Health Insurance/Access to Care
Health insurance is a contract between an individual and an insurance company. The insurance
plan specified in the contract provides part or complete payment of specified health care costs
for the enrollee(s). Coverage of health care costs depends on the plan. Some plans are provided
by employers, some by government programs such as Medicare, and others are purchased directly by
individuals from insurance companies.
Health care spending includes the costs of obtaining a wide variety of goods and services, from hospital care and prescription drugs to dental services and medical equipment. Most health care spending is for care provided by hospitals and physicians.
Health care spending includes the costs of obtaining a wide variety of goods and services, from hospital care and prescription drugs to dental services and medical equipment. Most health care spending is for care provided by hospitals and physicians.
Most people need medical care at some time in their lives. Medical care is often quite expensive
and is becoming more expensive. Health insurance covers all or some costs of care and protects people
from very high expenses. People without health coverage have to cover all costs. This can sometimes
lead people into debt or even bankruptcy. Rising health care costs make insurance less affordable
for individuals, families, and businesses.
People without health insurance are more likely to lack a usual source of medical care, such as a primary care provider. They more often skip routine and preventive medical care thus increasing their risk for developing serious and disabling health conditions that cost more to treat.
Concerns about rising health care costs and affordability of health care insurance led to enactment of the Affordable Care Act, or ACA. The key challenge moving forward will be finding the best mix of policies that promote health and prevent illness, and also ensure that government, corporate, and private health spending is as efficient as possible and best meets the health care needs of the nation.
People without health insurance are more likely to lack a usual source of medical care, such as a primary care provider. They more often skip routine and preventive medical care thus increasing their risk for developing serious and disabling health conditions that cost more to treat.
Concerns about rising health care costs and affordability of health care insurance led to enactment of the Affordable Care Act, or ACA. The key challenge moving forward will be finding the best mix of policies that promote health and prevent illness, and also ensure that government, corporate, and private health spending is as efficient as possible and best meets the health care needs of the nation.
Health care costs per capita in the U.S. grew an average 2.4 percentage points faster than the GDP
from 1970 to 2012. In addition, the share of economic activity (gross domestic product, or GDP)
devoted to health care has increased from 7.2% in 1970 to 17.9% in 2010. In 2010, the U.S. spent
$2.6 trillion on health care, an average of $8,402 per person. Many experts believe that new
technologies and the spread of existing ones account for a large portion of medical spending and its
growth. The U.S. spends substantially more on health care than other developed
countries.1
Though the rapid growth in spending for prescription drugs has received considerable
attention recently, as of 2010, it accounted for 10% of total costs. Private funds are the largest
contributor to health care payments (55% in 2010 compared to 45% from government funds).
Health care expenditures in Utah have historically been lower and have grown more slowly than expenditures nationally. Favorable demographics (younger population) and healthier lifestyles contribute to these relatively low per capita health care expenditures. However, an aging and expanding population, medical technology advancements, and the limits of managed care to contain costs may cause per capita expenditures to rise. As a percentage of per capita income, per capita expenditures for medical care slowly increased from 1993 to 2009.
Health care insurance costs more today than ever. Health insurance premium increases have consistently outpaced inflation and the growth in workers' earnings. And families are also paying more out-of-pocket for health care. Concurrently, employer shares of payroll going toward health insurance costs continue to rise. In addition, eligibility standards for public programs such as Medicaid and CHIP do not keep pace with rapid increases in the cost of health coverage.
Health care expenditures in Utah have historically been lower and have grown more slowly than expenditures nationally. Favorable demographics (younger population) and healthier lifestyles contribute to these relatively low per capita health care expenditures. However, an aging and expanding population, medical technology advancements, and the limits of managed care to contain costs may cause per capita expenditures to rise. As a percentage of per capita income, per capita expenditures for medical care slowly increased from 1993 to 2009.
Health care insurance costs more today than ever. Health insurance premium increases have consistently outpaced inflation and the growth in workers' earnings. And families are also paying more out-of-pocket for health care. Concurrently, employer shares of payroll going toward health insurance costs continue to rise. In addition, eligibility standards for public programs such as Medicaid and CHIP do not keep pace with rapid increases in the cost of health coverage.
1. Health Care Costs: A Primer, Kaiser Family Foundation. (2012).
Downloaded on 8/7/2014 from
http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7670-03.pdf.
All people are at risk of needing costly health care services during their lives. People without the
financial means and/or adequate health insurance coverage are at risk for not receiving the kinds of
health care that can optimize their health, especially as costs continue to increase and options for
care expand.
Health status is strongly associated with age. In general, health status declines with age. As health status declines, there is more need for medical services. Those with worse health use medical services more often. Women have higher medical services utilization than men.
Health status is strongly associated with age. In general, health status declines with age. As health status declines, there is more need for medical services. Those with worse health use medical services more often. Women have higher medical services utilization than men.
Numerous studies show that a disproportionate share of health spending is used to treat chronic and often
preventable diseases and conditions. Efforts to improve population health could have a long-term effect
on disease prevalence and help reduce health care spending. Many of the Affordable Care Act (ACA)
provisions are an attempt to reduce the risk of illness and injury so that people won't require high
cost health care in the first place. A critical component of the ACA was the creation of the National
Prevention Council and the development of the nation's first ever National Prevention and Health Promotion
Strategy.2 The strategies are designed to move us from a system of sick
care to one based on wellness and prevention.
The plan outlines 4 Strategic Directions:
It includes 7 Priorities:
Other ACA provisions address health care costs and the ability of individuals to afford those costs including:
The plan outlines 4 Strategic Directions:
- Healthy and Safe Community Environments
- Clinical and Community Preventive Services
- Empowered People
- Elimination of Health Disparities
It includes 7 Priorities:
- Tobacco Free Living
- Preventing Drug Abuse and Excessive Alcohol Use
- Healthy Eating
- Active Living
- Injury and Violence Free Living
- Reproductive and Sexual Health
- Mental and Emotional Well-Being
Other ACA provisions address health care costs and the ability of individuals to afford those costs including:
- Changes to the way health coverage and health care are provided in public and private settings
- A requirement (with some exceptions) that people obtain health insurance
- Creates new sources of coverage through health insurance exchanges
- Provides for premium and cost-sharing subsidies for those with low incomes
- Significantly expands Medicaid eligibility
- Makes changes designed to slow the growth of Medicare spending
- Short-term cost containment provisions
- Reduces payments to providers for Medicare services
- Eliminates unnecessary costs such as fraud and abuse in Medicare and Medicaid
- Simplifies health insurance administration by creating uniform electronic standards and operating rules for all private insurers, Medicare, and Medicaid
- Establishes an approval process for generic biologic agents
- Long-term cost containment provisions
- Creates the Center for Medicare and Medicaid Innovation to evaluate experimental models
- Establishes a new Independent Payment Advisory Board to recommend ways to slow the growth in private nation health expenditure while preserving or enhancing quality of care
- Creates a private Patient-Centered Outcomes Research Institute to identify and conduct research, and disseminate results
- Implements an excise tax on high-cost employer-sponsored health plans designed to encourage employers to make their plans more efficient and to encourage workers to use fewer services
2. National Prevention Strategy. National Prevention Council. (2011). Washington,
DC: U.S. Department of Health and Human Services, Office., downloaded on 8/7/2014 from
http://www.surgeongeneral.gov/priorities/prevention/strategy/report.pdf.
Health Care Coverage -
Estimates of the number of people who are uninsured are available from several different sources, including a number of federal surveys. Four federal surveys provide this information.
In Utah, we track health insurance coverage using the Utah Behavioral Risk Factor Surveillance System (BRFSS) survey. The BRFSS allows us to estimate the uninsured rate at sub-state geographic levels, even to the community level (Utah Small Areas) in Utah's urban areas.
Estimates of the number of people who are uninsured are available from several different sources, including a number of federal surveys. Four federal surveys provide this information.
- The U.S. Census Bureau Current Population Survey (CPS) - state-level estimates
- The American Community Survey (ACS) - state and sub-state level estimates
- The National Health Interview Survey (NHIS) - state level estimates for 43 states
- The Medical Expenditure Panel Survey - Household Component (MEPS-HS)
In Utah, we track health insurance coverage using the Utah Behavioral Risk Factor Surveillance System (BRFSS) survey. The BRFSS allows us to estimate the uninsured rate at sub-state geographic levels, even to the community level (Utah Small Areas) in Utah's urban areas.
- Ambulatory Care Sensitive Condition: Bacterial Pneumonia Hospitalization Among Adults
- Ambulatory Care Sensitive Conditions: Diabetes Hospitalization Among Adults
- Asthma Hospitalizations
- Breast Cancer - Mammography
- Child Care Numbers of Facilities
- Cost as a Barrier to Health Care
- Health Insurance Coverage
- Immunizations - Recommended Immunizations by Age 24 Months
- Managed Care (CAHPS) Survey: Health Plan Ratings
- Medicaid Inflation
- Medical Assistance Expenditures
- Personal Doctor or Health Care Provider
- Physician Supply
- Preconception Health and Health Care
- Prenatal Care
- Routine Dental Health Care Visits
- Routine Medical Care Visits
- UDOH Support for Health Professional Education (Grants Program)
- UDOH Support for Local Emergency Medical Services (EMS)
- Uninsured Children
Access to Health Care - Adults (BRFSS)
- Health Care Coverage - Crude Rates
- Health Care Coverage - Age-adjusted Rates
- Routine Medical Checkup - Crude Rates
- Routine Medical Checkup - Age-adjusted Rates
- Personal Doctor or Health Care Provider - Crude Rates
- Personal Doctor or Health Care Provider - Age-adjusted Rates
- Routine Dental Health Care - Crude Rates
- Routine Dental Health Care - Age-adjusted Rates
- Unable to Get Needed Care Due to Cost - Crude Rates
- Unable to Get Needed Care Due to Cost - Age-adjusted Rates
Insurance and Pregnancy (PRAMS)
Screening and Preventive Services
Find extensive information on immunizations and screening preventive services on the Immunizations and Screenings topic page.Prenatal Care (birth data)
- Percentage With Prenatal Care in the First Trimester
- Percentage With Prenatal Care in the Third Trimester
- Percentage With No Prenatal Care
- Percentage With Kotelchuk Prenatal Care=Adequate
- Percentage With Kotelchuk Prenatal Care=AdequatePlus
- Average Number of Prenatal Visits
Access to Care and Pregnancy (PRAMS)
- Preconception Visit (2012 and later)
- Healthcare Visit with Family Doctor or OB-GYN
- WIC During Pregnancy
- Postpartum Checkup
Hospitalizations
Emergency Department
- Emergency Department (ED) Encounter Selections
- Emergency Department (ED) Encounters for Primary Care Sensitive Conditions Selections
Prehospital
- October 2020 Health Status Update: Telehealth in Utah
- July 2020 Spotlight: Medicaid Now Covers COVID-19 Testing for Uninsured Residents
- February 2020 Spotlight: Accessing Primary Care: The Unheard Voices
- January 2020 Health Status Update: Medicaid Expansion Update
- December 2019 Spotlight: Publicly Available Price Transparency Data from the Utah All Payer Claims Database
- Summary of 2018 Health Insurance Analysis from the Behavioral Risk Factor Surveillance System (BRFSS)
- Special Edition Spotlight: Community Health Workers Can Help Lower Healthcare Costs
- Special Edition Spotlight: Opioid Epidemic, Medical Cannabis and Medicaid Expansion: Impacts to American Indian/Alaska Native communities in Utah
- July 2019 Spotlight: Medicaid Coverage of Residential Treatment for Substance Abuse Disorder
- June 2019 Spotlight: Antihypertensives
- May 2019 Spotlight: Medicaid Expansion
- March 2019 Community Health Spotlight: Medicaid Preferred Drug List (PDL) Savings
- Utah Primary Care Needs Assessment
- February 2019 Breaking News: Utah Medicaid Adopts Additional Limits on Opioid Prescriptions
- HIV Care Continuum and Linkage to Care Supplemental Report
- December 2018 Health Status Update: Seal Your Smile School-based Sealant Program: Addressing Oral Health Disparities in Children
- December 2018 Community Health Spotlight: Medicaid Dental Benefits for Individuals with Disabilities
- 2018 Utah Health Plan Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Qualified Health Plan Enrollee Experience (QHP) Survey Results
- Summary of 2017 Health Insurance Analysis from the Behavioral Risk Factor Surveillance System (BRFSS)
- October 2018 Breaking News: Reasons for Not Having Health Insurance Before Pregnancy
- October 2018 Community Health Spotlight: Insurance Coverage by Industry
- September 2018 Breaking News: Medicaid Migrates to Web-Based Platform for Provider Training
- 2016 Utah Hospital and Freestanding Ambulatory Surgery Center Utilization and Charge Profile for Outpatient Surgery, Facility Detail (AMBST-1)
- 2017 Utah Hospital and Freestanding Ambulatory Surgery Center Utilization and Charge Profile for Outpatient Surgery, Facility Detail (AMBST-1)
- 2016 Utah Inpatient Hospital Utilization and Charges Profile, Hospital Detail
- 2017 Utah Inpatient Hospital Utilization and Charges Profile, Hospital Detail
- 2016 Utah Emergency Department Utilization and Charges Profile, Hospital Detail
- 2017 Utah Emergency Department Utilization and Charges Profile, Hospital Detail
- June 2018 Breaking News: Medicaid Adult Expansion
- 2017 Utah Health Plan Quality of Care Report (HEDIS)
- February 2018 Breaking News: Targeted Adult Medicaid Program
- 2017 Consumer Assessment of Healthcare Providers and Systems (CAHPS) online product
- December 2017 Community Health Spotlight: Uninsured Rate at Lowest Point in More than a Decade
- Summary of 2016 Health Insurance Analysis from the Behavioral Risk Factor Surveillance System (BRFSS)
- October 2017 Community Health Spotlight: Combating Medicaid Fraud, Waste and Abuse with New Provider Enrollment Initiatives
- June 2017 Community Health Spotlight: Medically Complex Children's Waiver
- 2016 HEDIS
- May 2017 Utah Health Status Update: Bridging Communities and Clinics: Addressing Geographic Disparities in Primary Care and Oral Health Services
- April 2017 Community Health Spotlight: Cultural and Linguistically Appropriate Services in Mental/Behavioral Health
- 2016 Consumer Satisfaction Report of Utah Health Plans
- January 2017 Community Health Spotlight: Showcase of Usability of Utah All Payer Claims Data (APCD)
- Summary of 2015 Health Insurance Analysis from the Behavioral Risk Factor Surveillance System (BRFSS)
- October 2016 Community Health Spotlight: Utah Access Monitoring Review Plan
- Care Access (from Utah State Health Assessment 2016 Report)
- June 2016 Health Status Update: Using Clinical Risk Groups to Analyze the Utah All Payer Claims Data
- 2015 Consumer Satisfaction Report of Utah Health Plans
- Special Edition Utah Health Status Update: Healthcare Cost in Utah: Brief Summary of the 2014 Utah All Payer Claims Data
- December 2015 Breaking News: Office of Primary Care and Rural Health is Accepting Applications for the Rural Physician Loan Repayment Program
- November 2015 Utah Health Status Update: Autism Services for Medicaid Recipients
- Health Insurance Highlights 2014
- September 2015 Utah Health Status Update: Industry and Occupation Impact on Health
- September 2015 Breaking News: Medicaid Accountable Care Organizations Expand to Additional Counties
- August 2015 Utah Health Status Update: Health Status by Race and Ethnicity: 15 Years of Surveillance
- June 2015 Utah Health Status Update: The Patient Protection and Affordable Care Act and Utah's Public Health System
- April 2015 Community Health Spotlight: 2014 Consumer Satisfaction Survey Shows Large Differences Among Plan Types