Post on 24-Jul-2020
UMASS MEDICAL SCHOOL | COMMONWEALTH MEDICINE CENTER FOR HEALTH POLICY AND RESEARCH
Quantifying the Health Insurance Needs of Employed and Potentially Employed
Persons with Disabilities
Alexis Henry, Jack Gettens and Pei-Pei Lei University of Massachusetts Medical School
Presented at the DRC Annual Meeting Washington, DC
August 3, 2016
UMASS MEDICAL SCHOOL | COMMONWEALTH MEDICINE CENTER FOR HEALTH POLICY AND RESEARCH
Objectives of Study
• Describe and quantify employment-related health care needs of people with disabilities
o What health care services are used?
o What percentage of use is employment-related?
o What health care services are needed but not received?
o What percentage of unmet need is employment-related?
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UMASS MEDICAL SCHOOL | COMMONWEALTH MEDICINE CENTER FOR HEALTH POLICY AND RESEARCH
Policy Relevance
• Health insurance does not fully meet employment-related needs of some persons with disabilities
• Affordable Care Act improved situation but still gaps
• Potential Policy Solution: Coverage to ‘wrap-around’ primary coverage
• Findings inform potential policy development (along with two prior DRC studies)
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UMASS MEDICAL SCHOOL | COMMONWEALTH MEDICINE CENTER FOR HEALTH POLICY AND RESEARCH
Data and Methods
• Massachusetts Behavioral Risk Factor Surveillance System (BRFSS) • Massachusetts Department of Public Health in collaboration
with the Centers for Disease Control and Prevention • Health-related risk behaviors, chronic health conditions,
preventive service use • Random-digit dial phone survey; adults 18 and older • BRFSS used to identify sample of persons with disabilities
• Employment Needs Survey • Follow-up to BRFSS • Age 18 to 64, self-identified disability (American Community
Survey Questions with exception of hearing question) • Analysis on respondents with health insurance
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UMASS MEDICAL SCHOOL | COMMONWEALTH MEDICINE CENTER FOR HEALTH POLICY AND RESEARCH
BRFSS ‘Follow-up Survey’ for Disability Research
• Advantages • DHHS recommended disability questions (American
Community Survey)
• New questions or follow-up surveys are possible (in collaboration with states)
• Available BRFSS demographic, health-related risk behaviors, chronic health conditions, preventive service use data
• Reduced development time and cost
• Disadvantage • Somewhat low response rate (2014 Massachusetts, 38%)
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UMASS MEDICAL SCHOOL | COMMONWEALTH MEDICINE CENTER FOR HEALTH POLICY AND RESEARCH
Survey Administration
• Fielded February 2014 to January 2015
• 1,745 BRFSS respondents (sample)
• 1,016 Employment Needs Survey respondents
• Weighted to represent Massachusetts population of persons with disabilities
1. BRFSS re-weighted to match American Community Survey disability estimates by disability type
2. Employment Needs Survey weighted to match BRFSS population estimates
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UMASS MEDICAL SCHOOL | COMMONWEALTH MEDICINE CENTER FOR HEALTH POLICY AND RESEARCH
BRFSS and ACS Disability Proportions
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0
0.1
0.2
0.3
0.4
0.5
0.6
18 to24
25 to29
30 to34
35 to39
40 to44
45 to49
50 to54
55 to59
60 to64
65 to69
70 to74
75 to79
80 orolder
Pro
po
rtio
n w
ith
Dis
ab
ilit
y
Age Group ACS BRFSS
UMASS MEDICAL SCHOOL | COMMONWEALTH MEDICINE CENTER FOR HEALTH POLICY AND RESEARCH
Survey Content
• Health insurance type and duration
• Payments related to disability
• Employment status
• Health care services
• Health care cost-related problems
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UMASS MEDICAL SCHOOL | COMMONWEALTH MEDICINE CENTER FOR HEALTH POLICY AND RESEARCH
Employment Status
• Workers (31 %)
• Worked at a job or business last week, or
• Temporary absence from job or business and worked in past 12 months
• Potential workers (24 %)
• Looking for work now, or
• Plan to work in next few years, or
• Temporary absence from job or business and had not worked in past 12 months
• Non-workers (45 %)
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UMASS MEDICAL SCHOOL | COMMONWEALTH MEDICINE CENTER FOR HEALTH POLICY AND RESEARCH
Health Care Service Use (currently using service)
10
79
35
10
36
3
29 25
87 83
41
12
22
11 15 19
86
0
20
40
60
80
100
Pe
rce
nt
Workers Potential-Workers
Source: 2014 Employment Needs Survey **Different at the 0.05 level
UMASS MEDICAL SCHOOL | COMMONWEALTH MEDICINE CENTER FOR HEALTH POLICY AND RESEARCH
Employment-Related Service Use (Very important to maintaining employment or starting to work)
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Source: 2014 Employment Needs Survey **Different at the 0.05 level
57
26
6
30
2
20 15
70
58
28
11 12 9 9 10
67
0
20
40
60
80
100
Pe
rce
nt
Workers Potential-Workers
UMASS MEDICAL SCHOOL | COMMONWEALTH MEDICINE CENTER FOR HEALTH POLICY AND RESEARCH
Unmet Health Care Service Need (services needed but not received)
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Source: 2014 Employment Needs Survey *Different at the 0.10 level
7
15
6 8 3
13
3
34
15
7
16
9
2
20
4
39
0
10
20
30
40
50
Pe
rce
nt
Workers Potential-Workers
UMASS MEDICAL SCHOOL | COMMONWEALTH MEDICINE CENTER FOR HEALTH POLICY AND RESEARCH
Unmet Employment-Related Need (almost always or frequently interfered with job, or
would help you go to work ‘a lot’)
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Source: 2014 Employment Needs Survey **Different at the 0.05 level
2 4 2 1 1 2 0
7
13
5
14 9
1
17
2
33
0
10
20
30
40
50
Pe
rce
nt
Workers Potential-Workers
UMASS MEDICAL SCHOOL | COMMONWEALTH MEDICINE CENTER FOR HEALTH POLICY AND RESEARCH
Reason for Employment-Related Unmet Need
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Reasons for Employment-Related
Unmet Need
Workers (%) Potential Workers
(%)
Not covered or limited coverage 56.9 69.4
Can’t afford co-pays or
deductibles*
70.3 31.9
Source: 2014 Employment Needs Survey *P = 0.07
UMASS MEDICAL SCHOOL | COMMONWEALTH MEDICINE CENTER FOR HEALTH POLICY AND RESEARCH
Rough Estimate, Upper Limit Employment Effects (eliminate employment-related unmet need)
• Best case, increase Massachusetts employment rate from 31% to 39% • Assumption: 33% of potential workers with unmet
employment-related healthcare needs become employed
• Best case, alleviate ‘unmet need that interferes with job’ among 7% of workers
Limitations
– Potential workers likely have lower employment capacity compared to workers
– Some potential workers will have additional difficulties that will not be resolved by health care services
– Does not include ‘non-workers’
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UMASS MEDICAL SCHOOL | COMMONWEALTH MEDICINE CENTER FOR HEALTH POLICY AND RESEARCH
Findings Summary & Implications (Massachusetts)
• Health care services are very important to employment of workers and potential workers (70%)
• Unmet employment-related need greater among potential workers compared to workers (33% vs 7%)
• Potential Workers: Prescription medicine, rehabilitative services, special equipment and complementary care
• Eliminating unmet need may increase the employment of insured persons with disabilities (upper limit, 8 percentage point increase in Massachusetts)
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UMASS MEDICAL SCHOOL | COMMONWEALTH MEDICINE CENTER FOR HEALTH POLICY AND RESEARCH
Acknowledgments
• This work was funded by the Social Security Administration under the Disability Research Consortium
• The authors thank the Massachusetts Department of Public Health for their assistance on the Employment Needs Survey. The authors are not affiliated with the Massachusetts Department of Public Health and the Massachusetts Department of Public Health is not responsible for the accuracy and validity of the results
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UMASS MEDICAL SCHOOL | COMMONWEALTH MEDICINE CENTER FOR HEALTH POLICY AND RESEARCH
Contact Information
Jack.Gettens@umassmed.edu
508-856-4334
Alexis.Henry@umassmed.edu
508-856-8833
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