to Statistical Brief Prepared by the State Center for Health Statistics For the Council on Health Policy Information December 1996 HEALTH STATUS AND ACCESS TO ROUTINE CARE - North Carolina Adults Under Age 50 by Medicaid Status According to a recent telephone survey Figure 1 of North Carolina households, adult Percent of Adults by Reported Health Status (age 18 and over) Medicaid enrollees are less healthy than are non-Medicaid adults. Health status in this case was assessed using five indicators: a general self-report of health status (Poor to Excellent); reported limitations on physical activities; number of times hospitalized during last year; number of visits to the emergency room during last year; and the occurrence of a major health problem during last year. Medicaid enrollees had more routine care visits and were more likely than non-Medicaid adults to report problems Research Unit (SRU) at the University of North Carolina at getting to or from their source of routine Chapel Hill. The analysis of the survey is being conducted by care. Additionally, Medicaid enrollees the State Center for Health Statistics. were more likely to use the hospital or In 1994, a goal of the state's Health Planning Commission emergency room as a source of routine was to change the focus of the current health system from a care. "curative medical system " to "one that focuses on keeping The data for this Statistical Brief are people healthy. "' With this in mind, this Brief focuses on the from the North Carolina Health Profile present health status and access to routine (preventive) care (NCHP), a telephone survey of North among adults under age 50. Data for ages 50 to 64, and 65 Carolina households. The NCHP consists and over are presented in separate Briefs2 3. of three modules - adult health survey, child health survey, and a young child A higher percentage of Medicaid enrollees reports fair to survey (newborn to six years). The poor health (Figure 1). information in this Statistical Brief is from the adult health module. The adult • Compared to non-Medicaid individuals, Medicaid enrollees health survey was designed to collect reported more often their health as being fair to poor. data on health status, access to care, and attitudes about health care issues. The • Over half of Medicaid enrollees aged 35 to 49 reported survey was administered by the Survey having fair to poor health. This is much greater than the 10 percent reported by non-Medicaid individuals in the same age group. a Statistical Brief No. 6 N.C. Department of Environment, Health, and Natural Resources STATE LIBRARY OF NORTH CAROLINA Statistical Brief No. 6 - December 1996 State Center for Health Statistics 3091 00591 9980 ^ • Among the 34 and younger age group, 20 percent • The Medicaid population's greater use of the of the Medicaid enrollees reported fair to poor emergency room was true for both age groups. health compared to only 5 percent of non- Additionally, Medicaid enrollees were much Medicaid individuals. more likely to have gone two or more times to the emergency room during the last year, compared More Medicaid enrollees reported a major to the non-Medicaid group (Figure 2). health problem during the last year. Medicaid enrollees are more likely to report • About 22 percent of Medicaid enrollees reported having a usual source of routine health care. a major health problem during the last year. This compares to 8 percent of the non-Medicaid • Eighty-one percent of Medicaid enrollees re- population. ported having a usual source of routine health • Thirty-five percent of Medicaid enrollees re- care. By comparison, 72 percent of non-Medic- sponded that they or a related household member aid individuals indicated a usual source of routine had a major health problem during the last year. care. This is over two times that for non-Medicaid • Twelve percent of Medicaid enrollees compared individuals. to seven percent of non-Medicaid adults reported using the hospital, emergency room, or urgent Medicaid enrollees are more likely to have care center as their source of routine care. physical limitations due to health. • Medicaid enrollees were also more likely than others to use neighborhood or government clinics • Medicaid enrollees reported three or more for routine care. physical limitations more often than did non- Medicaid individuals. Over one-fourth of Medicaid enrollees and • Over 25 percent of the Medicaid enrollees reported almost half of non-Medicaid individuals that activities associated with work, housework, or report no routine care in the last year. school work were limited due to their health. • Twenty-nine percent of Medicaid enrollees Medicaid enrollees report hospitalization and reported not going for routine care in the last emergency room use more often. year. By comparison, 45 percent of non-Medicaid individuals reported not going for routine care • Medicaid enrollees were hospitalized more often, (Figure 3). and were more likely to report having been hospital- • Half of Medicaid enrollees went 2 or more times ized two or more times during the last year. for routine care during the last year. Only 26 • Fifty-four percent of Medicaid enrollees went to percent of non-Medicaid individuals went 2 or an emergency room or urgent care center during more times. the last year, compared to 22 percent of non- Medicaid individuals. Figure 3 Figure 2 fervent of Adults by Reported Number of Percent of Adults by Reported Number of Visits Emergency Room or Urgent Care Visits During for Routine Care During the Last Year the Last Year 60% -I 50% ■ Nne 50% 45% uOretfre 2orrTtrefimes 40% 30% 1 28°, 30% 26% 1 18% 20% 10% ;:!*: H 1 MBdcacl Non-K/fedcad State Center for Health Statistics Statistical Brief No. 6 - December 1996 More non-Medicaid individuals report they could not get routine care when they needed it. Figures Percent of Adults Rating Last Routine Visit 12% Ckring the Last Year as Fair/Poor • Five percent of non-Medicaid enrollees reported they could not get routine care when they needed ■ 181034 it during the past year. By comparison, two 351049 percent of Medicaid individuals reported not getting the routine care they needed. More Medicaid enrollees report problems ■ getting to or from routine care in the last year. • Almost 11 percent of Medicaid enrollees reported problems getting to or from their routine care Part of the reason that Medicaid enrollees are less provider. Less than one percent of the non- healthy, on average, is that some people qualify for Medicaid population reported a problem. Medicaid because of illnesses that deplete their • Medicaid enrollees aged 35 to 49 years had the economic resources or because they are blind or greatest difficulty, with 22 percent reporting prob- disabled. Medicaid enrollees were also more likely to lems getting to or from their routine care (Figure 4). have problems getting to or from their source of routine care. Figure A Changing this scenario of both poorer health status Percent of Adults Reporting Problems Getting To or From Last Routine Care During the Last Year and health care practices presents a major challenge to 25%- local, state, and federal policy makers. While there are 21% 20%- t '- " :- no simple answers, the survey suggests one area for 3510*9 possible intervention - a goal of increasing the use of 15%- routine care in the most appropriate setting needs to be 10% - _m7%. a major policy initiative. 5%- i% i% The implementation of the Carolina Access Pro- gram in North Carolina has focused on properly Medicaid Non-Medicaid channeling the Medicaid population through an array of health care services appropriate to needs. Medicaid Medicaid enrollees rate the quality of their in conjunction with some counties also initiated a routine care lower than do non-Medicaid Medicaid-managed care program, again directed at this individuals. goal. Both policy initiatives are still early in their • Nine percent of Medicaid enrollees rated their evolution and only time and research will tell if they last routine health care visit as fair or poor. Only prove to be effective. To make the most of the four percent of non-Medicaid individuals rated opportunity for quality data-based policy making, their last routine visit as fair or poor (Figure 5). sound statistical analyses of key Medicaid perfor- • Among Medicaid enrollees, the percentage that mance measures should be initiated now. reported fair to poor increased with age. The opposite was found among non-Medicaid indi- References viduals. 'North Carolina Health Planning Commission Recom- Discussion mendations. Raleigh, December 21, 1994. 2N.C. Department of Environment, Health, and Natural The fall 1995 North Carolina Health Profile Survey Resources, State Center for Health Statistics. Health and confirms two hypotheses about the Medicaid popula- the Elderly in North Carolina-Differences Between tion - Medicaid enrollees tend to be less healthy than Whites and Minorities. July 1996. the non-Medicaid population and they are more likely 3N.C. Department of Environment, Health, and Natural to use expensive sources of routine health care (a Resources, State Center for Health Statistics. Health and hospital, hospital emergency room, or urgent care the Pre-Elderly in North Carolina-Survey Estimates by center). Race. July J 996 Statistical Brief No. 6 - December 1996 State Center for Health Statistics For more information or a listing of the We'd Like to Hear From You Statistical Briefs available for viewing or down- loading, please access our website at In order for us to serve you better in future Briefs, please take a www.ehnr.state.nc.us/EHNRySCHS. Microsoft moment to check off your answers and FAX back to us at 919- Word 6.0 will be required to view the down- 733-8485. Thank you! loaded briefs. Information is timely and relevant U Yes LJ No Contact: Jean Yount (919) 715-4496 Charts and graphs are clear and concise D Yes D No e-mail: [email protected] Enough detail was presented on each topic D Yes U No Please send me information on the following topics: £*A Comments and suggestions: DEHISIR State of North Carolina James B. Hunt Jr., Governor Department of Environment, Health, and Natural Resources Jonathan B. Howes, Secretary State Center for Health Statistics Delton Atkinson, M.S.P.H., M.P.H., Director Department of Environment, Health, and Natural Resources BULK RATE State Center for Health Statistics U.S. Postage P.O. Box 29538 PAID Raleigh, NC 27626-0538 Raleigh, NC 27626-0538 Permit No. 1862 919/733-4728 ® > 1,600 copies of this public document were printed at a cost of $74.24 or 50 per copy. Printed on recycled paper