The Center for Healthcare Research & Transformation (CHRT), in partnership with the Institute for Public Policy and Social Research at Michigan State University, has surveyed Michigan residents three times (in 2009, 2010, and 2012) on key issues relating to health care coverage, access to care, and health status. The latest survey, Cover Michigan Survey 2013, was fielded in the third quarter of 2012.
This report compares data from 2010 and 2012 and focuses on one aspect of that survey: the relationship between coverage status and access to care.
Future reports will cover other aspects of health care in Michigan.
- More respondents said they had an identified primary care provider than in 2010; the greatest increase was found among those with Medicaid coverage.
- Those with Medicaid coverage reported a significantly easier time in scheduling appointments for primary and specialty care than in 2010—now on par with those with employer-sponsored coverage.
- Those with individually-purchased coverage reported greater difficulty scheduling appointments for primary care than in 2010.
- Respondents reported using public or community health clinics as their usual sources of care at significantly higher rates than in 2010.
- Respondents who lacked coverage reported using emergency rooms and urgent care centers as their usual sources of care at considerably higher rates than those who had coverage.
FIGURE 1: Primary care provider identification 2010 and 2012a
|Has a primary care provider||77%||83%|
|No primary care provider||23%||17%|
While 56 percent of those who were uninsured said they had identified a primary care provider in 2012 (an increase from 2010), they were still significantly less likely to have identified a primary care provider than those with coverage.
FIGURE 2: Primary care provider identification, by coverage status, 2010a and 2012b
|Has a primary care provider||81%||87%||50%||56%|
|No primary care provider||19%||13%||50%||44%|
b Significant difference for primary care identification by coverage status among 2012 responses
c Significant difference for primary care identification by coverage status comparing 2010 and 2012 for insured respondents
Those with Medicaid coverage reported the greatest increase in having identified a primary care provider. In 2010, 72 percent of Medicaid recipients reported having a primary care provider compared to 88 percent in 2012, a statistically significant difference. Those with individually-purchased coverage also experienced significant improvements—from 68 percent in 2010 to 82 percent in 2012.
FIGURE 4: Ease of scheduling primary care appointments, 2010 and 2012
|Very or somewhat easy||88%||86%|
|Very or somewhat difficult||12%||13%|
While the overall response was statistically unchanged from 2010 to 2012, there were changes from 2010 to 2012 when responses were broken down by coverage type. For example, a significantly higher proportion of Medicaid recipients reported it was either “very” or “somewhat” easy to schedule primary care appointments in 2012 compared to 2010 (91 percent vs. 74 percent). This change for Medicaid respondents suggests that they are now on par with other insured respondents on ease of scheduling primary care appointments.
Those with individually-purchased coverage were the one group with a significant drop in ease of scheduling. Eighty-three percent of those with individually-purchased coverage indicated that scheduling appointments was “very” or “somewhat” easy in 2012, down 13 percent from 2010, when 96 percent reported it was either “very” or “somewhat” easy to schedule a primary care appointment.
FIGURE 6: Ease of scheduling specialty care appointments, 2010 and 2012
|Very or somewhat easy||77%||79%|
|Very or somewhat difficult||23%||21%|
However, for respondents with Medicaid coverage, ease of scheduling specialty care appointments increased substantially from 2010 to 2012. In 2010, only 50 percent of Medicaid recipients reported it was “very” or “somewhat” easy to schedule specialty care appointments. In 2012, 83 percent reported it was either “very” or “somewhat” easy to schedule specialty care appointments.
FIGURE 8: Ease of scheduling appointments, for primary and specialty care, by primary care provider identification, 2012
|Primary Carea||Specialty Carea|
|Has a PCP||No PCPb||Has a PCP||No PCP|
|Very or somewhat easy||89%||76%||83%||55%|
|Somewhat or very difficult||11%||24%||17%||45%|
b 3% of those respondents with no identified PCP reported that the ease of scheduling primary care appointments was neither easy nor difficult
Community clinics include settings such as federally qualified health centers (FQHC). In 2012, Michigan had 46 more FQHC sites than in January 2010.1
Uninsured respondents used hospital emergency rooms and urgent care centers as usual sources of care at higher rates than those with any form of coverage, though the use of urgent care declined for the uninsured between 2010 and 2012. In 2012, 21 percent of uninsured respondents said they considered hospital emergency rooms or urgent care centers to be their usual locations of care, compared to fewer than 10 percent of insured respondents.
FIGURE 10: Usual location of care, by coverage status, 2010 and 2012a
|Public or community health clinic||3%||6%c||20%||25%|
|Hospital outpatient department||2%||3%||4%||1%|
|Hospital emergency room||3%||3%||9%||12%|
|Urgent care center||3%||3%||19%||9%|
b Significant differences in “doctor’s office” as a usual location of care among insured and uninsured comparing 2010 and 2012 data
c Significant difference in public or community clinic as usual location of care ONLY among the insured when comparing 2010 and 2012 data
d Significant differences in “Other” as a response to usual location of care ONLY among uninsured comparing 2010 and 2012 data
And, as in 2010, those who lacked health coverage were much less likely to have an identified primary care provider than insured respondents, and much more likely to use emergency rooms as their usual source of care.
Since 2010, a great deal has changed in the way health care is organized and delivered in Michigan—in public and private health insurance programs alike. This report should be useful information to policy makers who seek to understand which specific changes and initiatives were most directly connected to the results reported here.
For analytical purposes, survey data were weighted to adjust for the unequal probabilities of selection for each stratum of the survey sample (e.g., region of the state, listed vs. unlisted telephones, etc.) Additionally, data were weighted to adjust for non-response based on age, gender, and race according to population distributions from the United States Census 2010. Results were analyzed using SAS 9.3 software. Statistical significance of one-year variation was tested using a chi-squared test for independence. Z-tests were used to determine the statistical significance of individual groups when two years were compared. All relationships and tables marked as statistically significant are significant at p ≤ 0.05. Percentages may not add up to 100 due to rounding.
A full report of IPPSR’s State of the State Survey methodology can be found at: http://ippsr.msu.edu/soss/.
Suggested Citation: Young, Danielle; Stadler, Phillip; Udow-Phillips, Marianne; Riba, Melissa. Access to Health Care in Michigan. Cover Michigan Survey 2013. March 2013. Center for Healthcare Research & Transformation. Ann Arbor, MI.
Acknowledgements: The staff at the Center for Healthcare Research & Transformation would like to thank Matthew M. Davis, MD, MAPP, and Helen Levy, PhD, at the University of Michigan; Robert Goodman, DO, at Blue Care Network of Michigan; and the staff of the Institute for Public Policy and Social Research (IPPSR) at Michigan State University for their assistance with the design of the survey and data collection.