State Survey Highlights Disparities in Medical Care

2013_CHAS_Launch

Black Coloradans see the doctor less frequently, get less preventive care and report being in worse health than other residents of the state, according to a recent health survey.

The biennial Colorado Health Access Survey, which polled 10,224 households between April 15 and July 27, provides one of the most comprehensive snapshots of how Colorado residents experience the health care system.

Colorado Health Access Survey - The Uninsured

Colorado Health Access Survey - The Uninsured

The latest survey, released Tuesday, gives an important look at the current status of health care in the state ahead of a broad set of changes promised by the Affordable Care Act and the expansion of Medicaid.

Around 14 percent of the Coloradans surveyed said they were uninsured, down from around 16 percent in 2011.
But these numbers – and nearly all the information collected in the phone survey – varied widely across regions, income levels, age groups and ethnic groups, highlighting disparities in the way Coloradans receive medical care.

Only 5.3 percent of the people living in Douglas County didn’t have any insurance, for example, while in Northwest Colorado, a region that includes Routt, Moffat, Rio Blanco and Jackson counties, around 25 percent were uninsured.

Hispanics were the most likely to be uninsured. Around 22 percent of Latinos polled in the latest survey said they didn’t have any insurance. Still, more Hispanics had insurance than just two years ago, when 26 percent said they were uninsured.
Roughly 12 percent of non-Hispanic whites were uninsured, down from 13 percent in 2011.

By contrast, a growing number of African Americans reported being uninsured than in the past. Roughly 20 percent of those surveyed said they were uninsured, up sharply from 14 percent in 2011. The trend marked continued erosion in the ranks of the insured in Colorado’s small African-American community. In 2009, only 12 percent of African Americans surveyed said they didn’t have insurance.

At the same time, black Coloradans were increasingly less likely to report having seen a general doctor in the previous year or to have received preventive care. And around 19 percent of African Americans in the state said they used the emergency room as their primary source of care, compared with 5.7 percent of the population as a whole.
Grant Jones, executive director of the Denver-based Center for African American Health, said the information was surprising.

“At a time when we’re moving toward greater access and coverage and quality of care,” Jones said, “it’s alarming to see fewer people accessing care and seeing a doctor on a regular basis in the African American community.”
But African Americans weren’t skipping the doctor because they were healthier, the findings suggests. Instead, fewer black people in Colorado reported being in excellent health than other communities, while more reported being in poor health.
Black Coloradans were more likely than others to cite cost as a barrier to care, or to say they didn’t seek an appointment because they were uninsured, according to the Colorado Health Institute’s analysis of the survey. They were also more likely to say that they couldn’t get a doctor’s appointment in time, had trouble getting transportation or couldn’t get time off work.
“There’s lots of good research that points to the benefits of having primary and preventive care,” says Jeff Bontrager, director of research on coverage and access for Colorado Health Institute.
More doctor visits means more immunization for kids, early screening for cancer, mammograms and the chance to develop a relationship with a doctor, Bontrager notes. That’s the kind of health care that not only treats illness but stops it from developing in the first place.
The wide health discrepancies across the state provide an invitation to dig deeper into the causes and consequences, says Gretchen Hammer, executive director of the Colorado Coalition for the Medically Underserved.
“I don’t think this gives us the answer of why,” says Hammer. “It directs us to engage in these communities and see what they’re experiencing.”
Jones believes that the Affordable Care Act should help improve access to care among African Americans. But he says more should be done to focus on the communities that aren’t receiving adequate care.
“If we could make a dent in improving outcomes for African Americans and Latinos,” says Jones, “it would lift the status of our state in a dramatic way.”

County-by-county breakout

The 2013 Colorado Health Access Survey: The biennial survey by the Colorado Trust and Colorado Health Institute asks Colorado residents views on a variety of health issues. For the major questions, it breaks out results by 21 regions. The most populous counties are self-contained regions while others are a combination of contiguous counties.

Here is a look at what the survey found for some of the counties and regions.

FRONT RANGE COUNTIES

Weld County

Weld County had the third lowest percent of uninsured in the state at 9.3 percent, trailing only Douglas County (5.3 percent). That was down dramatically from two years ago when the survey found more than 18 percent Weld County residents were uninsured.

Colorado Health Access Survey - Emergency Room Visits

Colorado Health Access Survey - Emergency Room Visits

About 60 percent of residents had visited a dentist in the past 12 month, about 75 percent had gone to a health care facility and about 18 percent sought treatment at an emergency room. All were slightly below statewide figures.

Almost nine in 10 county residents, 88 percent, reported they were in excellent health more than nine in 10, 91.5 percent said they were in good mental health.

County residents were more pessimistic about how the health care system treated themselves and their family and Coloradans in general than their counterparts statewide. The survey found 62 percent thought the system met their family’s needs compared with 69 percent statewide and 39 percent said the system met most Coloradans needs compared to 44 percent statewide.

Larimer County

About 15 percent of Larimer County residents said they were uninsured, the survey found, about the same level as two years ago and slightly higher than the statewide figure.

The survey found that about 68 percent of residents had seen a dentist in the previous 12 months and 79 percent had gone to a health care facility, mirroring the statewide figures. However, only about 14 percent said they had gone to the emergency room in the previous year, the second lowest rate in the state behind the west central region of Colorado.

About nine in 10 county residents said they were in excellent health and more than nine in 10 said they had good mental health, the survey found. Both were higher percentages than the statewide averages.

About 65 percent of residents thought the health care system met their family’s needs compared to 47 percent who believed the system met most Coloradans needs.

El Paso County

The percent of uninsured residents edged up slightly to about 13 percent from about 12.5 percent between 2011 and 2013, but remained one of lowest in the state among counties and regions.

The survey found that about 68 percent of residents had visited a dentist in the past 12 months, 83 percent had gone to a health care facility and 22 percent had gone to the emergency room. All but dental visits were above the state averages.

As far as their health status, 89 percent said they were in excellent health and 89 percent said they had good mental health, on par with statewide percentages.

El Paso County residents felt better about the overall health care system than they did in 2011. The survey found that 76.5 percent said it meant their family’s needs, up from 67.5 percent in 2011 and 43 percent said they believed it met most Coloradans’ health care needs, up 39.5 percent in 2011.

Pueblo County

The county had one of the lowest rates of uninsured residents among Colorado’s counties and regions, but one of the highest percentages of residents covered by public insurance such as Medicaid and Medicare, the survey found. About 11percent of the county’s residents were uninsured and 26.5 percent had public insurance

The county had the lowest percent of residents who had seen a dentist in the past 12 months, 52 percent, one of the lowest rates in the state of going to a health care facility, 71 percent, and the highest rate in the state in terms of emergency room visits in the previous 12 months, 26 percent.

Residents also did not think highly of their health status. Only 79 percent reported they were in excellent health and good mental health. Those were the lowest rates in the state.

About 60 percent of the county’s residents said the health care system met their family’s needs and 45 percent believed the system met most Coloradans’ needs.

Boulder/Broomfield

The Boulder Broomfield area had among the lowest percentages in the state of uninsured residents, about 12 percent, but an increase from nine percent in 2011.

The survey found that 67.5 percent of residents had gone to a dentist in the past 12 months, 78 percent had gone to a health care facility and 14 percent had used the emergency room. The E.R. rate was among the lowest in the state.

The area had the second highest percent of residents who thought they were in excellent health, 91 percent, slightly behind Douglas County. It also found that 92 percent reported they were in good mental health, one of the highest rates in the state.

About 69 percent of residents thought the health care system met their family’s needs but they were far more pessimistic about its effectiveness statewide. Only 37 percent thought it met most Coloradans needs, one of the lowest rates in the state.

Mesa County

The percent of Mesa County residents who reported no health insurance rose to 18.5 percent in 2013, the fourth highest rate among the state’s counties and regions. In 2011 during the previous survey, the rate was 17.5 percent.

Only 59.5 percent of residents saw a dentist in the previous 12 months, below the state average of 65.2 percent, and 85percent visited a health care facility, above the state average.

Only 17 percent went to an emergency room, the fourth lowest percent in the state.

As far as their health status, 82.5 percent considered themselves in excellent health and 85.5percent thought they were in good mental health. Both were slightly lower than the state percentages.

Residents did not think highly of the state’s health care system. Only 58 percent believed it met their family’s needs and only 40 percent believed it met the needs of most Coloradans. Those were lower than the state figures.

WESTERN SLOPE REGIONS

Southwest region: La Plata, Dolores, Montezuma, Archuleta and San Juan counties

The southwest region of Colorado, which includes Durango, saw the percent of uninsured drop from more than 20 percent in 2011 to 15 percent this year, according to the health survey. Still the latest rate is above the state average of about 14 percent.

The survey found that 63 percent of the region’s residents had seen a dentist in the past 12 months, 78 percent had gone to a health care facility and 22 percent had visited an emergency room. Those were close to the state averages.

As far as health status, 82 percent considered themselves in excellent health, the fourth lowest percent among Colorado’s counties and regions. In addition, 87 percent said they were in good mental health, slightly below the state average of 89 percent

About 61.5 percent of residents thought the health care system met their family’s needs, while only about 40 percent though the system met most Coloradans needs. Those were slightly below the state rates.

Ski Country: Summit, Grand, Eagle, Garfield and Pitkin counties.

The counties along the I-70 corridor on the Western Slope had the third highest rate of uninsured residents among the state’s regions, the survey found. About 19 percent did not have health insurance. However, that was down from 25percent the last time the survey was conducted in 2011.

The survey found that about 69 percent had visited a dentist in the prior 12 months and 77 percent had gone to a health care facility, mirroring the state averages. However, about 22 percent had gone to an emergency room in the past year, which was higher than the state average.

About 88 percent of residents said they were in excellent health and 92.5 percent said they had good mental health, slightly higher than overall state figures.

About 70 percent of the region’s residents believed the state’s health care system met their family’s needs, while 48.5 percent said the system met most Coloradans health needs.

Northwest Colorado: Routt, Moffat, Rio Blanco and Jackson counties.

About 25 percent of the residents in the four counties in northwest Colorado were uninsured, the highest rate in the state, and almost double the statewide rate of about 14 percent.

The survey found that 65 percent had visited a dentist in the past year, 79 percent had gone to a health care facility and 24 percent had gone to an emergency room for treatment, the third highest rate in the state.

About 83 percent of the residents said they were in excellent health and 92.5 percent said they were in good mental health.

Despite the high percent of uninsured residents, 68 percent thought the state’s health care system met their family’s needs and 47 percent agreed that the system met most Coloradans health needs.

METRO AREA COUNTIES

Adams

The survey found that about 15 percent of Adams County residents did not have health insurance, slightly higher than the statewide figure of 14.3 percent. However, that was significantly lower than the 21 percent in 2011 the last time the survey was conducted.

The survey found that 62 percent of residents visited a dentist in the past year, 76 percent went to a health care facility and 23 percent visited an emergency room. All three rates were near the state average for medical visits.

As far as their health status, about 83 percent said they were in excellent health and 86 percent said they had good mental health.
About 62 percent of county residents believed the present health care system met their family’s need compared to 42 percent who thought the system met most Coloradans’ needs.

Arapahoe

The percent of uninsured residents jumped from 12 percent to 17 percent between 2011 and 2013, the survey found. As a result, the county’ uninsured rate went from lower than the state average to above the state average in two years.

The survey found that 71 percent of residents went to a dentist in the previous year, 77.5 percent visited a health care facility and 19 percent sought treatment in an emergency room, all close to the state averages for medical visits.

About 87 percent of residents said they were in excellent health and 88 percent said they were in good mental health.

The survey found that 68.5 percent of residents believe the health care system met their family’s needs, but only about 45 percent felt it met the needs of most Coloradans.

Douglas

The county had the lowest rate of uninsured residents in the state in 2013 at 5.4 percent. That’s down from 7.3 percent in 2011 when it was also the lowest rate in the state.

The county also had among the highest use of the medical system by its residents. The survey found 83 percent of residents went to a dentist in the past year, 86 percent visited a health care facility and 20 percent sought treatment in an emergency room.

The survey found that 95.5 percent of residents said they were in excellent health, the highest percent in the state, and about 95 percent said they were in good mental health, among the highest rates in the state.

More than 80 percent of county residents believed the health care system met their family’s needs and 54 percent felt the system met most Coloradans health needs. Those were among the highest rates in the state.

Jefferson

The percent of uninsured residents in the county plunged to about 12 percent, one of the lowest rates in the state. That is down from 17 percent in 2011 when it was higher than the state average.

The survey found 66 percent of residents saw a dentist in the past year, 81 percent visited a health care facility and 18 percent visited an emergency room, mirroring the statewide rates.

About 86 percent of the county’s residents said they were in excellent health and about 90 percent reported they were in good mental health.

The survey found 69 percent felt the health care system met their family’s needs, compared to only 44 percent who thought it met the needs of most Coloradans.

Denver

The percent of uninsured residents in Denver fell between 2011 and 2013, but remained one of the highest rates in the state. A total of about 18 percent of Denver residents did not have health insurance in 2013 compared to 21 percent in 2011.

The survey also found that 62 percent of residents saw a dentist in the prior year, 73 percent went to a health care facility and 19 percent sought treatment in an emergency room. Those rates were all lower than the statewide figures.

About 86 percent of the city’s residents said they were in excellent health and 85.5 percent said they were in good mental health.

The survey found that 65 percent of city residents felt the health care system met their family’s needs compared to 43 percent who believed it met the needs of most Coloradans.

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