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2 0 1 4 M A S S A C H U S E T T S H E A LT H I N S U R A N C E S U RV E Y
KEY FINDINGS
Prepared by:
Laura Skopec, Sharon K. Long, and Thomas H. Dimmock, Urban Institute
Susan Sherr, David Dutwin, and Kathy Langdale, SSRS
MAY 2015
2
The Massachusetts Health Insurance Survey (MHIS),
conducted by the Center for Health Information and
Analysis (CHIA), provides information on health
insurance coverage, health care access and use and
perceived health care affordability for Massachusetts
residents. The MHIS is a tool used by CHIA,
legislators, policymakers, employers, insurers and
other stakeholders to track and monitor the
experiences of Massachusetts residents in obtaining
timely and affordable health care.
In 2014, the MHIS methodology was modified to
provide a better understanding of health insurance
coverage in the Commonwealth. Specifically, the 2014
MHIS used a dual-frame random digit dialing (RDD)
landline and cell phone sample, with the survey
completed entirely over the phone. The 2008-2011
surveys used a dual-frame landline RDD and
address-based sample, with surveys completed by
phone, via the Internet, and in hard copy. In 2014, the
MHIS also oversampled landlines in areas with higher
OVERVIEWconcentrations of low income residents and
oversampled respondents with prepaid cell phones
not attached to a permanent account.
Both oversampling strategies were designed to
increase the number of interviews completed with low
income and uninsured respondents.
Because of the change in methodology, it is not
possible to determine whether any changes over time
are due to the survey design change or due to
underlying changes in health insurance coverage,
health care access, and health care affordability in
Massachusetts. Therefore, the 2014 MHIS should be
considered a new baseline and should not be used to
calculate changes from earlier years of the survey.
Along with changes in methodology, the 2014 MHIS
introduces two new topics: insurance coverage
transitions and respondents’ strategies to lower their
health care costs.
3
The Massachusetts Health Insurance Survey (MHIS)
provides information on health insurance coverage,
health care access and use and perceived health care
affordability for the non-institutionalized population in
Massachusetts. Information on health insurance
coverage and demographic information is collected for
all members of the household, with more detailed
information collected for one randomly selected
household member (referred to as the target person in
the household) and other members of his or her family
who are residing in the household. Target adults tend
to respond to the survey for themselves, while a
proxy, generally a parent, responds for a target child.
The data reported here are for the household target
person. For simplicity, we refer to the target person as
the respondent in discussing survey findings.
.
BACKGROUND ON THE MHISThe survey is conducted in English and Spanish and
its average completion time is 21 minutes. The 2014
MHIS was fielded between May 14 and July 30, 2014.
Surveys were completed with 4,024 Massachusetts
households, collecting data on 4,024 target persons,
including 504 children aged 0 to 18, 2,553 non-elderly
adults aged 19 to 64, and 967 elderly adults aged 65
and older.
The overall response rate for the 2014 MHIS was 30.9
percent, combining the response rate of 32.4 percent
for the landline telephone sample and the 27.7
percent for the cell phone sample. All estimates based
on the survey are prepared using weights that adjust
for the complex survey design, for undercoverage,
and for survey nonresponse.
Additional information about the MHIS is available in
the MHIS Methodology Report.
1. HEALTH INSURANCE COVERAGE AND UNINSURANCE
5
2008 2009 2010 2011 2012 2013 20140%
5%
10%
15%
20%
25%
2.6 2.7 1.93.1
3.75.9 5.5
3.9
6.6
9.2
Uninsured at the time of the survey (MHIS 2008-2011)Uninsured at the time of the survey (MHIS 2014)Ever uninsured over the past 12 months (MHIS 2008-2011)Ever uninsured over the past 12 months (MHIS 2014)
Uninsurance Rate for All Massachusetts Respondents, 2008-2011 and 2014
Note: Due to a change in survey design for the MHIS in 2014, estimates for 2014 are not directly comparable to estimates for 2008-2011.Source: 2008-2011, 2014 Massachusetts Health Insurance Survey
6
Insured at the time of the survey Insured at any time over the past 12 months
Always insured over the past 12 months
0%
20%
40%
60%
80%
100% 96.3 97.690.7
Health Insurance Coverage for All Massachusetts Respondents in 2014
Source: 2014 Massachusetts Health Insurance Survey
7
Insured at the time of the survey Insured at any time over the past 12 months
Always insured over the past 12 months
0%
20%
40%
60%
80%
100% 98.2 99.995.994.9 96.5
87.7
99.0 98.8 95.3
Children (0 to 18) Non-elderly adults (19 to 64) Elderly adults (65 and older)
Health Insurance Coverage in Massachusetts in 2014, by Age Group
Source: 2014 Massachusetts Health Insurance Survey
8
Insured at the time of the survey Insured at any time over the past 12 months
Always insured over the past 12 months
0%
20%
40%
60%
80%
100% 97.8 98.993.094.6 96.2
88.3
Female Male
Health Insurance Coverage in Massachusetts in 2014, by Gender
Source: 2014 Massachusetts Health Insurance Survey
9
Insured at the time of the survey Insured at any time over the past 12 months
Always insured over the past 12 months
0%
20%
40%
60%
80%
100% 96.9 98.092.693.7 97.4
87.796.9 97.9
88.092.9 94.4
82.0
White, non-Hispanic Black, non-HispanicOther or multiple races, non-Hispanic Hispanic
Health Insurance Coverage in Massachusetts in 2014, by Race/Ethnicity
Source: 2014 Massachusetts Health Insurance Survey
10
Insured at the time of the survey Insured at any time over the past 12 months
Always insured over the past 12 months
0%
20%
40%
60%
80%
100% 94.1 95.2
83.3
94.5 96.1
84.3
94.7 97.793.1
99.0 99.8 97.9
Income at or below 138% of the Federal Poverty Level (FPL) Income between 138 and 299% of the FPLIncome between 300 and 399% of the FPL Income at or above 400% of the FPL
Health Insurance Coverage in Massachusetts in 2014, by Family Income
Source: 2014 Massachusetts Health Insurance Survey
11
Health Insurance Coverage in Massachusetts in 2014, by Region
Source: 2014 Massachusetts Health Insurance Survey
Insured at the time of the survey (%)
Insured at any time over the past 12
months (%)
Always insured over the past 12 months
(%)
Western MA 96.5 96.8 90.5
Central MA 96.2 97.6 89.0
Northeast MA 96.9 98.5 91.3
Metro West 98.6 99.2 94.1
Metro Boston 93.9 96.0 87.6
Metro South 97.0 97.6 92.0
Southcoast 98.2 99.6 94.7
Cape and Islands 96.6 98.1 94.9
12
Always insured over past 12 months
Ever uninsured over past 12 months
Gained coverage over past 12 months
Lost coverage over past 12 months
Always uninsured over past 12 months
0%
20%
40%
60%
80%
100%90.7
9.25.5
2.2 1.6
Transitions in Health Insurance Coverage for All Massachusetts Respondents in 2014
Note: The categories listed in this figure are not mutually exclusive. The group “Ever uninsured over past 12 months” includes those always uninsured over the past 12 months, gaining coverage over the past 12 months, and losing coverage over the past 12 months.Source: 2014 Massachusetts Health Insurance Survey
13
Always insured over past 12 months
Ever uninsured over past 12 months
Gained coverage over past 12 months
Lost coverage over past 12 months
Always uninsured over past 12 months
0%
20%
40%
60%
80%
100% 95.9
4.0 2.2 1.8 0.0
87.7
12.37.2
2.7 2.4
95.3
4.7 3.7 0.4 0.6
Children (0 to 18) Non-elderly adults (19 to 64) Elderly adults (65 and older)
Transitions in Health Insurance Coverage in Massachusetts in 2014, by Age Group
Note: The categories listed in this figure are not mutually exclusive. The group “Ever uninsured over past 12 months” includes those always uninsured over the past 12 months, gaining coverage over the past 12 months, and losing coverage over the past 12 months.Source: 2014 Massachusetts Health Insurance Survey
14
Always insured over past 12 months
Ever uninsured over past 12 months
Gained coverage over past 12 months
Lost coverage over past 12 months
Always uninsured over past 12 months
0%
20%
40%
60%
80%
100% 93.0
7.0 4.8 1.6 0.6
88.3
11.76.3
2.8 2.6
Female Male
Transitions in Health Insurance Coverage in Massachusetts in 2014, by Gender
Note: The categories listed in this figure are not mutually exclusive. The group “Ever uninsured over past 12 months” includes those always uninsured over the past 12 months, gaining coverage over the past 12 months, and losing coverage over the past 12 months.Source: 2014 Massachusetts Health Insurance Survey
15
Always insured over past 12 months
Ever uninsured over past 12 months
Gained coverage over past 12 months
Lost coverage over past 12 months
Always uninsured over past 12 months
0%
20%
40%
60%
80%
100% 92.6
7.5 4.4 1.8 1.3
87.7
12.36.0 5.3
1.0
88.0
12.0 8.91.3 1.8
82.0
17.610.3
3.8 3.4
White, non-Hispanic Black, non-HispanicOther or multiple races, non-Hispanic Hispanic
Transitions in Health Insurance Coverage in Massachusetts in 2014, by Race and Ethnicity
Note: The categories listed in this figure are not mutually exclusive. The group “Ever uninsured over past 12 months” includes those always uninsured over the past 12 months, gaining coverage over the past 12 months, and losing coverage over the past 12 months.Source: 2014 Massachusetts Health Insurance Survey
16
Always insured over past 12 months
Ever uninsured over past 12 months
Gained coverage over past 12 months
Lost coverage over past 12 months
Always uninsured over past 12 months
0%
20%
40%
60%
80%
100%
83.3
16.610.7
4.1 1.8
84.3
15.610.0
2.2 3.4
93.1
6.91.6 3.0 2.3
97.9
2.2 1.2 0.8 0.2
Income at or below 138% of Federal Poverty Level (FPL) Income between 138 and 299% FPL
Income between 300 and 399% FPL Income at or above 400% FPL
Transitions in Health Insurance Coverage in Massachusetts in 2014, by Family Income
Note: The categories listed in this figure are not mutually exclusive. The group “Ever uninsured over past 12 months” includes those always uninsured over the past 12 months, gaining coverage over the past 12 months, and losing coverage over the past 12 months.Source: 2014 Massachusetts Health Insurance Survey
17
Transitions in Health Insurance Coverage in Massachusetts in 2014, by Region
Always insured over the past 12
months (%)
Ever uninsured over the past 12
months (%)
Gained coverage over the past 12
months (%)
Lost coverage over the past 12
months (%)
Always uninsured over
the past 12 months (%)
Western MA 90.5 9.5 6.0 1.9 1.6
Central MA 89.0 11.0 7.1 1.9 2.0
Northeast MA 91.3 8.5 5.5 1.9 1.2
Metro West 94.1 5.9 4.3 1.1 0.4
Metro Boston 87.6 12.3 6.2 4.0 2.2
Metro South 92.0 8.1 5.1 1.0 2.0
Southcoast 94.7 5.3 3.5 1.5 0.3
Cape and Islands 94.9 5.5 2.1 1.5 1.9
Note: The categories listed in this figure are not mutually exclusive. The group “Ever uninsured over past 12 months” includes those always uninsured over the past 12 months, gaining coverage over the past 12 months, and losing coverage over the past 12 months.Source: 2014 Massachusetts Health Insurance Survey
18
Employer-sponsored insurance
Medicare Private non-group coverage, including
Commonwealth Choice
MassHealth or Commonwealth
Care
Other coverage or coverage type not
reported
0%
20%
40%
60%
80%
100%
58.8
16.47.9
15.6
1.3
Health Insurance Coverage among Insured Respondents in Massachusetts in 2014
Notes: Respondents were assigned a single coverage type based on the following hierarchy: employer-sponsored insurance; Medicare; private non-group coverage including Commonwealth Choice; MassHealth or Commonwealth Care; and other coverage. Medicare coverage estimates include Railroad Retirement board coverage. MassHealth or Commonwealth Care includes temporary coverage while the respondent's application for coverage from the Health Connector or MassHealth is being processed. Estimates may not sum to 100% due to rounding. It is important to remember that survey respondents often have difficulty reporting type of insurance coverage correctly.Source: 2014 Massachusetts Health Insurance Survey
19
Employer-sponsored insurance
Medicare Private non-group coverage, including
Commonwealth Choice
MassHealth or Commonwealth
Care
Other coverage or coverage type not
reported
0%
20%
40%
60%
80%
100%
65.1
2.57.6
24.1
0.8
63.6
9.5 9.415.7
1.8
29.5
67.0
2.0 1.2 0.3
Children (0 to 18) Non-elderly adults (19 to 64) Elderly adults (65 and older)
Health Insurance Coverage among Insured Respondents in Massachusetts in 2014, by Age Group
Notes: Respondents were assigned a single coverage type based on the following hierarchy: employer-sponsored insurance; Medicare; private non-group coverage including Commonwealth Choice; MassHealth or Commonwealth Care; and other coverage. Medicare coverage estimates include Railroad Retirement board coverage. MassHealth or Commonwealth Care includes temporary coverage while the respondent's application for coverage from the Health Connector or MassHealth is being processed. Estimates may not sum to 100% due to rounding. It is important to remember that survey respondents often have difficulty reporting type of insurance coverage correctly.Source: 2014 Massachusetts Health Insurance Survey
20
Employer-sponsored insurance
Medicare Private non-group coverage, including
Commonwealth Choice
MassHealth or Commonwealth
Care
Other coverage or coverage type not
reported
0%
20%
40%
60%
80%
100%
56.8
17.68.2
16.5
0.9
61.1
15.17.4
14.5
1.9
Female Male
Health Insurance Coverage among Insured Respondents in Massachusetts in 2014, by Gender
Notes: Respondents were assigned a single coverage type based on the following hierarchy: employer-sponsored insurance; Medicare; private non-group coverage including Commonwealth Choice; MassHealth or Commonwealth Care; and other coverage. Medicare coverage estimates include Railroad Retirement board coverage. MassHealth or Commonwealth Care includes temporary coverage while the respondent's application for coverage from the Health Connector or MassHealth is being processed. Estimates may not sum to 100% due to rounding. It is important to remember that survey respondents often have difficulty reporting type of insurance coverage correctly.Source: 2014 Massachusetts Health Insurance Survey
21
Employer-sponsored insurance
Medicare Private non-group coverage, including
Commonwealth Choice
MassHealth or Commonwealth
Care
Other coverage or coverage type not
reported
0%
20%
40%
60%
80%
100%
64.3
17.67.5 9.8
0.9
46.7
12.94.4
31.4
4.6
54.1
7.4 11.5
23.5
3.6
29.8
17.79.1
42.4
1.0
White, non-Hispanic Black, non-HispanicOther or multiple races, non-Hispanic Hispanic
Health Insurance Coverage among Insured Respondents in Massachusetts in 2014, by Race and Ethnicity
Notes: Respondents were assigned a single coverage type based on the following hierarchy: employer-sponsored insurance; Medicare; private non-group coverage including Commonwealth Choice; MassHealth or Commonwealth Care; and other coverage. Medicare coverage estimates include Railroad Retirement board coverage. MassHealth or Commonwealth Care includes temporary coverage while the respondent's application for coverage from the Health Connector or MassHealth is being processed. Estimates may not sum to 100% due to rounding. It is important to remember that survey respondents often have difficulty reporting type of insurance coverage correctly.Source: 2014 Massachusetts Health Insurance Survey
22
Employer-sponsored insurance
Medicare Private non-group coverage, including
Commonwealth Choice
MassHealth or Commonwealth
Care
Other coverage or coverage type not
reported
0%
20%
40%
60%
80%
100%
16.5
32.4
8.4
41.0
1.7
46.4
20.712.5
19.2
1.2
70.3
14.27.7 6.2 1.6
85.4
6.0 5.1 2.3 1.1
Income at or below 138% of Federal Poverty Level (FPL) Income between 138 and 299% FPLIncome between 300 and 399% FPL Income at or above 400% FPL
Health Insurance Coverage among Insured Respondents in Massachusetts in 2014, by Family Income
Notes: Respondents were assigned a single coverage type based on the following hierarchy: employer-sponsored insurance; Medicare; private non-group coverage including Commonwealth Choice; MassHealth or Commonwealth Care; and other coverage. Medicare coverage estimates include Railroad Retirement board coverage. MassHealth or Commonwealth Care includes temporary coverage while the respondent's application for coverage from the Health Connector or MassHealth is being processed. Estimates may not sum to 100% due to rounding. It is important to remember that survey respondents often have difficulty reporting type of insurance coverage correctly.Source: 2014 Massachusetts Health Insurance Survey
23
Health Insurance Coverage among Insured Respondents in Massachusetts in 2014, by Region
Employer-sponsored insurance
(%)
Medicare (%)
Private non-group coverage, including
Commonwealth Choice (%)
MassHealth or Commonwealth
Care (%)
Other coverage or coverage type not reported (%)
Western MA 50.9 20.4 9.8 18.3 0.5
Central MA 58.2 19.5 6.3 13.2 2.8
Northeast MA 63.7 11.7 7.8 16.5 0.4
Metro West 69.4 15.8 6.4 6.9 1.5
Metro Boston 60.4 12.8 7.5 17.5 1.9
Metro South 57.4 21.1 6.0 13.6 2.0
Southcoast 42.6 23.7 9.7 23.4 0.7
Cape and Islands 47.8 19.7 17.0 15.4 0.2Notes: Respondents were assigned a single coverage type based on the following hierarchy: employer-sponsored insurance; Medicare; private non-group coverage including Commonwealth Choice; MassHealth or Commonwealth Care; and other coverage. Medicare coverage estimates include Railroad Retirement board coverage. MassHealth or Commonwealth Care includes temporary coverage while the respondent's application for coverage from the Health Connector or MassHealth is being processed. Estimates may not sum to 100% due to rounding. It is important to remember that survey respondents often have difficulty reporting type of insurance coverage correctly.Source: 2014 Massachusetts Health Insurance Survey
2. HEALTH CARE ACCESS AND USE
25
2008 2009 2010 2011 2012 2013 201450%
60%
70%
80%
90%
100%
91.9 91.092.9
90.987.7
88.3 88.0 88.1 87.9 86.8
78.3 78.5 79.3 78.4 78.5
Had a usual source of care (excluding the emergency department) (MHIS 2008-2011)
Had a usual source of care (excluding the emergency department) (MHIS 2014)
Had a visit to a general doctor or specialist in the past 12 months (MHIS 2008-2011)
Had a visit to a general doctor or specialist in the past 12 months (MHIS 2014
Had a visit to a general doctor for preventive care in the past 12 months (MHIS 2008-2011)
Had a visit to a general doctor for preventive care in the past 12 months (MHIS 2014)
Health Care Access and Use for All Massachusetts Respondents, 2008-2011 and 2014
Note: Due to a change in survey design for the MHIS in 2014, Massachusetts estimates for 2014 are not directly comparable to estimates for 2008-2011.Source: 2008-2011, 2014 Massachusetts Health Insurance Survey
26
Had a usual source of care (excluding the emergency
department)
Had a visit to a general doctor or specialist in the
past 12 months
Had a visit to a general doctor for preventive care
in the past 12 months
Had a dental care visit in the past 12 months
0%
20%
40%
60%
80%
100%
87.7 86.8
78.5
70.1
Health Care Access and Use for All Massachusetts Respondents in 2014
Source: 2014 Massachusetts Health Insurance Survey
27
Had a usual source of care (excluding the emergency
department)
Had a visit to a general doctor or specialist in the
past 12 months
Had a visit to a general doctor for preventive care
in the past 12 months
Had a dental care visit in the past 12 months
0%
20%
40%
60%
80%
100% 94.5 92.988.5
81.384.6 83.4
73.967.8
89.9 91.8
81.9
62.2
Children (0 to 18) Non-elderly adults (19 to 64) Elderly adults (65 and older)
Health Care Access and Use in Massachusetts in 2014, by Age Group
Source: 2014 Massachusetts Health Insurance Survey
28
Had a usual source of care (excluding the emergency
department)
Had a visit to a general doctor or specialist in the
past 12 months
Had a visit to a general doctor for preventive care
in the past 12 months
Had a dental care visit in the past 12 months
0%
20%
40%
60%
80%
100%90.9 90.6
81.7
72.2
84.3 82.875.0
67.9
Female Male
Health Care Access and Use in Massachusetts in 2014, by Gender
Source: 2014 Massachusetts Health Insurance Survey
29
Had a usual source of care (excluding the emergency
department)
Had a visit to a general doctor or specialist in the
past 12 months
Had a visit to a general doctor for preventive care
in the past 12 months
Had a dental care visit in the past 12 months
0%
20%
40%
60%
80%
100%90.3 88.8
80.672.5
78.9 81.675.3
69.4
80.2 81.572.3
54.2
80.7 80.4
70.3 66.6
White, non-Hispanic Black, non-HispanicOther or multiple races, non-Hispanic Hispanic
Health Care Access and Use in Massachusetts in 2014, by Race and Ethnicity
Source: 2014 Massachusetts Health Insurance Survey
30
Had a usual source of care (excluding the emergency
department)
Had a visit to a general doctor or specialist in the
past 12 months
Had a visit to a general doctor for preventive care
in the past 12 months
Had a dental care visit in the past 12 months
0%
20%
40%
60%
80%
100%
82.7 84.175.8
55.3
85.2 84.875.4
59.8
83.7 82.573.0 71.5
93.2 90.883.4 84.0
Income at or below 138% of Federal Poverty Level (FPL) Income between 138 and 299% FPLIncome between 300 and 399% FPL Income at or above 400% FPL
Health Care Access and Use in Massachusetts in 2014, by Family Income
Source: 2014 Massachusetts Health Insurance Survey
31
Health Care Access and Use in Massachusetts in 2014, by Region
Source: 2014 Massachusetts Health Insurance Survey
Had a usual source of care (excluding the
emergency department) (%)
Had a visit to a general doctor or specialist in
the past 12 months (%)
Had a visit to a general doctor for preventive
care in the past 12 months (%)
Had a dental care visit in the past 12 months
(%)
Western MA 85.8 86.3 78.5 65.8
Central MA 85.5 86.9 80.0 65.6
Northeast MA 91.3 88.7 81.2 71.7
Metro West 90.0 92.8 83.0 81.2
Metro Boston 82.9 80.6 70.6 68.6
Metro South 90.2 88.0 80.4 70.9
Southcoast 89.3 93.6 84.9 61.6
Cape and Islands 94.1 87.4 80.8 78.7
32
0%10%20%30%40%50%
12.4 13.519.2
Difficulties Getting Health Care for All Massachusetts Respondents in 2014
Source: 2014 Massachusetts Health Insurance Survey
33
0%10%20%30%40%50%
8.8 6.613.215.6 17.6
23.6
5.0 6.8 10.2
Children (0 to 18) Non-elderly adults (19 to 64) Elderly adults (65 and older)
Difficulties Getting Health Care in Massachusetts in 2014, by Age Group
Source: 2014 Massachusetts Health Insurance Survey
34
0%10%20%30%40%50%
13.8 15.722.1
11.0 11.116.1
Female Male
Difficulties Getting Health Care in Massachusetts in 2014, by Gender
Source: 2014 Massachusetts Health Insurance Survey
35
0%10%20%30%40%50%
11.5 12.7 17.411.8 14.1
20.312.9 11.7
24.018.9 19.8
27.7
White, non-Hispanic Black, non-HispanicOther or multiple races, non-Hispanic Hispanic
Difficulties Getting Health Care in Massachusetts in 2014, by Race and Ethnicity
Source: 2014 Massachusetts Health Insurance Survey
36
Told doctor's office or clinic did not accept insurance type over the past
12 months
Told doctor's office or clinic was not accepting new patients over the past
12 months
Unable to get an appointment with a health provider as soon as needed
over the past 12 months
0%
10%
20%
30%
40%
50%
19.9 18.4
23.8
15.9 15.418.2
10.5 11.5
18.6
6.710.1
17.3
Income at or below 138% of Federal Poverty Level (FPL) Income between 138 and 299% FPL
Income between 300 and 399% FPL Income at or above 400% FPL
Difficulties Getting Health Care in Massachusetts in 2014, by Family Income
Source: 2014 Massachusetts Health Insurance Survey
37
Difficulties Getting Health Care in Massachusetts in 2014, by Region
Source: 2014 Massachusetts Health Insurance Survey
Told doctor's office or clinic did not accept insurance type over the past 12 months
Told doctor's office or clinic was not accepting new
patients over the past 12 months
Unable to get an appointment with a health provider as
soon as needed over the past 12 months
Western MA 15.9 18.3 18.6Central MA 13.2 12.9 20.5Northeast MA 9.5 8.4 16.5Metro West 13.1 18.1 20.3Metro Boston 11.2 12.5 20.0Metro South 13.6 14.0 20.1Southcoast 14.8 15.2 22.8Cape and Islands 14.3 18.0 17.2
38
0%10%20%30%40%50%
31.2
14.7
38.7
Emergency Department Use by All Massachusetts Respondents in 2014
Note: A non-emergency condition is one that the respondent thought could have been treated by a regular doctor if one had been available.Source: 2014 Massachusetts Health Insurance Survey
39
0%10%20%30%40%50%
29.2
11.4
42.431.8
15.5
40.231.5
16.826.6
Children (0 to 18) Non-elderly adults (19 to 64) Elderly adults (65 and older)
Emergency Department Use in Massachusetts in 2014, by Age Group
Note: A non-emergency condition is one that the respondent thought could have been treated by a regular doctor if one had been available.Source: 2014 Massachusetts Health Insurance Survey
40
0%10%20%30%40%50%
33.0
15.9
38.529.2
13.5
38.9
Female Male
Emergency Department Use in Massachusetts in 2014, by Gender
Note: A non-emergency condition is one that the respondent thought could have been treated by a regular doctor if one had been available.Source: 2014 Massachusetts Health Insurance Survey
41
0%10%20%30%40%50%60%
28.1
12.4
30.043.5
21.9
*
28.1
12.9*
48.4
28.8
55.2
White, non-Hispanic Black, non-HispanicOther or multiple races, non-Hispanic Hispanic
Emergency Department Use in Massachusetts in 2014, by Race and Ethnicity
* The value has been suppressed due to small sample size.Note: A non-emergency condition is one that the respondent thought could have been treated by a regular doctor if one had been available.Source: 2014 Massachusetts Health Insurance Survey
42
0%
10%
20%
30%
40%
50% 45.8
27.5
42.3
33.1
18.0
38.5
29.2
10.0
*
22.3
7.0
34.6
Income at or below 138% of Federal Poverty Level (FPL) Income between 138 and 299% FPLIncome between 300 and 399% FPL Income at or above 400% FPL
Emergency Department Use in Massachusetts in 2014, by Family Income
* The value has been suppressed due to small sample size.Note: A non-emergency condition is one that the respondent thought could have been treated by a regular doctor if one had been available.Source: 2014 Massachusetts Health Insurance Survey
43
Emergency Department Use in Massachusetts in 2014, by Region
Any emergency department (ED) visit
over the past 12 months (%)
More than one ED visit over the past 12
months (%)
Among those with an ED visit over the past 12
months, most recent ED visit was for a non-
emergency condition (%)
Western MA 32.3 16.6 37.8Central MA 34.5 20.2 43.4Northeast MA 27.4 12.0 38.9Metro West 28.7 12.0 *Metro Boston 33.2 16.0 39.4Metro South 29.7 11.8 *
Southcoast 35.8 17.3 *
Cape and Islands 31.3 13.7 *
* The value has been suppressed due to small sample size.Note: A non-emergency condition is one that the respondent thought could have been treated by a regular doctor if one had been available.Source: 2014 Massachusetts Health Insurance Survey
3. HEALTH CARE AFFORDABILITY
45
2008 2009 2010 2011 2012 2013 20140%
10%
20%
30%
40%
50%
20.7 20.7 22.7 23.927.9
15.7 15.217.5 18.0 19.6
Any unmet need for health care because of costs (MHIS 2008-2011)Any unmet need for health care because of costs (MHIS 2014)Had difficulty paying medical bills in the past 12 months (MHIS 2008-2011)Had difficulty paying medical bills in the past 12 months (MHIS 2014)
Unmet Health Care Needs and Difficulty Paying Family Medical Bills for All Massachusetts Respondents, 2008-2011 and 2014
Note: Due to a change in survey design for the MHIS in 2014, estimates for 2014 are not directly comparable to estimates from 2008-2011. Estimates for unmet need for health care due to costs include unmet needs for dental as well as medical care. Medical care includes doctor care, specialist care, and prescription drugs.Source: 2008-2011, 2014 Massachusetts Health Insurance Survey
46
0%10%20%30%40%50%
27.9
8.8 11.220.1
Reported Unmet Need for Health Care Because of Costs for All Massachusetts Respondents in 2014
Note: Any unmet need for care is defined as reporting one or more of the following unmet needs for care due to cost: unmet need for doctor care, unmet need for specialist care, unmet need for dental care, or ever went without a prescription drug because of costs. Medical care includes doctor care, specialist care, and prescription drugs.Source: 2014 Massachusetts Health Insurance Survey
47
0%10%20%30%40%50%
12.33.4 4.6 7.5
35.2
12.1 14.5
25.922.0
3.9 8.315.4
Children (0 to 18) Non-elderly adults (19 to 64) Elderly adults (65 and older)
Reported Unmet Need for Health Care Because of Costs in Massachusetts in 2014, by Age Group
Note: Any unmet need for care is defined as reporting one or more of the following unmet needs for care due to cost: unmet need for doctor care, unmet need for specialist care, unmet need for dental care, or ever went without a prescription drug because of costs. Medical care includes doctor care, specialist care, and prescription drugs.Source: 2014 Massachusetts Health Insurance Survey
48
0%10%20%30%40%50%
31.1
8.7 13.121.424.4
8.9 9.318.6
Female Male
Reported Unmet Need for Health Care Because of Costs in Massachusetts in 2014, by Gender
Note: Any unmet need for care is defined as reporting one or more of the following unmet needs for care due to cost: unmet need for doctor care, unmet need for specialist care, unmet need for dental care, or ever went without a prescription drug because of costs. Medical care includes doctor care, specialist care, and prescription drugs.Source: 2014 Massachusetts Health Insurance Survey
49
0%10%20%30%40%50%
26.4
7.9 10.118.8
26.6
6.3 9.1
21.230.3
10.4 14.121.0
36.9
15.8 18.027.5
White, non-Hispanic Black, non-HispanicOther or multiple races, non-Hispanic Hispanic
Reported Unmet Need for Health Care Because of Costs in Massachusetts in 2014, by Race and Ethnicity
Note: Any unmet need for care is defined as reporting one or more of the following unmet needs for care due to cost: unmet need for doctor care, unmet need for specialist care, unmet need for dental care, or ever went without a prescription drug because of costs. Medical care includes doctor care, specialist care, and prescription drugs.Source: 2014 Massachusetts Health Insurance Survey
50
0%
10%
20%
30%
40%
50%
40.7
13.919.3
30.1
39.1
12.916.7
29.324.0
8.0 8.2
16.015.5
3.9 4.5
10.4
Income at or below 138% of Federal Poverty Level (FPL) Income between 138 and 299% FPL
Income between 300 and 399% FPL Income at or above 400% FPL
Reported Unmet Need for Health Care Because of Costs in Massachusetts in 2014, By Family Income
Note: Any unmet need for care is defined as reporting one or more of the following unmet needs for care due to cost: unmet need for doctor care, unmet need for specialist care, unmet need for dental care, or ever went without a prescription drug because of costs. Medical care includes doctor care, specialist care, and prescription drugs.Source: 2014 Massachusetts Health Insurance Survey
51
Reported Unmet Need for Health Care Because of Costs in Massachusetts in 2014, by Region
Any unmet need for health
care over the past 12 months
because of costs (%)
Any unmet met need for doctor
care over the past 12 months
because of costs (%)
Ever went without
prescription drugs over the past 12 months because
of costs (%)
Any unmet need for dental care
over the past 12 months because
of costs (%)
Western MA 37.7 11.2 17.3 27.5Central MA 28.0 11.1 10.9 18.1Northeast MA 24.1 7.8 10.4 18.8Metro West 23.9 8.1 9.0 13.0Metro Boston 26.8 7.8 9.8 19.9Metro South 27.3 9.2 9.4 21.7Southcoast 31.9 7.4 15.6 21.5Cape and Islands 31.0 9.7 12.3 21.9
Note: Any unmet need for care is defined as reporting one or more of the following unmet needs for care due to cost: unmet need for doctor care, unmet need for specialist care, unmet need for dental care, or ever went without a prescription drug because of costs. Medical care includes doctor care, specialist care, and prescription drugs.Source: 2014 Massachusetts Health Insurance Survey
52
Out-of-pocket health care spending greater than $1000 over the past 12
months
Out-of-pocket health care spending greater than $3000 over the past 12
months
Had difficulty paying medical bills over the past 12 months
0%
10%
20%
30%
40%
50%
38.1
19.0 19.6
Out-of-Pocket Family Health Care Spending and Difficulty Paying Family Medical Bills for All Massachusetts Respondents in 2014
Source: 2014 Massachusetts Health Insurance Survey
53
Out-of-pocket health care spending greater than $1000 over the past 12
months
Out-of-pocket health care spending greater than $3000 over the past 12
months
Had difficulty paying medical bills over the past 12 months
0%
10%
20%
30%
40%
50%
40.5
21.017.6
38.8
18.722.3
31.2
16.9
10.9
Children (0 to 18) Non-elderly adults (19 to 64) Elderly adults (65 and older)
Source: 2014 Massachusetts Health Insurance Survey
Out-of-Pocket Family Health Care Spending and Difficulty Paying Family Medical Bills in Massachusetts in 2014, by Age Group
54
Out-of-pocket health care spending greater than $1000 over the past 12
months
Out-of-pocket health care spending greater than $3000 over the past 12
months
Had difficulty paying medical bills over the past 12 months
0%
10%
20%
30%
40%
50%
37.5
18.320.3
38.7
19.6 18.8
Female Male
Source: 2014 Massachusetts Health Insurance Survey
Out-of-Pocket Family Health Care Spending and Difficulty Paying Family Medical Bills in Massachusetts in 2014, by Gender
55
Out-of-pocket health care spending greater than $1000 over the past 12
months
Out-of-pocket health care spending greater than $3000 over the past 12
months
Had difficulty paying medical bills over the past 12 months
0%
10%
20%
30%
40%
50%
42.1
21.018.717.8
8.9
20.6
36.6
17.521.122.5
11.1
24.2
White, non-Hispanic Black, non-HispanicOther or multiple races, non-Hispanic Hispanic
Source: 2014 Massachusetts Health Insurance Survey.
Out-of-Pocket Family Health Care Spending and Difficulty Paying Family Medical Bills in Massachusetts in 2014, by Race and Ethnicity
56
Out-of-pocket health care spending greater than $1000 over the past 12
months
Out-of-pocket health care spending greater than $3000 over the past 12
months
Had difficulty paying medical bills over the past 12 months
0%
10%
20%
30%
40%
50%
20.4
11.1
25.3
36.2
16.4
29.7
41.4
22.7 22.1
48.4
23.8
9.9
Income at or below 138% of Federal Poverty Level (FPL) Income between 138 and 299% FPLIncome between 300 and 399% FPL Income at or above 400% FPL
Source: 2014 Massachusetts Health Insurance Survey.
Out-of-Pocket Family Health Care Spending and Difficulty Paying Family Medical Bills in Massachusetts in 2014, by Family Income
57
Source: 2014 Massachusetts Health Insurance Survey.
Out-of-pocket health care spending greater than $1000 over the past 12 months (%)
Out-of-pocket health care spending greater than $3000 over the past 12 months (%)
Had difficulty paying medical bills over the past 12 months (%)
Western MA 34.3 18.8 24.8
Central MA 42.4 20.3 23.8
Northeast MA 41.1 21.5 18.8
Metro West 47.0 21.9 16.8
Metro Boston 34.6 16.0 15.5
Metro South 37.5 16.8 21.3
Southcoast 22.8 14.3 24.3
Cape and Islands 41.5 25.1 15.2
Out-of-Pocket Family Health Care Spending and Difficulty Paying Family Medical Bills in Massachusetts in 2014, by Region
58
Approaches Used by Families to Lower Health Care Costs for All Massachusetts Respondents in 2014
Source: 2014 Massachusetts Health Insurance Survey
0%10%20%30%40%50%
31.3 28.4
11.45.9 5.3
59
0%20%40%60%80%
100%
31.6 27.28.3 4.8 5.8
33.7 29.314.1 7.2 5.8
20.9 26.34.8 1.7 2.2
Children (0 to 18) Non-elderly adults (19 to 64) Elderly adults (65 and older)
Approaches Used by Families to Lower Health Care Costs in Massachusetts in 2014, by Age Group
Source: 2014 Massachusetts Health Insurance Survey
60
0%20%40%60%80%
100%
31.2 29.710.6 5.4 5.8
31.6 26.912.2 6.3 4.7
Female Male
Approaches Used by Families to Lower Health Care Costs in Massachusetts in 2014, by Gender
Source: 2014 Massachusetts Health Insurance Survey
61
0%20%40%60%80%
100%
31.3 27.610.7 5.0 5.2
36.8 38.3
9.7 10.1 6.9
33.1 29.316.1 8.6 3.7
27.5 27.513.2 7.4 6.1
White, non-Hispanic Black, non-HispanicOther or multiple races, non-Hispanic Hispanic
Approaches Used by Families to Lower Health Care Costs in Massachusetts in 2014, by Race and Ethnicity
Source: 2014 Massachusetts Health Insurance Survey
62
Someone in family tried to stay healthier
Someone in family switched to a lower
cost health insurance plan
Someone in family went without needed
care
Someone in family went without health
insurance
Someone in family changed to a lower cost doctor or other
provider
0%
20%
40%
60%
80%
100%
29.3 29.0
15.29.3 6.0
37.029.2
17.310.7 7.5
30.1 28.0
12.75.1 2.5
29.8 27.6
5.4 1.5 4.4
Income at or below 138% of Federal Poverty Level (FPL) Income between 138 and 299% FPLIncome between 300 and 399% FPL Income at or above 400% FPL
Approaches Used by Families to Lower Health Care Costs in Massachusetts in 2014, by Family Income
Source: 2014 Massachusetts Health Insurance Survey
63
Approaches Used by Families to Lower Health Care Costs in Massachusetts in 2014, by Region
Someone in family tried
to stay healthier
(%)
Someone in family switched
to lower cost health
insurance plan (%)
Someone in family went
without needed health
care (%)
Someone in family went
without health
insurance (%)
Someone in family changed to lower cost doctor
or other health care provider (%)
Western MA 34.9 30.6 12.2 7.5 6.6Central MA 27.6 26.1 12.3 5.1 2.7Northeast MA 30.3 28.6 11.3 4.8 7.4Metro West 37.5 26.6 9.0 7.5 8.3Metro Boston 26.5 27.8 9.8 6.4 3.5Metro South 35.1 33.1 13.0 5.0 3.4Southcoast 36.8 26.9 16.7 4.3 5.3Cape and Islands 31.5 20.1 10.2 6.0 5.0
Source: 2014 Massachusetts Health Insurance Survey