Taking the Pulse of Health in Ohio Results of the 2008 Ohio Family Health Survey
History and Study Design • The 2008 OFHS is the third survey, also done in 2004 and 1998 • Survey data between years are not fully comparable because of changes in design and questions to improve the quality of the results • The 2008 OFHS contains responses from almost 51,000 adults, one per household • This survey contains proxy responses for over 13,000 children, one per household • This survey is a complex design that requires using special statistical techniques and software to analyze 2
Topics Addressed In The 2008 Ohio Family Health Survey Include: • Employment characteristics • Income • Health status • Access to care • Health care utilization • Health outcomes & selected disease estimates • Health coverage status • Coverage for supplemental services (vision, dental, prescriptions, & mental health) • Unmet needs • Health risk factors 3
Types of Analysis Possible • Rates by race (White, Black, and Asian), and ethnicity (Hispanic) • Rates by region: Appalachia, Metropolitan, Rural non-Appalachia, and Suburban • Rates by county on many variables, depending on sample size • Rates by income • Rates by type of coverage • Rates by uninsured and insured 4
For the 2008 Ohio Family Health Survey Mahoning, Trumbull, and Ashtabula Counties are not counted in the Appalachian Region because that change by the Board of Demographers 5 took place after the project started
Caveats and Reminders • The income reported is the annual family income for the 2007 calendar year; it does not reflect current reality • The insurance status and working status reference the week prior to being surveyed; the rates are likely different currently because of changes in the economy • Survey results should not be considered reliable or reported when the confidence intervals associated with a proportion cover zero (e.g., -2.1, 0, 2.1) • The survey results include upper and lower counts based on the confidence intervals. Traditionally, the middle point count associated with a variable’s proportion should be reported – caution should be used when considering how to report the upper and lower confidence limits. 6
Key Findings • Ohio's child uninsured rate was 4.0% in 2008, down from 5.4% in 2004 • Ohio's 18-64 uninsured rate had increased from 15.0% in 2004 to 17.0% in 2008 • 84.2% of the 18-64 uninsured had incomes below 300% of poverty (88.0% for children) • Appalachia and Rural Ohio regions had large increases in the uninsured 18-64 group (17.8% to 21.9% and 13.3% to 17%); Suburban Ohio region had improvement in uninsured rates 7
Key Findings • Hispanics children were 3.25 times more likely to be uninsured, 2.57 times for 18-64 Hispanics • 18-64 Blacks were 1.79 times more likely to be uninsured than Whites, while Black and White children had a similar uninsured rate • The percent of 18-64 Ohioans who got coverage through job-based coverage fell from 63.5% in 2004 to 61.7% in 2008 • The uninsured reported greater issues with access to care, unmet need, and paying for care than the insured (e.g., uninsured 18-64 and children were 2.68 and 5.1 times more likely to not have a usual source of care) 8
Key Findings • The uninsured reported poorer health status and more ER use, but a lower use of hospitalizations • Some insured reported issues with access to care and paying medical bills (e.g., 23.5% reported difficulty paying bills) • More Ohioans reported lacking coverage for dental, vision, mental health, or prescription drug services than being uninsured • Medicare Part D had lowered the percent of seniors reporting no drug coverage by almost 60%, though 12% still reported not having prescription drug coverage 9
Key Findings • A key reason for an increase in the 18 – 64 uninsured rate was a large increase in the number of those 18 – 64 who were not working, up from 30.6% in 2004 to 35.1% in 2008 • Most of the uninsured children (77,023) had incomes below 201% of poverty, suggesting that they are income eligible for Medicaid/SCHIP 10
Profile Of Ohio’s Uninsured and Insured Populations: Children (< 18), Working Age Adults (18 – 64), and Seniors ( ≥ 65) 11
Ohio’s Child Uninsured Declined; 18-64 Uninsured Rate Increased 18.0% 17.0% 16.0% 2004 2008 15.0% 14.0% 12.0% 10.0% 8.0% 6.0% 5.4% 4.0% 4.0% 2.0% 1.1% 0.7% 0.0% child 18-64 seniors Between 2004 and 2008 the number of uninsured Ohio children fell from 155,973 to 111,255, while the number of uninsured 12 18-64 Ohioans increased from 1,055,651 to 1,220,895
Child uninsured rate varied by region; highest in rural counties in 2008 7.0% 2004 2008 6.0% 6.3% 5.5% 5.4% 5.0% 5.1% 4.9% 4.8% 4.8% 4.0% 4.0% 3.9% 3.0% 3.3% 2.0% 1.0% 0.0% Ohio Appalachia Metropolitan Rural Suburban 13
Uninsured Rate for Children Varied Among Metro Counties 2008 Uninsured Children By Metro County Summit 3.0% Stark 3.0% Richland 5.7% Montgomery 6.1% Mahoning 2.2% Lucas 4.1% Lorain 3.7% Hamilton 4.3% Franklin 4.5% Cuyahoga 3.4% Butler 2.8% Allen 2.2% 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% Differences in the uninsured rate between some counties may not be statistically significant 14
18-64 Uninsured Rate Varied by Region; Significant Increase in Appalachia and Rural Regions since 2004 25.0% 21.9% 2004 2008 20.0% 17.8% 17.4% 17.0% 17.0% 15.0% 15.2% 15.0% 14.1% 13.3% 12.3% 10.0% 5.0% 0.0% Ohio Appalachia Metropolitan Rural Suburban 15
18 – 64 Uninsured Varied Across Metro Counties 19.80% Summit 15.40% Stark 18.20% Richland 17.90% Montgomery 15.10% Mahoning 19.50% Lucas 15.90% Lorain 16.40% Hamilton 18.90% Franklin 17.60% Cuyahoga 12.40% Butler 18.90% Allen 0.00% 5.00% 10.00% 15.00% 20.00% 686,247 or 56.2% of Ohio’s 1,220,895 18-64 uninsured lived in metropolitan counties 16
Uninsured Rate was Higher in Younger Age Adult Population 35.0% 30.0% % uninsured within age group 29.4% 25.0% 20.0% 20.8% 15.0% 14.8% 13.2% 10.0% 10.8% 5.0% 0.0% 18-24 25-34 35-44 45-54 55-64 age groups 17
Uninsured Rate was Significantly Higher for People with Lower Educational Levels 35.0% 30.0% 33.0% 25.0% 20.0% 21.0% 15.0% 16.6% 10.0% 5.0% 6.5% 0.0% less t han high high school some college college gr aduat e school gr aduat e 18
Hispanics Experienced Significantly Higher Uninsured Rates for All Age Groups; Blacks for 18 – 64 Age Group 45.0% Children 40.0% 18-64 39.0% 35.0% Seniors 30.0% 27.1% 25.0% 20.0% 15.0% 12.4% 15.2% 12.3% 10.0% 4.5% 3.8% 3.4% 5.0% 2.3% 1.8% 0.6% 0.0% White Black Hispanic Asian 19
Being Uninsured Was Not a Short Term Experience: 63.9% 18-64 Uninsured > 1 year, 47.3% for Children 70.0% child 63.9% 60.0% 18-64 50.0% 48.4% 47.3% 40.0% 41.5% 30.0% 32.4% 28.1% 20.0% 10.0% 0.0% < 1 year > 1 year > 3 years 20
Fewer Ohioans Got Coverage Through Their Employer, Children's Rate Dropped Even More Than 18 – 64 Rate 90.0% 2004 2008 80.0% 77.3% 70.0% 72.2% 68.1% 60.0% 63.5% 61.7% 60.1% 59.5% 50.0% 53.6% 53.3% 48.9% 40.0% 30.0% 20.0% 10.0% 0.0% 18-64 18-64 151- 18-64 201- 18-64 251- children 200% FPL 250% FPL 300% FPL The categories shown have statistically significant changes between 2004 and 2008. There were not significant changes 21 in income groups below 151% FPL and above 300% FPL
6.2 Percentage Point Decrease in Children on Job-based Coverage; Drop Highest in Appalachia and Rural Regions 70.0% 65.8% 65.4% 64.4% 2004 2008 60.0% 59.5% 57.8% 55.4% 53.3% 50.0% 52.1% 51.2% 40.0% 40.3% 30.0% 20.0% 10.0% 0.0% Ohio Appalachian Metropolitan Rural Non- Suburban Appalachian 22
Independent Workers and Workers in Small Firms had Highest Uninsured Rates; Rates Highest in Appalachian Region 9.1% 12.3% All Workers 12.5% 16.3% 20.1% 27.7% Independent 27.3% 34.1% 17.0% 22.1% 2-49 Employees 23.6% 27.0% 5.4% 10.6% 50-249 Employees 10.7% 13.8% 4.2% Suburban 3.9% 250-999 Employees 7.3% Rural 6.6% Metropolitan 4.3% Appalachian 5.2% ≥ 1,000 Employees 4.3% 6.0% 0% 5% 10% 15% 20% 25% 30% 35% 40% Independent worker refers to people who are self- employed with no employees 23
Independent workers and workers in small firms had highest uninsured rates; rates highest for Blacks and Hispanics 11.0% All Workers 20.7% 33.4% 25.2% Independent 43.6% 40.5% 20.5% 2-49 Employees 39.2% 46.9% 8.2% 50-249 Employees 20.2% 38.4% 5.4% White 250-999 Employees 10.2% 18.7% Black Hispanic 3.9% ≥ 1,000 Employees 10.0% 7.9% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Independent worker refers to people who are self- employed with no employees 24
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