2014 National Healthcare Quality & Disparities Report

Key Findings

The key findings of the 2014 QDR are organized around three axes: access to health care, quality of health care, and NQS priorities. 

Access and Access Disparities

To obtain high-quality care, Americans must first gain entry into the health care system. Measures of access to care tracked in the QDR include having health insurance, having a usual source of care, encountering difficulties when seeking care, and receiving care as soon as wanted. Historically, Americans have experienced variable access to care based on race, ethnicity, socioeconomic status, age, sex, disability status, sexual orientation, and residence location.

ACCESS: After years without improvement, the rate of uninsurance among adults ages 18-64 decreased substantially during the first half of 2014.

Adults ages 18-64 who were uninsured at the time of interview, 2000-2014

Chart shows adults ages 18-64 who were uninsured at the time of interview. Go to table below for details.

Year Uninsured
2000 18.7
2001 18.3
2002 19.1
2003 20.1
2004 19.4
2005 18.9
2006 19.8
2007 19.4
2008 19.7
2009 21.1
2010 22.3
2011 21.3
2012 20.9
2013 20.4
Jan-Mar 2014 18.4
Apr-Jun 2014 15.6

 

Source: National Center for Health Statistics, National Health Interview Survey, 2000-June 2014.

The Affordable Care Act is the most far-reaching effort to improve access to care since the enactment of Medicare and Medicaid in 1965. Provisions to increase health insurance options for young adults, early retirees, and Americans with pre-existing conditions were implemented in 2010. Open enrollment in health insurance marketplaces began in October 2013 and coverage began in January 2014. Expanded access to Medicaid in many states began in January 2014, although a few had opted to expand Medicaid earlier.

Trends:

  • From 2000 to 2010, the percentage of adults ages 18-64 who reported they were without health insurance coverage at the time of interview increased from 18.7% to 22.3%.
  • From 2010 to 2013, the percentage without health insurance decreased from 22.3% to 20.4%.
  • During the first half of 2014, the percentage without health insurance decreased to 15.6%.
  • Data from the Gallup-Healthways Well-Being Index indicate that the percentage of adults without health insurance continued to decrease through the end of 2014,1 consistent with these trends.

ACCESS: Between 2002 and 2012, access to health care improved for children but was unchanged or significantly worse for adults.

People who needed care right away for an illness, injury, or condition in the last 12 months who sometimes or never got care as soon as wanted

Chart shows People who needed care right away for an illness, injury, or condition in the last 12 months who sometimes or never got care as soon as wanted. Go to table below for details.

Age and Insurance 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Children, Any Private 6.3 7.4 6.2 7.0 6.2 5.6 4.7 3.1 2.3 3.2 2.7
Children, Medicaid / CHIP Only 10.4 13.9 9.8 10.6 9.7 13.1 6.4 7.5 6.6 5.5 5.5
Adults 18-64, Any Private 13.7 11.9 11.7 13.2 13.0 12.1 13.5 12.0 11.9 12.1 12.9
Adults 18-64, Medicaid Only 18.6 21.8 22.2 23.5 24.0 21.9 22.2 21.3 21.5 19.6 21.7
Adults 18-64, Uninsured 32.8 34.6 33.8 32.5 32.8 29.7 33.6 33.3 33.8 31.7 35.0

 

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2012.

People who made an appointment for routine health care in the last 12 months who sometimes or never got an appointment as soon as wanted, by age and insurance, 2002-2012

Chart shows people who made an appointment for routine health care in the last 12 months who sometimes or never got an appointment as soon as wanted, by age and insurance. Go to table below for details.

Age and Insurance 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Children, Any Private Insurance 9.0 6.7 5.7 5.4 5.7 6.3 5.9 4.6 4.4 4.8 4.2
Children, Medicaid / CHIP Only 13.1 13.0 10.3 11.1 10.0 9.6 7.5 7.5 7.3 8.1 6.6
Adults 18-64, Any Private Insurance 17.6 15.8 15.7 15.2 15.2 16.0 15.9 15.2 15.5 14.9 15.0
Adults 18-64, Medicaid Only 23.1 21.7 22.5 23.0 25.2 24.8 21.1 22.7 20.6 20.8 19.9
Adults 18-64, Uninsured 26.2 24.6 26.9 24.2 22.8 20.9 27.1 30.8 26.6 27.9 27.8

 

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2012.

Trends:

  • From 2002 to 2012, the percentage of people who were able to get care and appointments as soon as wanted improved for children but did not improve for adults ages 18-64.

Disparities:

  • Children with only Medicaid or CHIP coverage were less likely to get care as soon as wanted compared with children with any private insurance in almost all years.
  • Adults ages 18-64 who were uninsured or had only Medicaid coverage were less likely to get care as soon as wanted compared with adults with any private insurance in all years.

ACCESS: Through 2012, improvement was observed across a broad spectrum of access measures among children but less so among adults ages 18-64.

Average annual rates of change of access to care measures through 2012, by age

Scatterplot showing average annual percent change in performance of access measures for all ages, children ages 0-17, adults ages 18-44, and adults ages 45-64. The median change for all ages was less than 1% per year. The median change for children was 5% per year. For adults ages 18-44, the median change was zero. For adults ages 45-64, the median change was negative.

Note: Each point represents one measure. Large red diamonds indicate median values. Access measures include insurance, usual provider, barriers to care, and timeliness of care. For the vast majority of measures, trend data are available from 2001-2002 to 2012. For each measure with at least four estimates over time, weighted log-linear regression is used to calculate average annual percentage change. Measures are aligned so that positive change indicates improved access to care.

Trends:

  • Through 2012, most access measures improved for children. The median change was 5% per year.
  • Few access measures improved substantially among adults. The median change was zero.

ACCESS DISPARITIES: During the first half of 2014, declines in rates of uninsurance were larger among Black and Hispanic adults ages 18-64 than among Whites, but racial differences in rates remained.

Adults ages 18-64 who were uninsured at the time of interview, by race/ethnicity, 2010-2014

Chart shows adults ages 18-64 who were uninsured at the time of interview, by race/ethnicity. Go to table below for details.

Year White Black Hispanic
2010 16.4 27.2 43.2
2011 15.6 24.8 42.2
2012 15.1 23.6 41.3
2013 14.5 24.9 40.6
Jan-Mar 2014 13.5 20.2 35.7
Apr-Jun 2014 11.1 15.9 33.2

 

Source: National Center for Health Statistics, National Health Interview Survey, 2010-June 2014.

Trends:

  • Historically, Blacks and Hispanics have had higher rates of uninsurance than Whites.ii

Disparities:

  • During the first half of 2014, the percentage of adults ages 18-64 without health insurance decreased more quickly among Blacks and Hispanics than Whites, but differences in uninsurance rates between groups remained.
  • Data from the Urban Institute's Health Reform Monitoring System indicate that between September 2013 and September 2014, the percentage of Hispanic and non-White non-Hispanic adults ages 18-64 without health insurance decreased to a larger degree in states that expanded Medicaid under the Affordable Care Act than in states that did not expand Medicaid.2

ACCESS DISPARITIES: In 2012, disparities were observed across a broad spectrum of access measures. People in poor households experienced the largest number of disparities, followed by Hispanics and Blacks.

Disparities: Access measures for which members of selected groups experienced better, same, or worse access to care compared with reference group, 2012

Chart shows access measures for which members of selected groups experienced better, same, or worse access to care compared with reference group. Go to table below for details.

  Poor vs. High Income (n=19) Black vs. White (n=21) Hispanic vs. White (n=21) Asian vs. White (n=18) AI/AN vs. White (n=13)
Better     3 3  
Same 0 11 4 9 9
Worse 19 10 14 6 4

 

Key: AI/AN = American Indian or Alaska Native; n = number of measures.

Note: Poor indicates family income less than the federal poverty level; high Income indicates family income four times the federal poverty level or greater. Numbers of measures differ across groups because of sample size limitations. Measures that achieve an overall performance level of 95% or better are not reported in the QDR and are not included in these analyses. Because disparities are typically eliminated when overall performance reaches 95%, our analyses may overstate the percentage of measures exhibiting disparities.

The relative difference between a selected group and its reference group is used to assess disparities.

  • Better = Population had better access to care than reference group. Differences are statistically significant, are equal to or larger than 10%, and favor the selected group.
  • Same = Population and reference group had about the same access to care. Differences are not statistically significant or are smaller than 10%.
  • Worse = Population had worse access to care than reference group. Differences are statistically significant, are equal to or larger than 10%, and favor the reference group.

Example: Compared with Whites, Hispanics had worse access to care on 14 of the 21 access measures, similar access on 4 measures, and better access on 3 measures.

Disparities:

  • In 2012, people in poor households had worse access to care than people in high-income households on all access measures (green).
  • Blacks had worse access to care than Whites for about half of access measures.
  • Hispanics had worse access to care than Whites for two-thirds of access measures.
  • Asians and American Indians and Alaska Natives had worse access to care than Whites for about one-third of access measures.

ACCESS DISPARITIES: Through 2012, across a broad spectrum of access measures, some disparities were reduced but most did not improve.

Change in Disparities: Number and percentage of all access measures for which disparities related to race, ethnicity, and income were improving, not changing, or worsening, through 2012

Chart shows number and percentage of all access measures for which disparities related to race, ethnicity, and income were improving, not changing, or worsening, through 2012. Go to table below for details.

  Poor vs. High Income (n=19) Black vs. White (n=21) Hispanic vs. White (n=21) Asian vs. White (n=18) AI/AN vs. White (n=10)
Improving 1 2 6 4 3
No Change 17 19 13 13 7
Worsening 1   2 1  

 

Key: AI/AN = American Indian or Alaska Native; n = number of measures.

Note: Poor indicates family income less than the federal poverty level; High Income indicates family income four times the federal poverty level or greater. Numbers of measures differ across groups because of sample size limitations. For the vast majority of measures, trend data are available from 2001-2002 to 2012. For each measure, average annual percentage changes were calculated for select populations and reference groups. Measures are aligned so that positive rates indicate improvement in access to care. Differences in rates between groups were used to assess trends in disparities.

  • Worsening = Disparities are getting larger. Differences in rates between groups are statistically significant and reference group rates exceed population rates by at least 1% per year.
  • No Change = Disparities are not changing. Differences in rates between groups are not statistically significant or differ by less than 1% per year.
  • Improving = Disparities are getting smaller. Differences in rates between groups are statistically significant and population rates exceed reference group rates by at least 1% per year.

Disparity Trends

  • Through 2012, most disparities in access to care related to race, ethnicity, or income showed no significant change (blue), neither getting smaller nor larger.
  • In four of the five comparisons shown above, the number of disparities that were improving (black) exceeded the number of disparities that were getting worse (green).

ii. In this report, racial groups such as Blacks and Whites are non-Hispanic, and Hispanics include all races.


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Page last reviewed April 2015
Page originally created April 2015
Internet Citation: Key Findings. Content last reviewed April 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqdr14/key1.html