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 are growing . 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: 1) enrollment in health insurance; and 2) access to and delivery of preventive health services and primary care that are shown to improve overall health.
- 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.
Health Care Efficiency and Affordability Law for New Yorkers Phase 9 (HEAL 9) - Local Health Planning Initiatives Grant Program
The Department awarded 18 grants to support collaborative local health planning efforts, with the goal of developing an accessible, affordable, high-quality and cost-effective health care delivery system. These 18 awardees are engaged in innovative approaches to health planning that identify and prioritize community health needs and result in recommendations for aligning the health care delivery system with those needs.
Data and Statistics
Access to Quality Health Care
- Quality Assurance Reporting Requirements (eQARR) is a reporting system developed by the NYSDOH to enable consumers, employers, insurers, and government officials to evaluate the quality of health care services provided by New York State's managed care plans. The eQARR, an electronic version of the report, shows how well a health plan performed in areas such as provider network, child and adolescent health, women's health, adults living with illness, behavioral health, and satisfaction with care. The Access and Utilization Report contains information on utilization of services by health plan members.
- Prevention Quality Indicator (PQI) website is the first free, publicly accessible tool in NYS to identify hospitalization rates by ZIP code level for conditions generally considered preventable with access to good primary care. Information is also provided on health disparities by breaking data down according to patients' race and ethnicity. Indicators available in these data include circulatory, respiratory and acute conditions.
- Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing telephone health survey system that has been tracking risk behaviors and health conditions in New York State and other states yearly since 1984. Prevalence and trend data are available for health care access indicators such as:
- NYS Cancer Registry collects, processes and reports on information about every New Yorker diagnosed with cancer. Data from the Registry include cancer incidence rates, as well as the percent of cancers diagnosed at an early stage.
Health Insurance Coverage
The number and percent of New York State residents without health insurance are presented in a NYSDOH report entitled, Profile of the Uninsured in New York State in 2008, and are 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 U.S. Census Bureau on September 10, 2009 and analyzed by NYSDOH staff, except as noted in the final section.
Basic Rates and Counts
- In 2008, 14.1% of the state’s population was uninsured, about 2,720,000 people.
- The rate for children under 19 was 7.4%, with 343,000 uninsured.
- The rate for adults 19 to 64 was 19%, with 2,310,000 uninsured.
- These rates are below the comparable values for the nation, which were 15.4% for all, 10.3% for children under 19, and 20.3% for adults 19 to 64.
- The 2008 estimate of uninsured NYS residents is about 201,000 higher than in 2007.
- The NYS and national uninsured rates for adults in 2008 were about the same as they were five years earlier. The NYS rate for adults increased in 2008, returning to its 2006 value. The uninsured rate for children in NYS was notably lower in 2008 than it was five years earlier, and the sharp decline in 2008 reversed the three consecutive annual increases.
- Uninsured rates were higher in NYC than in the rest of the state.
New York City
- Most (55.6%) of the state’s uninsured live in NYC, with 1,512,000 uninsured in 2008.
- The uninsured rate in NYC was 18.2%, compared to a rate of 11.1% for the rest of the state.
- The NYC rate for children (7.9%) was somewhat higher than the rate in the rest of the state (7.0%). Among non-elderly adults, the NYC uninsured rate (24.6%) was substantially higher than the rate in the rest of state (14.6%).
- The 2008 estimate for NYC is about 144,000 more than 2007, accounting for about 70% of the 201,000 statewide increase.
- The 2008 estimate for NYC was 11% higher than in 2007, compared to a 5% increase in the rest of the state.
Demographics and Disparities
- Half of the uninsured (49.8%) are in the 19 to 39 year age group, with 29.5% in the 19 to 29 year age group. The rest are divided among children (12.6%), those aged 40 to 49 years (16.3%), and those aged 50 years and older (21.3%) [(50-64: 18.8%, 65+: 2.5%)].
- Racial/ethnic “minorities” are about 58.6% of uninsured, but only about 39.6% of population.
- The proportion of New Yorkers who were uninsured in 2008 was 9.7% for non-Hispanic Whites; 19.3% for African-Americans; 23.7% for persons of Hispanic origin; and 17.5% for others.
- About 22.6% of NYS uninsured are poor (see U.S. Census Bureau’s poverty definition).
- The proportion of poor who were uninsured in 2008 (22.5%) was higher than in 2007 (20.7%).
- More than a quarter (26.6%) of NYS uninsured are not U.S. citizens; 36.7% of non-citizens were uninsured.
Eligibility for Publicly Funded Coverage
- NYSDOH estimates that 90.9% of the state’s 343,000 uninsured children under age 19 (311,000 children) are now eligible for publicly subsidized health insurance.
- About half (51.3%) of those eligible children qualify for Medicaid and the remaining for Child Health Plus (CHPlus).
- About 47,000 of those children are eligible because of the recent expansion of CHPlus eligibility to 400% of FPL.
- Another 31,000 uninsured children above 400% of FPL are eligible to enroll in CHPlus without public subsidy by paying the full state-negotiated monthly premium rate.
- NYSDOH estimates that 37.4% of the state’s 2.31 million uninsured adults, or 865,000 people, are eligible for public health insurance programs.
- About three-quarters (75.1%) 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. However, it has found that private insurance coverage in general and employment-based coverage specifically were essentially unchanged between 2007 and 2008. The CPS estimates that 11.3 million NYS residents were insured through employment-based programs in 2008.
- Another federal survey (MEPS-IC) found that employment-based coverage was available to about two-thirds (71%) of the estimated 7.5 million private-sector workers in NYS in 2008. The remaining one-third worked in firms that have no health insurance program (9.6% of workers) or were not eligible for their company’s program (21.5% of workers).
- More than three-fourths (78%) of workers in NYS who were offered employment-based health insurance through their company’s program, according to the MEPS-IC.
- In smaller firms (under 100 employees), 57.2% of workers had the opportunity to enroll and about 72.1% of those given the opportunity did enroll in the company’s plan.
County Estimates of the Number of People who are Uninsured
Every year, the Census Bureau estimates each state’s uninsured population using data from the Current Population Survey (CPS). These national and state estimates are the most-widely cited source in discussion of the likely impact and costs of healthcare reform proposals and trends in coverage. However, the CPS files do not provide estimates by county. To satisfy the need for county estimates of the uninsured, the Census Bureau developed a national regression model based on tax information, Medicaid enrollment, food stamp caseloads, and population estimates.
This year, the Census Bureau also released direct estimates of the uninsured for 38 NYS counties with at least 65,000 residents, as part of its American Community Survey (ACS). The CPS and ACS provide two different estimates of the uninsured in New York State. We believe the CPS provides the most useful estimate of the uninsured statewide. Since the ACS county estimates are derived from a local population survey instead of a national regression model, we believe they provide a more valid picture of the distribution of the uninsured across the state.
In recent years, the New York State Department of Health has allocated the statewide CPS results into counties based on the Census Bureau’s national regression model. Our procedure ensures that the counties sum to the statewide CPS findings that are used in most other contexts. For this year’s allocation we relied on the ACS data when available (counties of 65,000 or more), and resorted to the regression model to allocate the remaining uninsured into the 24 counties that were not estimated in the ACS. The results of our allocation of the CPS-estimated uninsured children and adults are included in tables below. The following is a table for the estimated number of people who were uninsured in 2008 by county of residence.
New York State Department of Health Programs
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. Learn more about these health insurance programs:
Enrollment in New York’s Public Health Insurance Programs
More than two million of New Yorkers covered are children and teens with approximately 1.7 million enrolled in Medicaid and nearly 390,000 in Child Health Plus. Learn more about enrollment by program and county :
Where to Sign-up for Health Insurance Coverage
To enroll in Child Health Plus, Medicaid and Family Health Plus, families and individuals will need to fill out an application and provide proof of age, identity, home address, income and citizenship or immigration status for everyone applying.
Families and individuals can apply for Medicaid and Family Health Plus at their Local Department of Social Services/local Medicaid office or through a facilitated enroller. Families with children who may be eligible for Child Health Plus may apply with a directly with a participating Child Health Plus health plan. Across New York, over 100 organizations and 21 authorized health plans have staff, called facilitated enrollers, to help individuals and families apply for Child Health Plus, Medicaid, or Family Health Plus. Facilitated enrollers screen the applicant for the appropriate program, help individuals and families complete the application, gather the required documentation, and follow-up to ensure they complete the application process. Facilitated enrollers are available to help during the work day, evenings and weekends.
For Application Assistance:
- Facilitated Enrollers and Local Departments of Social Services
- Participating Child Health Plus Insurers
It is important to know that New Yorkers must renew their Child Health Plus, Medicaid and Family Health Plus coverage annually. Children and adults are enrolled in their health insurance for about one year. Before the year is over, they will receive a packet in the mail from their local Medicaid program or their Child Health Plus plan. This form must be completed and returned. If the renewal is not submitted on time or requests for additional information are not returned, the consumer will lose coverage.
Strategies - The Evidence Base for Effective Interventions
Access to and receipt of clinical preventive services and primary care
Managed care plans that serve those who are 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 of all patients.
To ensure that 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 screening rates for breast cancer, cervical cancer and colorectal cancer. In addition, the DOH has new initiatives designed to ensure that 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). The PIPs are small scale research projects designed to test various system changes as a way of improving care. Many of them have focused on improving rates of preventive health screenings among their members.
County Strategies and Partners Matrix
The County Strategies and Partners Matrix for Access to Quality Health Care was compiled from the 2010-2013 community health assessments submitted in 2009 by 36 local health departments. It describes how local health departments collaborate with hospitals and community organizations to plan and address this priority to improve population health outcomes.
Reports for Quality of Care
- New York State 2009 - Managed Care Plan Performance
- 2009 Managed Care Plan Access and Utilization Report
- 2009 Managed Care Regional Consumer Guides (these guides help families choose a managed care plan that meets their health care needs).
- 2010 Managed Care Plan - Interactive Query Report
Medicaid Managed Care Performance Improvement Projects. 2009-2010 Pediatric Obesity-Summary of Projects (This summary describes 2009-2010 projects by managed care providers targeted at reducing childhood obesity.)
Evidence-based Strategies for Helping People Get Enrolled
The organizations listed below feature some of the most recent research and literature on the issue of the uninsured, health care coverage, and access to care.
- Health Coverage & the Uninsured: Kaiser Family Foundation
- Health Insurance and Access to Care: Kaiser Commission on Medicaid and the Uninsured
- Center for Children and Families: Georgetown University Health Policy Institute
- Cover The Uninsured
- Robert Wood Johnson Foundation
- Center on Budget and Policy Priorities
- Institute of Medicine of the National Academies
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:
Impact of being uninsured on access to care for adults
- More than 50% of uninsured adults have no regular source of care.
- Uninsured are more likely to delay or forgo needed care, which can lead to more serious health problems and can result in hospitalizations for avoidable conditions.
- Uninsured individuals are four times more likely to delay or forgo needed care than the insured because they anticipate high medical costs for their care.
- The uninsured are twice as likely as those who are insured to be unable to pay for basic family needs, such as food and housing, due to medical bills.
- With continuous health coverage, premature mortality rates can be decreased by up to 25% among uninsured adults.
Impact of health care coverage on access to care for children and pregnant women
- Uninsured children are less likely to get routine well-child care, have worse access to health care, and use medical and dental services less frequently than insured children.
- Uninsured women are more likely to have poor outcomes during pregnancy and delivery than are insured women.
- Uninsured pregnant women have a greater likelihood of maternal complications, infant death and low birth weight.
- Community-Based Facilitated Enrollment Programs
- Coalition of New York State Public Health Plans
- New York State Health Plan Association
- Hinman Straub P.C.
Resources for Other Health Care Coverage Options
More InformationOffice of Health Insurance Programs
Division of Coverage and Enrollment
Division of Quality and Evaluation
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