The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #60320

Ning Lu, PhD, MPH¹, Wayne Higgins, PhD¹, and Michael E. Samuels, DrPH². (1) Department of Public Health, Western Kentucky University, 1 Big Red Way, Bowling Green, KY 42101-3576, 270-745-5260, ning.lu@wku.edu, (2) Rural Health Policy, College of Medicine, University of Kentucky, MN-150 Chandler Medical Center, 800 Rose Street, Lexington, KY 40536-0298

In early 1994, Kentucky General Assembly passed a comprehensive package of health reforms, which included major changes in the state's health insurance system and the creation of a large state controlled health insurance purchasing alliance. The reforms, which aimed at providing universal coverage, encountered strong opposition from providers and insurers who objected to the rate setting provisions and to the size and power of the proposed state controlled health insurance purchasing alliance, and from small business owners who objected to the employer mandate and payroll taxes (play-or-pay). Subsequently, the comprehensive package was substantially modified and became an incremental approach when it was enacted. This study investigated the changes in access to health care in the past decade by examining the data of years 1991, 1995 and 2000, which may reflect the impact of the Kentucky health care reform on access to care. We used data from the Kentucky Behavioral Risk Factor Surveillance System of years 1991, 1995 and 2000, during which health access information and demographics were collected from a representative sample of Kentucky's adult population. We focused the data analysis on those ages eighteen to sixty-four. For all analyses standard errors were adjusted for the complex survey design. Our data revealed that the uninsurance rate dropped from 21% in 1991 to about 17% in 1995, immediately after execution of the health reform, and remained roughly the same in 2000. But a significant increase in uninsurance rate from 16% in 1991 to 23% in 1995 and 2000 was observed among middle-income class ($15,000-35,000). For the same period of time, the percentage of people who reported not being able to see a doctor when they needed due to the cost increased across all segments of the population, especially among self-employed, low- and middle-income groups. In 1991, 7.7% of the self-employed reported inability to see a doctor due to the cost. This proportion increased to more than 17% in 1995 and 2000. The same pattern was found among low- and middle-income groups with 7 to12 percentage points increase from 1991 to 1995 and about 4 percentage points increase from 1995 to 2000. Our study suggests that access to care problems in the early 1990s are persisting and still exist today. Incremental approaches may not solve the fundamental problems inherent in our nation's health insurance system. Consensus on a more comprehensive vision of health care reform and how to achieve it are needed.

Learning Objectives:

At the conclusion of the session, the participant in this session will be able to:
• Describe the changes in access to health care in the past decade.
• Describe the uninsurance patterns by demographic and socioeconomic characteristics.
• Realize that consensus on a more comprehensive vision of health care reform and how to achieve it are needed.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.