetts. In addition, the environment, as theyconsider where policy
Division administers the Uncompensated investigation or action maybe appropriate.
Care Pool, a fund that reimburses Massa- As part of its health care information
chusetts acute care hospitals and commu- program, the Division of Health Care
nity health centers for services provided to FinanceandPolicypublishesreportstomeet
uninsured and underinsured individuals. this need for information. These reports
Mission
The Division's mission is to contribute to the development of policies that improve the
delivery and financing of health care in Massachusetts by:
• collecting and analyzing data from throughout the health care delivery system;
• disseminating accurate information and analysis on a timelybasis;
• facilitatingthe use ofinformation among health care purchasers, providers, consumers
and policymakers; and
• ensuringaccess to health care forlow-incomeuninsured andunderinsured Massachusetts
residentsthrough thoughtful administration ofthe Uncompensated Care Pool.
v
focus on various health care policy and improve health services to uninsured and
market issues. underinsured persons while reducing the
demand on the Pool to finance free care.
Organizational Structure Finally, the group is charged with providing
information to consumers on managed care
The Division of Health Care Finance organizations in Massachusetts.
and Policy is an administrative agency
within the Executive Office of Health Health Data Policy Group
and Human Services. The Commissioner is The Health Data Policy Group (HDPG)
appointed by the Governor. is chargedwith thedevelopment and appro-
The organizational structure is com- priate use of Division databases and is
prised of several distinct groups: responsible for evaluating health care data
managementissuesacrossorganizationsand
• Health Systems Measurement and providing information and reports to pro-
Improvement Group viders, plans, researchers and the govern-
ment.
• Health Data Policy Group HDPG is responsible for the collection
and release of hospital discharge data and
• Pricing Policy and Financial observation stay data. The group is also
Analysis Group responsible for managing the release of
accurate hospital and nursing home cost
• Audit Compliance and Evaluation and financial data. HDPG, in partnership
Group with other organizations, uses these data
for projects that involve benchmarking.
Each group is responsible for a differ- HDPG develops products that meet antici-
ent aspect ofthe agency mission. pated information needs includingindustry
trends, data products and custom reports.
Health Systems Measurement As well, HDPG is responsible for developing
andImprovement Group and implementing confidentiality and pri-
The Health Systems Measurement and vacyprotocols fortheuse ofdata. Thegroup
Improvement Group (HSMIG) works to conducts research and evaluates new health
improvethedeliveryofhealthcareinMassa- data policyissues such as nationalstandards
chusetts by evaluating the changing health for electronic data interchange and privacy
care system and providing useful analyses legislation.
and information to policy makers, health
care providers, and purchasers. The group PricingPolicy
also conducts health services research and andFinancialAnalysis Group
policy analysis for a variety of different The Pricing Policy and Financial Anal-
audiences to improve the delivery and value ysis Group develops health care policies,
of care. In recent years, the Group has ana- methods and payment rates that support
lyzed and reported on several areas of inter- theprocurementofhigh quality services for
est, including preventable hospitalizations, public beneficiaries and that promote pro-
hospital readmissions, health care reform in gram goals and efficiency in the health care
HMO
Massachusetts, trends in premiums deliverysystem. Thisgroupalso administers
and insurance status. The group manages the Uncompensated Care Pool in a manner
demonstration projects funded through the that ensures access to health care for low-
Uncompensated Care Pool whose goal is to income uninsured and underinsured indi-
vi Foreword