"The Effects of Health Care Financing Arrangements on Consumer UtilizationDecisions in Harris County." 

Presented at the Healthcare Safety Net Initiatives Conference: Policy and Performance on February 9, 2007

Pamela Behan, PhD., Assistant Professor of Sociology University of Houston-Downtown

Patrice Williams, Graduate Research AssistantUniversity of Texas School of Public Health

Project DescriptionTelephone Survey with telephone numbers from a random-digit-dialed list from University of Houston Center for Public Policy.

Inclusion criteria

Harris County resident

At least 18 yrs of age

Comprehensive knowledge of a time in the past year when someone in Harris County needed medical care

Exclusion criteria

Business telephone numbers

Less than 18 years of age

The study budget

Houston Health Services Collaborative

University of Houston Center for Public Policy

Spanish Survey Experience

• Finding translators

• Translation of survey

• Delivery of the survey

What terms used Healthcare changed to medical care issues The introductory statement

When to callMorningsAfternoonsEvenings Weekends

Where to conduct the surveyU of H survey labHome Office

How to conduct the surveys Pen and paper surveys Computer assisted Internet

Flexibility

Thank you for your time

The Effects of The Effects of Health Care Financing Health Care Financing

Arrangements on Consumer Arrangements on Consumer Utilization Decisions in Harris Utilization Decisions in Harris

County:County:

Preliminary ResultsPreliminary Results

OROR

Does our safety net

(and system)

work the way we think it does?

The Problem:The Problem:

A lack of timely care leads to:

▫ preventable health care problems▫ pain, stress, grief, poverty ▫ wasted human potential▫ the need for more expensive care ▫ wasted safety net resources

Why do people not get timely Why do people not get timely care?care?

One explanation:

Lack of insurance or funds ->

Refusal by providers

Another explanation:

Inadequate insurance or funds, or confusion about either ->

Fear of costs or fear of refusal ->

Delay or avoidance by consumers

Is it only the uninsured that don’t Is it only the uninsured that don’t get timely care?get timely care?

One answer:

Yes. Insurance takes care of access & costs.

Another possibility:

No. All insurance is not equal. Some requires cash to get care and covers very little, while other insurance requires no cash and covers a lot.

Also, insurance is changing:Also, insurance is changing:

Increasing health care costs ->

Decreasing coverage by employment-related and government insurance programs ->

Increased likelihood of less timely care among the insured

Which answers are correct? Which answers are correct? How can we find out?How can we find out?

Which answers are correct? Which answers are correct? How can we find out?How can we find out?

Ask consumers!

How?How?

Our Research Format:

Telephone Survey

Random Sample of 500 Harris County residents

Questions about:

▫ a recent episode of need for medical care

▫ the patient’s insurance coverage

▫ the patient and decision-Maker (if different)

Preliminary ResultsPreliminary Resultsbased on:based on:

• 403 cases• 82% insured; 18% uninsured• Patient ages: 1 to 99; average 51years old• Patient race/ethnicity: 51% white, 27% African-

American, 20% Hispanic, 2% Other• Patient gender: 62% female; 38% male• Household Incomes: 15% < $10,000 per year; 32% > $75,000 per year; average $35-50,000

First, we look at decisions which First, we look at decisions which involved insurance or financial involved insurance or financial

considerations:considerations:

• Total: 270

• Positive only: 182 (67%)

• Negative only: 69 (26%)

• Mixed: 19 (7%)

Types of decisions affected by Types of decisions affected by insurance or financial insurance or financial

considerations:considerations:

• To seek care right away (98)• To wait before seeking care (61)• To not seek care (22)• To have all recommended tests and

treatments done right away (121)• To wait on some or all tests & treatments (5)• To not have all tests & treatments done (20)

Now, we look at decisions to delay Now, we look at decisions to delay or avoid care:or avoid care:

• Total (188) • For non-financial reasons (91)• For financial or insurance-related reasons (98)

Now let’s add in insurance status:Now let’s add in insurance status:

Delayed or avoided care, tests or treatments:• Insured (136 / 327) 42%• Uninsured (52 / 73) 71%

Considered insurance or finances in making that decision:

• Insured (47 / 327) 14%• Uninsured (51 / 73) 70%

Other factors that appear to affect care Other factors that appear to affect care avoidance or delay for financial or avoidance or delay for financial or

insurance-related reasons:insurance-related reasons:

• Insurance source• Race• Income• Age• Whether the patient

makes their own care decisions

• Whether the patient has a regular provider

• Whether the patient has ever been refused care

• Whether the patient has avoided care in the last year

Decisions are made differently when a Decisions are made differently when a situation is perceived as an emergency.situation is perceived as an emergency.

• Insurance and financial considerations are ignored (73)

• Care is sought “in spite of” financial or insurance concerns (40)

Possible ImplicationsPossible Implications

• About the same number (not percent) of insured as uninsured citizens are discouraged by financial concerns from getting care in a timely manner.

• Any insurance is not necessarily better than no insurance in its consequences for timely care.

• Current arrangements ignore many user concerns and decision-making patterns, leading to less timely care.

• These concerns and patterns must be clarified and used in policy planning if resource waste is to be minimized and program results maximized.