Survey shows health coverage is important — but not sufficient to guarantee access to care

June 20, 2011 | Publication

The second annual Cover Michigan Survey, released today by the Center for Healthcare Research & Transformation (CHRT), shows that people who lack health coverage are more likely to seek medical treatment in costlier care settings and less likely to have regular, preventive care.

The survey of 1,000 Michigan adults also reveals that simply having health coverage does not guarantee access to care.

Among those with health coverage, those with Medicaid coverage reported the greatest difficulty gaining access to preferred primary care providers or specialists and were the most likely to delay seeking care when needed.

The uninsured—who reported more difficulty accessing care when compared to the insured—appeared to be sicker or more acutely ill at the point they sought health care services. And among the uninsured, nearly one in three (32 percent) reported having been diagnosed with depression, compared to one in ten (11 percent) of the insured.

“This second-year survey tells us that having any kind of health insurance is better than being uninsured. Those with coverage—including Medicaid—are better linked to primary care doctors who can provide regular, preventive care,” says Marianne Udow-Phillips, director of CHRT. “But when we see the level of difficulty in finding providers to accept their coverage and provide them with the care they need reported today by Medicaid beneficiaries, it raises concerns about the ability of Michigan’s Medicaid system to handle the expected increase in enrollment when the expanded eligibility provision of the Affordable Care Act goes into effect in 2014.”

Udow-Phillips says CHRT is collaborating with the Michigan Department of Community Health on a follow-up study to better understand the underlying issues regarding access to care in the Medicaid population.

Additional findings from the survey include:

  • The uninsured were far less likely than those insured to seek medical care at a doctor’s office—35 percent compared to 86 percent, respectively.
  • A higher percentage of the uninsured reported using hospital emergency departments (10 percent) and urgent care facilities (19 percent) as sources of regular health care, as compared to the those with insurance (3 percent for both ER and urgent care).
  • Forty-two percent of Medicaid recipients reported having been told their primary care doctor was not accepting their coverage, compared to just 15 percent of those with Medicare, 12 percent of those with employer-based coverage, and 10 percent of individual insurance holders.
  • Access issues were not confined to adults. Forty-six percent of those with Healthy Kids (Michigan’s Medicaid program for children and pregnant women) reported having been told their specialist would not accept their child’s coverage, compared to 14 percent with MIChild (Michigan’s Children’s Health Insurance Program for uninsured children of working families.)
  • There was a slight decline over last year in self-reported health levels. Just 31 percent reported their health as “very good” this year as compared to 41 percent last year, while 14 percent reported their health as “fair” this year as compared to just 10 percent last year.
  • Depression was the most commonly reported condition among all survey respondents. The uninsured reported the highest incidence of depression (32 percent), but it was also prevalent among those with public coverage: nearly one in five Medicaid beneficiaries (18 percent) and one in six Medicare beneficiaries (16 percent) reported having been diagnosed with depression.

“The findings from this survey are not unique to Michigan,” says Udow-Phillips. “These results are applicable to states across the country and highlight the significant challenge there is in providing health care to the uninsured and Medicaid recipients in particular. We hope this survey will inform policy makers as they think about ways to make primary, specialty and mental health care more accessible, coordinated and integrated for those in need.”

For more information, and to review the survey results in more detail, go to: