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State of Alaska

Health Indicator Report of Health Care - Cost as a Barrier (HA2020 Leading Health Indicator: 23)

Access to quality healthcare is influenced by a number of factors, including: having health insurance, having access to care, and being able to afford care.^1^ Inadequate prenatal care--including late initiation of care, infrequent prenatal visits, or no care at all--is associated with poor infant and maternal outcomes, including low birth weight or preterm infants and for the mothers an increased risk for pregnancy-related mortality and complications of childbirth.^2^ Preventable hospitalizations are a set of conditions for which hospitalization could be avoided if patients had early access to good quality outpatient healthcare; this metric can be used to assess the effectiveness and accessibility of primary healthcare. A study using the National Hospital Discharge Survey found that 12% of all hospitalizations in 1990 (3.1 million) were for potentially preventable conditions.^3^[[br]] [[br]] ---- {{class .SmallerFont 1. DeVoe, Baez A, Angier H, Krois L, et al. Insurance plus access does not equal health care: typology of barriers to health care access for low-income families. Ann Fam Med 2007;5(6):511-518. 2. Young MB, Perham-Hester KA, Kemberling MM. Alaska maternal and child health data book 2011: Alaska Native edition. Anchorage, AK: A collaboration of the Alaska Department of Health and Social Services, Division of Public Health, and the Alaska Native Tribal Health Consortium, Alaska Native Epidemiology Center. October 2011. [http://anthctoday.org/epicenter/publications/prams/pramsFullVersion.pdf]. Accessed October 19, 2016. 3. Pappas G, Hadden WC, Kozak LJ, Fisher GF. Potentially avoidable hospitalizations: inequalities in rates between US socioeconomic groups. Am J Public Health 1997;87(5):811-16. }}

Notes

** Data Not Available U.S. values are based upon the median value of the states, District of Columbia, and territories.

Data Sources

  • Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion
  • U.S. Data: National Center for Chronic Disease Prevention and Health Promotion, Behavioral Risk Factor Surveillance System (BRFSS)

Data Interpretation Issues

Alaska Native people in analyses of the BRFSS refers to any mention of American Indian or Alaska Native heritage when enumerating racial and ethnic background. Individuals who indicate multiple races including American Indian/Alaska Native are considered Alaska Native in the data. When race and ethnicity are consider concurrently, Hispanic individuals with American Indian/Alaska Native heritage are combined into the Alaska Native (any mention) group and removed from the Hispanic class. This definition of the Alaska Native group is intended to conform to the eligibility requirements for access to Alaska Native Tribal Health Consortium health care services.

Definition

Percentage of adults 18 years and older who responded "Yes" on the [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System (BRFSS)] to the question: "Was there a time in the past 12 months when you needed to see a doctor but could not because of cost?"

Numerator

Weighted number of adults (18+) who responded "Yes" on the BRFSS to the question: "Was there a time in the past 12 months when you needed to see a doctor but could not because of cost?"

Denominator

Weighted number of adults (18+) with valid responses to the question: "Was there a time in the past 12 months when you needed to see a doctor but could not because of cost?", excluding those with missing, "Don't know/Not sure" or "Refused" responses.

Healthy People Objective: Reduce the proportion of individuals who are unable to obtain or delay in obtaining necessary medical care, dental care, or prescription medicines: Individuals--medical care

U.S. Target: 4.2%

Other Objectives

Healthy Alaskans 2020 Target: 14.0% of adult (18+) who reported they were unable to receive needed health care in the past 12 months but could not because of cost.

How Are We Doing?

The crude percentage of Alaska adults (18+) who reported being unable to see a doctor in the past 12 months due to cost was 13.4% in 2016, which is below the Healthy Alaskans 2020 (HA2020) goal of 14.0%. However, the ability to afford health care is not evenly distributed throughout the population. Alaska adults with low incomes or less than a high school education were much more likely to report cost as a barrier to health care than those with higher incomes or educational attainment. A gender gap seen earlier in the decade has diminished, such that women are currently not more likely than men to see cost as a barrier. Individuals between the ages of 18 and 44 were at increased risk of not being able to afford health care. Only Alaska Native people (12.4%) and non-Hispanic white individuals (12.9%) met the HA2020 goal of 14% for the 3-year period of 2014-2016. Those adults who were unemployed or unable to work reported significantly higher rates of cost as a barrier than those who were employed. Prevalence rates for cost as a barrier to accessing health care from the BRFSS are initially presented for all Alaskans, Alaska Native people, and the median from states, District of Columbia, and territories for all available years. Subsequent analyses by demographic subpopulations (i.e., sex, age, race/ethnicity, ethnicity, marital status, education, employment status, income, and poverty status) are limited to 2010 and later to allow for ease of assessing recent trends. Crosstabulations were also conducted for three-year averages by body mass index, current smoking, sexual orientation, disability, and Adverse Childhood Experiences (ACEs). Significant differences were evident in each contrast except for body mass index and are included. Results for comparisons with body mass index are available upon request. Prevalence of cost as a burden by regions of Alaska are presented for the most recent time period allowing reporting for all Alaskans and Alaska Native people: 1) single-year for the 6 Alaska Public Health Regions, 2) three-year averages by the 7 Metropolitan and Micropolitan Statistics Areas and rural remainder, 3) single-year for the 10 behavioral health assessment regions based upon aggregations of 20,000 population, 4) three-year averages for 29 boroughs and census areas, and 5) five-year averages for the 12 tribal health organization regions. These time intervals match those for the InstantAtlas health profiles for each of the geographic regionalizes of Alaska for those desiring longer time series.

How Do We Compare With the U.S.?

Since 2011, there has been a reduction in the prevalence of cost being a barrier to health care in both the United States and Alaska. In 2015, the median prevalence for the United States was 12.2% compared to 14.1% for all Alaskans and 15.4% for Alaska Native people.

What Is Being Done?

The Alaska Department of Health and Social Services administers programs to improve access to care, such as Medicaid, the Children's Health Insurance Program (CHIP), and primary care grants, and clinics for children with disabilities. Federally Qualified Health Centers provide preventive services such as immunizations and screenings at low or no cost to eligible persons who cannot afford them. Federally Qualified Health Centers and other providers strive to meet the needs of the medically underserved in Alaska.

Evidence-based Practices

As part of the Healthy Alaskans 2020 health improvement process, groups of Alaska subject matter experts met over a period of months in a rigorous review process to identify and prioritize strategies to address the 25 health priorities. Public health partners around the state are aligning work around these approaches adapted to Alaska's unique needs.* '''Strategy 1:''' [[br]]Improve insurance coverage for Alaskans who have financial barriers to care. '''Evidence Base:''' [[br]]Inability to access health care can result in unmet health needs and delays in receiving appropriate care, financial hardship, and hospitalizations that could have been prevented. High health care costs present a significant barrier to care, and one approach to making health care more affordable from the patient's perspective is health insurance coverage. Insurance coverage helps people obtain preventive and screening services, prescription drug benefits, mental health and other services, and improves continuity of care. Numerous studies by leading health research organizations, such as the Institute of Medicine and the Agency for Healthcare Research and Quality, note the significance of health insurance coverage for overcoming financial barriers to health care access. '''Strategy 2:''' [[br]]Address underlying health care costs that drive higher insurance premiums in Alaska. '''Evidence Base:''' [[br]]The largest cost component of health insurance premiums is payment for covered health care services. The remaining cost components, administrative costs and profits, are limited under the Affordable Care Act. Studies by economists and health care actuaries have identified high prices for health care services relative to cost of living as the primary driver of health insurance premium price differences between Alaska and comparison states. Many factors contribute to reimbursement rates for physicians and hospitals, such as higher real costs experienced by providers in Alaska, accommodation for small markets, and compensation for providers. Higher health insurance premiums negatively affect affordability of insurance for individuals. Studies by economists and health care actuaries have documented the drivers of health care costs nationally and in Alaska. Numerous studies by leading health research organizations, such as the Institute of Medicine and the Agency for Healthcare Research and Quality, document opportunities for reducing health care costs through quality improvement and consumer engagement. '''Strategy 3:''' [[br]]Improve access to health care safety net services. '''Evidence Base:''' [[br]]The health care safety net consists of providers delivering care to low-income and other vulnerable populations. Safety net providers typically have either a legal mandate or an explicit policy to provide services regardless of a patient's ability to pay. Safety net providers are generally the only source of health care for uninsured, low-income individuals. Safety net providers, such as community health centers and community hospitals play an important role nationally and in Alaska by providing affordable health services for the uninsured and working poor individuals. * Sources for all strategies can be found at: [http://hss.state.ak.us/ha2020/assets/EBS/HA2020_EBS23_CostBarriersToHealthcare.pdf] A listing of strategies, actions, and key partners on this measure can be found at: [http://hss.state.ak.us/ha2020/assets/Actions-Partners_23_CostasBarrier.pdf].

Available Services

Alaska Medicaid Program: visit [http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx] or one of the regional centers: ANCHORAGE DISTRICT OFFICE 400 Gambell Street Anchorage, AK 99501 (907) 269-6599 - Phone (907) 269-6450 - Fax BETHEL DISTRICT OFFICE P.O. Box 365 Bethel, AK 99559 (907) 543-2686 - Phone (1-800-478-2686) (907) 543-5912 - Fax COASTAL FIELD OFFICE 3601 C Street, Suite 410 P.O. Box 240249 Anchorage, AK 99524 (907) 269-8950 - Phone 1-800-478-4372 (907) 562-1619 - Fax EAGLE RIVER JOB CENTER 11723 Old Glenn Highway, Sp. B-4 Eagle River, AK 99577-7595 (907) 694-7008 (907) 694-1490 - Fax FAIRBANKS DISTRICT OFFICE 675 7th Avenue, Station D Fairbanks, AK 99701 (907) 451-2850 - Phone (1-800-478-2850) (907) 451-2923 - Fax 1-877-451-2923 toll free fax HOMER DISTRICT OFFICE New address! Homer District Office 3670 Lake Street, # 200 Homer, AK 99603 (907) 226-3040 - Phone (907) 235-6176 - Fax JUNEAU FIELD OFFICE 10002 Glacier Hwy, Suite 200 Juneau, AK 99801 (907) 465-3537 - Phone (1-800-478-3537) (907) 465-4657 - Fax KENAI PENINSULA JOB CTR 11312 Kenai Spur Hwy, Suite #2 Kenai, AK 99611 (907) 283-2900 - Phone (1-800-478-9032) (907) 283-6619 - Fax KETCHIKAN DISTRICT OFFICE 2030 Sea Level Dr., Suite 301 Ketchikan, AK 99901 (907) 225-2135 - Phone (1-800-478-2135) (907) 247-2135 - Fax KODIAK DISTRICT OFFICE 211 Mission Road, Suite 101 Kodiak, AK 99615 (907) 486-3783 - Phone (1-888-480-3783) (907) 486-3116 - Fax KOTZEBUE DISTRICT OFFICE P.O. Box 1210 Kotzebue, AK 99752 (907) 442-3451 - Phone (907) 442-2151 - Fax MAT-SU DISTRICT OFFICE 855 W. Commercial Drive Wasilla, AK 99654 (907) 376-3903 - Phone (1-800-478-7778) (907) 373-1136 - Fax MULDOON DISTRICT OFFICE 1251 Muldoon Rd, Suite 111B Anchorage, AK 99504 (907) 269-0001 - Phone (907) 269-0070 - Fax NOME DISTRICT OFFICE P.O. Box 2110 Nome, AK 99762 (907) 443-2237 - Phone (1-800-478-2236) (907) 443-2307 - Fax SOUTHEAST ADULT PUBLIC ASSISTANCE & SPECIALIZED MED 10002 Glacier Hwy, Suite 200 Juneau, AK 99801 (907) 465-3537 - Phone (1-800-478-3537) (907) 465-4657 - Fax SITKA DISTRICT OFFICE 201 Katlian Street, Suite 107 Sitka, AK 99835 (907) 747-8234 - Phone (1-800-478-8234) (907) 747-8224 - Fax [http://dhss.alaska.gov/dhcs/Pages/denalikidcare/default.aspx Denali KidCare] is Alaska's Children's Health Insurance Program (CHIP): If you have questions or need further information, please visit their website at [http://dhss.alaska.gov/dhcs/Pages/denalikidcare/default.aspx] or call them at: Within the Anchorage area, phone 269-6529. If you prefer, you may fax your application to 1-855-769-0986. In Anchorage, our office is located at 3601 C Street, 1st floor of the Frontier Building. Outside of Anchorage, please view Public Assistance office locations. If you have questions about Denali KidCare or would like an application or renewal mailed to you, please email denali.kid.care@alaska.gov The [http://www.alaskapca.org/ Alaska Primary Care Association (APCA)] is the primary care association for the state of Alaska. APCA members include Federally Qualified Health Centers (FQHC) and other providers who strive to meet the needs of the medically underserved. APCA and its member organizations are part of a statewide and national movement to reduce barriers to health care by enhancing primary care service delivery through prevention, health promotion, and community participation. Alaska Primary Care Association [http://www.alaskapca.org/] 903 W Northern Lights Blvd. Suite 200 Anchorage, AK 99503 Tel: 907.929.2722 Fax: 907.929.2734 Email: info@alaskapca.org
Page Content Updated On 08/17/2017, Published on 09/21/2017
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health (Ak-IBIS) web site (http://ibis.dhss.alaska.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Thu, 24 May 2018 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health web site: http://ibis.dhss.alaska.gov ".

Content updated: Thu, 21 Sep 2017 10:36:12 AKDT
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics AK-IBIS web site (http://ibis.dhss.alaska.gov/). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Thu, 24 May 2018 0:15:39 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Indicator-Based Information System for Public Health Web site: http://ibis.dhss.alaska.gov/ ".

Content updated: Thu, 21 Sep 2017 10:36:12 AKDT