Quantifying the Health Insurance Needs of Employed and ... Gettens.pdf · Quantifying the Health...

UMASS MEDICAL SCHOOL | COMMONWEALTH MEDICINE CENTER FOR HEALTH POLICY AND RESEARCH

Quantifying the Health Insurance Needs of Employed and Potentially Employed

Persons with Disabilities

Alexis Henry, Jack Gettens and Pei-Pei Lei University of Massachusetts Medical School

Presented at the DRC Annual Meeting Washington, DC

August 3, 2016


Objectives of Study

• Describe and quantify employment-related health care needs of people with disabilities

o What health care services are used?

o What percentage of use is employment-related?

o What health care services are needed but not received?

o What percentage of unmet need is employment-related?

2


Policy Relevance

• Health insurance does not fully meet employment-related needs of some persons with disabilities

• Affordable Care Act improved situation but still gaps

• Potential Policy Solution: Coverage to ‘wrap-around’ primary coverage

• Findings inform potential policy development (along with two prior DRC studies)

3


Data and Methods

• Massachusetts Behavioral Risk Factor Surveillance System (BRFSS) • Massachusetts Department of Public Health in collaboration

with the Centers for Disease Control and Prevention • Health-related risk behaviors, chronic health conditions,

preventive service use • Random-digit dial phone survey; adults 18 and older • BRFSS used to identify sample of persons with disabilities

• Employment Needs Survey • Follow-up to BRFSS • Age 18 to 64, self-identified disability (American Community

Survey Questions with exception of hearing question) • Analysis on respondents with health insurance

4


BRFSS ‘Follow-up Survey’ for Disability Research

• Advantages • DHHS recommended disability questions (American

Community Survey)

• New questions or follow-up surveys are possible (in collaboration with states)

• Available BRFSS demographic, health-related risk behaviors, chronic health conditions, preventive service use data

• Reduced development time and cost

• Disadvantage • Somewhat low response rate (2014 Massachusetts, 38%)

5


Survey Administration

• Fielded February 2014 to January 2015

• 1,745 BRFSS respondents (sample)

• 1,016 Employment Needs Survey respondents

• Weighted to represent Massachusetts population of persons with disabilities

1. BRFSS re-weighted to match American Community Survey disability estimates by disability type

2. Employment Needs Survey weighted to match BRFSS population estimates

6


BRFSS and ACS Disability Proportions

7

0

0.1

0.2

0.3

0.4

0.5

0.6

18 to24

25 to29

30 to34

35 to39

40 to44

45 to49

50 to54

55 to59

60 to64

65 to69

70 to74

75 to79

80 orolder

Pro

po

rtio

n w

ith

Dis

ab

ilit

y

Age Group ACS BRFSS


Survey Content

• Health insurance type and duration

• Payments related to disability

• Employment status

• Health care services

• Health care cost-related problems

8


Employment Status

• Workers (31 %)

• Worked at a job or business last week, or

• Temporary absence from job or business and worked in past 12 months

• Potential workers (24 %)

• Looking for work now, or

• Plan to work in next few years, or

• Temporary absence from job or business and had not worked in past 12 months

• Non-workers (45 %)

9


Health Care Service Use (currently using service)

10

79

35

10

36

3

29 25

87 83

41

12

22

11 15 19

86

0

20

40

60

80

100

Pe

rce

nt

Workers Potential-Workers

Source: 2014 Employment Needs Survey **Different at the 0.05 level


Employment-Related Service Use (Very important to maintaining employment or starting to work)

11


57

26

6

30

2

20 15

70

58

28

11 12 9 9 10

67

0

20

40

60

80

100

Pe

rce

nt



Unmet Health Care Service Need (services needed but not received)

12

Source: 2014 Employment Needs Survey *Different at the 0.10 level

7

15

6 8 3

13

3

34

15

7

16

9

2

20

4

39

0

10

20

30

40

50

Pe

rce

nt



Unmet Employment-Related Need (almost always or frequently interfered with job, or

would help you go to work ‘a lot’)

13


2 4 2 1 1 2 0

7

13

5

14 9

1

17

2

33

0

10

20

30

40

50

Pe

rce

nt



Reason for Employment-Related Unmet Need

14

Reasons for Employment-Related

Unmet Need

Workers (%) Potential Workers

(%)

Not covered or limited coverage 56.9 69.4

Can’t afford co-pays or

deductibles*

70.3 31.9

Source: 2014 Employment Needs Survey *P = 0.07


Rough Estimate, Upper Limit Employment Effects (eliminate employment-related unmet need)

• Best case, increase Massachusetts employment rate from 31% to 39% • Assumption: 33% of potential workers with unmet

employment-related healthcare needs become employed

• Best case, alleviate ‘unmet need that interferes with job’ among 7% of workers

Limitations

– Potential workers likely have lower employment capacity compared to workers

– Some potential workers will have additional difficulties that will not be resolved by health care services

– Does not include ‘non-workers’

15


Findings Summary & Implications (Massachusetts)

• Health care services are very important to employment of workers and potential workers (70%)

• Unmet employment-related need greater among potential workers compared to workers (33% vs 7%)

• Potential Workers: Prescription medicine, rehabilitative services, special equipment and complementary care

• Eliminating unmet need may increase the employment of insured persons with disabilities (upper limit, 8 percentage point increase in Massachusetts)

16


Acknowledgments

• This work was funded by the Social Security Administration under the Disability Research Consortium

• The authors thank the Massachusetts Department of Public Health for their assistance on the Employment Needs Survey. The authors are not affiliated with the Massachusetts Department of Public Health and the Massachusetts Department of Public Health is not responsible for the accuracy and validity of the results

17


Contact Information

[email protected]

508-856-4334

[email protected]

508-856-8833

18

mailto:[email protected]

mailto:[email protected]

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