Chartbook on Care Affordability: Slide Presentation

Slide 1

National Healthcare Quality and Disparities Report

Chartbook on Care Affordability, June 2015

Slide 2

Organization of the Chartbook on Care Affordability

• Part of a series related to the National Healthcare Quality and Disparities Report (QDR).
• Contents:
  
  • Overview of the QDR.
  • Overview of Care Affordability, one of the priorities of the National Quality Strategy.
  • Summary of trends and disparities in Care Affordability from the QDR.
  • Tracking of individual measures of Care Affordability:
    
    • Access problems due to health care costs.
    • Inefficient care due to use of services associated with more harm than benefit.

Slide 3

National Healthcare Quality and Disparities Report

• Annual report to Congress mandated in the Healthcare Research and Quality Act of 1999 (P.L. 106-129).
• Provides a comprehensive overview of:
  
  • Quality of health care received by the general U.S. population.
  • Disparities in care experienced by different racial, ethnic, and socioeconomic groups.
• Assesses the performance of our health system and identifies areas of strengths and weaknesses along three main axes:
  
  • Access to health care.
  • Quality of health care.
  • Priorities of the National Quality Strategy.

Slide 4

National Healthcare Quality and Disparities Report

• Based on more than 250 measures of quality and disparities covering a broad array of health care services and settings.
• Data generally available through 2012.
• Produced with the help of an Interagency Work Group led by the Agency for Healthcare Research and Quality and submitted on behalf of the Secretary of Health and Human Services.

Slide 5

Changes for 2014

• New National Healthcare Quality and Disparities Report (QDR)
  
  • Integrates findings on health care quality and health care disparities into a single document to highlight the importance of examining quality and disparities together.
  • Focuses on summarizing information over the many measures that are tracked.

Slide 6

Key Findings of the 2014 QDR

• Demonstrates that the Nation has made clear progress in improving the health care delivery system to achieve the three aims of better care, smarter spending, and healthier people, but there is still more work to do, specifically to address disparities in care.
  
  • Access improved.
  • Quality improved for most National Quality Strategy priorities.
  • Few disparities were eliminated.
  • Many challenges in improving quality and reducing disparities remain.

Slide 7

2014 Chartbooks

• 2014 QDR supported by a series of related chartbooks that:
  
  • Present information on individual measures.
  • Are updated annually.
  • Are posted on the Web (https://archive.ahrq.gov/research/findings/nhqrdr/2014chartbooks/).
• Order and topics of chartbooks:
  
  • Access to care.
  • Priorities of the National Quality Strategy.
  • Access and quality of care for different priority populations.

Slide 8

Chartbooks Organized Around Priorities of the National Quality Strategy

1. Making care safer by reducing harm caused in the delivery of care.
2. Ensuring that each person and family is engaged as partners in their care.
3. Promoting effective communication and coordination of care.
4. Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease.
5. Working with communities to promote wide use of best practices to enable healthy living.
6. Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models.

Go to: National Quality Strategy Priority in Action: Blue Cross Blue Shield Massachusetts Alternative Quality Contract.

Slide 9

Priority 6: Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models

Long-Term Goals:

1. Ensure affordable and accessible high-quality health care for people, families, employers, and governments.
2. Support and enable communities to ensure accessible, high-quality care while reducing waste and fraud.

Slide 10

Chartbook on Care Affordability

• This chartbook includes:
  
  • Summary of trends across measures of Care Affordability from the QDR.
  • Figures illustrating select measures of Care Affordability.
• Introduction and Methods contains information about methods used in the chartbook.
• Appendixes include information about measures and data.
• A Data Query tool (http://nhqrnet.ahrq.gov/inhqrdr/data/query) provides access to all data tables.

Slide 11

Care Affordability Trends

• Few measures of Care Affordability can be tracked over time.
• Two measures of Care Affordability showed worsening over time from 2002 to 2010:
  
  • People who indicate a financial or insurance reason for not having a usual source of care.
  • People unable to get or delayed in getting needed medical care, dental care, or prescription medicines due to financial or insurance reasons.

Slide 12

Care Affordability Trends

• No measures of Care Affordability:
  
  • Achieved 95% performance and were removed from the reports this year.
  • Improved quickly, defined as an average annual rate of change greater than 10% per year.
  • Showed elimination or widening of disparities.

Slide 13

Measures of Care Affordability

• This chartbook tracks measures of Care Affordability through 2012 and 2013, overall and for populations defined by:
  
  • Age.
  • Race, ethnicity.
  • Income, education, insurance.
  • Number of chronic conditions.
• Measures of Care Affordability include:
  
  • Access problems due to health care costs.
  • Inefficient care due to use of services associated with more harm than benefit.

Slide 14

Measures of Access Problems Due to Health Care Costs

• People under age 65 whose family's health insurance premiums and out-of-pocket medical expenses were more than 10% of total family income.
• People without a usual source of care who indicate a financial or insurance reason for not having a source of care.
• People unable to get or delayed in getting needed medical care, dental care, or prescription medicines who indicate a financial or insurance reason for the problem.

Slide 15

People under age 65 whose family's health insurance premiums and out-of-pocket medical expenses were more than 10% of total family income, by chronic conditions and family income, 2006-2012

Image: Charts show percentage of people under age 65 whose family's health insurance premiums and out-of-pocket medical expenses were more than 10% of total family income, by chronic conditions and family income.

Left Chart:

Right Chart:

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2006-2012.
Denominator: Civilian noninstitutionalized population under age 65.
Note: For this measure, lower rates are better. Total financial burden includes premiums and out-of-pocket costs for health care services.

• Importance: Health care expenses that exceed 10% of family income are a marker of financial burden for families.
• Overall Percentage: In 2012, 17.9% of people under age 65 had health insurance premium and out-of-pocket medical expenses that were more than 10% of total family income.
• Trends:
  • From 2006 to 2012, there were no statistically significant changes in the overall percentage.
  • Among  people with 4 or more chronic conditions and poor people, the percentage improved.
• Groups With Disparities: In 2012, the percentage of people under age 65 whose family’s health insurance premium and out-of-pocket medical expenses were more than 10% of total family income was about 3 times as high for poor individuals and low-income individuals and more than twice as high for middle-income individuals compared with high-income individuals.

Slide 16

People without a usual source of care who indicate a financial or insurance reason for not having a source of care, by insurance and race/ethnicity, 2002-2012

Image: Charts show percentage of people without a usual source of care who indicate a financial or insurance reason for not having a source of care, by insurance and race/ethnicity:

Left Chart:

Right Chart:

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2012.
Denominator: Civilian noninstitutionalized population without a usual source of care.
Note: For this measure, lower rates are better.

• Importance:  High-quality health care is facilitated by having a regular provider, but some Americans may not be able to afford one.
• Overall Percentage: In 2012, 20.2% of people without a usual source of care indicated a financial or insurance reason for not having a source of care.
• Trends:
  • The overall percentage worsened from 2002 to 2010 and then leveled off.
  • The percentage worsened among uninsured people and among Blacks and Hispanics.
• Groups With Disparities: In 2012, the percentage of people without a usual source of care who indicated a financial or insurance reason for not having a source of care was higher:
  • Among uninsured people and people with public insurance compared with people with any private insurance.
  • Among Hispanics and Blacks compared with Whites.

Slide 17

People unable to get or delayed in getting needed medical care, dental care, or prescription medicines who indicate a financial or insurance reason, by insurance and family income, 2002-2012

Image: Charts show percentage of people unable to get or delayed in getting needed medical care, dental care, or prescription medicines who indicate a financial or insurance reason, by insurance and family income.

Left Chart:

Right Chart:

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2012.
Denominator: Civilian noninstitutionalized population who were unable to get or delayed in getting needed medical care, dental care, or prescription medicines.
Note: For this measure, lower rates are better.

• Importance: Some Americans cannot afford all the care they need.
• Overall Percentage: In 2012, of people unable to get or delayed in getting needed medical care, dental care, or prescription medicines, 69.3% indicated a financial or insurance reason for the problem.
• Trends:
  • The overall percentage worsened from 2002 to 2010 and then leveled off.
  • The percentage worsened among people with any private insurance and among people from middle- and high-income families.
• Groups With Disparities: In 2012, the percentage of people unable to get or delayed in getting needed medical care, dental care, or prescription medicines who indicated a financial or insurance reason for the problem was higher:
  • Among uninsured people and people with public insurance compared with people with any private insurance.
  • Among  poor, low-income, and middle-income people compared with high-income people.

Slide 18

Measures of Inefficiency

• Ruptured appendix per 1,000 adult admissions with appendicitis.
• Men age 40+ who had a screening prostate-specific antigen test in the past year.

Slide 19

Ruptured appendix per 1,000 adult admissions with appendicitis, by race/ethnicity and insurance, 2001-2012

Image: Charts show ruptured appendixes per 1,000 adult admissions with appendicitis, by race/ethnicity and insurance.

Left Chart:

Right Chart:

Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, State Inpatient Databases, disparities analysis files and Nationwide Inpatient Sample, 2001-2012.
Denominator: Adults age 18 and over.
Note: For this measure, lower rates are better. Annual rates are adjusted for age and gender.

• Importance: Timely assessment of abdominal pain and diagnosis of appendicitis reduces rates of ruptured appendix.
• Overall Rate: In 2012, there were 314 ruptured appendixes for every 1,000 adult admissions with appendicitis.
• Trends:
  • From 2001 to 2012, there were no statistically significant changes in the overall rate.
  • The rate improved among Blacks and Hispanics and among people with Medicare, Medicaid, and other insurance.
• Groups With Disparities: In 2012, the rate of ruptured appendix was:
  • Lower among Hispanics compared with Whites.
  • Higher among people whose primary payer was Medicare compared with people whose primary payer was private insurance.
• Achievable Benchmark:
  • In 2008, the top 4 State (Connecticut, Hawaii, Massachusetts, New Jersey) achievable benchmark for ruptured appendix per 1,000 admissions with appendicitis was 232.
  • No group reached the benchmark by 2012.

Slide 20

Men age 40+ who had a screening prostate-specific antigen test in the past year, by age, race, and education, 2012

Image: Chart shows percentage of men age 40+ who had a screening prostate-specific antigen test in the past year, by age, race, and education:

Key: AI/AN = American Indian or Alaska Native.
Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance Survey, 2012.
Denominator: Men age 40 and over.
Note: For this measure, lower rates are better.

• Importance: Finding more harm than benefit, in 2008, the U.S. Preventive Services Task Force recommended against screening men age 75 and over with prostate-specific antigen (PSA) tests.  In 2012, this recommendation was extended to all men.
• Overall Rate: In 2012, half of men age 40 and over reported a PSA test in the past year (data not shown).
• Groups With Disparities:
  • Among men ages 55-74, Blacks, Asians, and American Indians and Alaska Natives were less likely than Whites to receive PSA testing.
  • In 2012, men with less than a high school education were less likely than men with any college to receive PSA testing across all age groups. High school graduates ages 40-54 and 55-74 were also less likely to receive PSA testing than men with any college.

Slide 21

Supplemental Measures of Care Affordability

• Supplemental measures:
  
  • May provide contextual information related to health care quality.
  • Are not part of the measure set tracked in the QRDR because they are difficult to interpret.
• Supplemental measures of Care Affordability:
  
  • Per capita national health expenditures.

Slide 22

Per capita national health expenditures in 2009 $, by largest components, 2003-2013

Image: Chart shows per capita national health expenditures in 2009 $, by largest components:

Source: Centers for Medicare & Medicaid Services, National Health Expenditure Data, 2003-2013.
Denominator: U.S. population.

• Importance: Higher per capita national health expenditures may make health care unaffordable for some Americans.
• Trends:
  • Total per capita national health expenditures in 2009 dollars rose from $7,283 in 2003 to $8,555 in 2013.
  • Expenditures on hospitals and physicians rose at 2% per year while expenditures on prescription drugs changed little.
• The five largest components of national health expenditures were hospital, physician and clinical, prescription drug, and nursing care expenditures, along with health insurance administration and profit.