Health And Health Insurance In Detroit - University Of Michigan

ISSUE BRIEFHealth and Health Insurance in DetroitIdentifying barriers to accessing health care

Winter 2019 2OverviewOnly 8.7 percent of Detroit residents lack health insurance according to a 2018 survey conducted by the University of Michigan’s DetroitMetro Area Communities Study (DMACS). This represents a substantial drop in the fraction of Detroiters without insurance. As of 2013– the year before the Affordable Care Act was implemented – American Community Survey data found that 19.4 percent of Detroitresidents were uninsured.Despite the large number of Detroit residents who have health insurance, many still face barriers to accessing health care. According tothe 2018 DMACS survey, nearly 10 percent of Detroit residents report being unable to afford a copayment or prescription in the last 12months, while another third report that they have been unable to access one or more types of desired health care especially dentalcare in the past 12 months. These barriers are even more pronounced among people who lack health insurance. Three out of everyfive Detroiters without health insurance report being unable to access the health care they desire and nearly a quarter report beingunable to afford care in the last 12 months.The survey also reveals important health disparities within the city’s population related to racial and economic inequality. For example,the city’s African-American residents and residents of a lower socio-economic status report lower levels of health than other residentsand are significantly more likely to use emergency rooms as their primary place of care.These results highlight some of the findings from DMACS’ Summer 2018 survey, developed in partnership with the Detroit HealthDepartment. The survey examined city residents’ experience with and access to health care and other aspects of their health and wellbeing. These surveys, collected between June and October 2018 from a representative sample of 1,206 Detroit residents, provide newinsights into the health status and barriers to health affecting Detroiters.Key FindingsA majority of Detroiters have health insurance, but some groups aredisproportionately uninsured.Following the implementation of the Affordable Care Act (ACA) in 2014, the number of Americans without health insurance droppedprecipitously.1 In Michigan, estimates suggest that 1.2 million residents gained access to health insurance through expanded insuranceprograms from the ACA.2 In Detroit, the number of uninsured fell by more than half since 2013, when 19.4 percent of Detroiters wereKaiser Family Foundation. December 2018. Key Facts about the Uninsured Population. Accessed cts-about-the-uninsured-population/2Reindl, JC. November 1, 2018. “How Obamacare has affected Michigan 5 years after rollout.” Detroit Free Press. Accessed fordable-care-act-obamacare-michigan/1807230002/1

Winter 2019 3uninsured according to the American Community Survey. As shown in Figure 1, 91.3 percent of Detroit residents were covered by someform of health insurance in 2018, while 8.7 percent report having no health insurance.FIGURE 1Detroiters’ Health Insurance CoverageNearly one third (31.8%) of insuredDetroiters receive health care coveragethrough their job or through school, while8.7%more than half are insured through agovernment insurance program, as shownin Figure 2. Of those insured through agovernment program, most (31.1%) areInsuredUninsuredcovered by Medicare , which providesinsurance for Americans 65 and older andfor those with some disability status, while22.5 percent of Detroiters with healthinsurance are insured through HealthyMichigan, the state’s Medicaid option thatexpanded following the passage of the91.3%Affordable Care Act. Ten percent ofinsured Detroit residents purchase healthinsurance through a health exchange ordirectly from an insurance provider.FIGURE 2Health Insurance Provider for Insured DetroitersMIChild (CHiP), the VA, or some other source5.0%Purchase health insurance through a healthexchange or directly from an insurance provider9.7%Healthy Michigan (Medicaid)22.5%Medicare31.1%Private health insurance through a job or school0.0%31.8%5.0%10.0% 15.0% 20.0% 25.0% 30.0% 35.0%

Winter 2019 4Detroiters under age 55 are most likely to beuninsured.Detroiters under the age of 55 are significantly more likelythan older residents to be uninsured.3 Roughly one in eight(12.2%) residents aged 18 to 34 report no insurance coverage,compared to less than five percent of those 55 and older.Additionally, nearly a quarter (22.0%) of Hispanic residentsreport lacking insurance, compared to 11.2 percent of Whiteresidents and 6.9 percent of Black residents. Employmentstatus was another source of disparities in health carecoverage. Roughly a fifth (21.0%) of people employed parttime lack health insurance, but this fraction is lower amongthose employed full-time (7.8%), those who are currentlyunemployed (8.2%), and those who are retired (1.5%).FIGURE 3Race/EthnicityEmploymentDemographics of Uninsured Detroiters, by Age, Race/Ethnicity, and Employment StatusUnemployed91.8%Retired anic92.2%22.0%78.0%6.9%White65 Age8.2%93.1%11.2%88.8%5.7%94.3%55-64 0.0%100.0%Unless otherwise noted, descriptive analyses comparing group means throughout this report represent statistically significantdifferences at the 95% confidence level.3

Winter 2019 5Most Detroiters report being in good health, but thereare significant disparities in health levels.FIGURE 4Detroit Residents’ Self-Reported Health ScorePoor4%Fair18%Good28%Very Good28%Excellent22%00.050.10.150.20.250.3Figure 4 summarizes Detroiters’ self-reported health status.health, while only 10.8 percent of White Detroiters reportOne in five (22.3%) report being in fair or poor health, which issimilarly low levels of health. More than a quarter of allhigh compared to statewide and national estimates from thefemales (27.2%) report being in poor health compared to 17.3Centers for Disease Control that found that 18.4 percent ofpercent of men. Those with lower levels of educationalMichiganders and 17.6 percent of US residents reported beingattainment and those who are low income are also more likelyin fair or poor health in 2017.4 One in five Detroiters reportto report being in poor health. In fact, a third of those whothat they are in excellent health, while more than half (56.2%)earn 30,000 or less a year report being in poor health. Onlyof Detroiters state their health is good or very good.four percent of those who have lived in Detroit for fewer thanfive years report being in poor health, while nearly a quarterThere are also striking disparities between Detroiters who(24.6%) of longer-term residents (those who have lived inreport being in fair or poor health compared to those whoDetroit for more than five years) report their health is fair orreport being in good or excellent health, as captured in Figurepoor.5. A quarter of Black Detroiters report being in fair or poorBRFSS Prevalence & Trends Data. Centers for Disease Control and Prevention. Accessed at:https://www.cdc.gov/brfss/brfssprevalence/4

Winter 2019 6FIGURE 5Demographics of Detroiters who Report Being in Fair or Poor HealthTenure20 Years26.6%6-20 Years13.8%Income35.1%61.7%13.9%31.1%62.9% 10,000 - 29,99929.3%Less than 10,00034.8%Some College or Associate's 9%14.8%24.9%58.8%Black24.7%26.5%55.4%White 10.8%19.9%62.7%10%Fair or Poor17.2%51.6%27.2%0%17.0%59.6%High School or LessHispanic14.2%48.2%20.6%Male23.2%56.6%College 10.3%Race26.6%60.9%7.2% 30,000 - 59,99918.2%59.5%0-5 Years 4.0% 60,000 Gender Education55.2%20%30%40%Good or Very Good50%60%70%26.5%80%90% 100%ExcellentNearly one fifth of Detroiters rely on the emergency room as theirtypical place of care.Most Detroiters (85.3%) report having a typical place they go when they are sick. The majority (57.3%) of Detroiters who have a regularplace of health care go to a doctor’s office, while 10.3 percent utilize a health center clinic, 6.8 percent utilize urgent care clinics, and 6.1percent utilize a hospital outpatient department. Nearly one in five Detroiters (17.2%) report that they typically go to the hospitalemergency room when they feel sick, and this is even more common among those who lack health insurance.FIGURE 6Primary Sources of Health Care for Detroiters with a Usual Place of Care When SickHospital Outpatient DepartmentOther Urgent Care Clinic6.1%6.8%Hospital Emergency Room17.2%Doctor's OfficeClinic or Health 70.0%

Winter 2019 7As shown in Figure 7, about two-fifths (41.9%) of DetroitersDetroiters making 10,000 or less and those with lowerwho lack health insurance and nearly one-third (28.5%) ofeducational attainment are significantly more likely to turn toDetroiters who report being unable to access one or morethe ER for care than other city residents. Additionally, one-fifthtypes of health care in the last 12 months turn to the ER as(19.8%) of the city’s Black residents report using the ER as theirtheir typical place of care. The ER also serves as the typicaltypical place of care.place of care for less socio-economically advantaged residents.FIGURE 7Use of Hospital ER as Usual Place of Care When SickInsuranceEver Unable to Access Care28.5%Uninsured41.9%Insured15.9%Income 60,000 4.7% 30,000 - 59,99912.9% 10,000 - 29,99917.6%EducationLess than 10,00026.5%College 9.4%Some College or Associate's Degree13.2%High School or .0%10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0%While most Detroiters are able to access a type ofmedical care they desire, unmet demand for dentalcare is high.Most Detroiters report that they have been able to access theonly 8.3 percent were not able to get care they needed fromtype of medical care they wanted in the past year. Forother types of doctors (i.e., specialists) in the past year. Figureexample, only 6.3 percent of Detroiters were not able to8 provides more detailed results on the unmet demand forobtain care they needed from a primary care physician, andhealth care.

Winter 2019 8FIGURE 8Detroiters’ Access to Health Care, by Care TypeHolistic MedicineFamily planning13.3%78.2%11.5%85.0%Dental CareSubstance Abuse Care29.1%14.2%91.0%15.5%Physical Therapy3.5%56.6%6.5%Mental Health cialist54.3%5.1%37.5%Primary Care70.4%0%10%20%Able to Access Care30%40%50%Didn't Want60%70%8.2%19.1%80%6.3%90%100%Unable to AccessNearly three out of ten Detroiters (29.1%) report that theydental insurance as lack health insurance.5 In addition tohave not been able to access at least one type of desireddental care, 8.3 percent of Detroiters report being unable tohealth care in the past 12 months. The greatest unmetaccess desired mental health care. These unmet medicaldemand is for dental care. One out of every seven Detroitersneeds may reflect systemic shortages in care in Wayne County.(14.2%), report that they wanted but were unable to accessThe Department of Health and Human Services hasdental care in the past 12 months. This gap is likely due to thedesignated multiple areas within Wayne County, including thefact that dental coverage isn’t typically included in healthcity of Detroit, as medically underserved areas, specificallyinsurance plans, including Medicaid and Medicare. Nationallacking dental and mental health professionals.6data suggests that nearly three times as many Americans lackNational Association of Dental Plans. “Who has dentalbenefits today?” Accessed at:https://www.nadp.org/dental benefits basics/dental bb 1.aspx5Michigan Department of Health and Human Services. “Whereare Michigan's Designated Shortage Areas?” Accessed 1 2945 47514-176079--,00.html6