From 1998 to 2005, the Fund's Health Care in New York City Program worked to improve coverage and access to care for the city's most vulnerable residents. The program informed the city's policymakers and health care community by generating information on health insurance, health care utilization, and barriers to care and by supporting innovations in delivering care.
Health Insurance Trends
Without health insurance, people are less likely to receive timely primary and preventive care and more likely to use the emergency department and delay seeking care when sick. These problems are especially acute for minorities, recent immigrants, and low-income individuals. A grant to the New York City Department of Health and Mental Hygiene provided partial support for the 2003 and 2004 Community Health Surveys, each of 10,000 New Yorkers.
The loss of employer-sponsored health insurance contributes to the problem of the uninsured. In order to manage rising health costs, employers report that they are increasing the amount workers pay for coverage. According to a 2003 survey, employees paid 54 percent more for family coverage than in 2001. Two of five employers said they were likely to increase the amount workers pay in the next year, raising concerns that more low-wage workers will be unable to afford coverage. Many employers expressed interest in helping lower-wage workers get coverage through public programs.
Public Coverage Programs
New York's public programs are among the most generous in the country in terms of eligibility and benefits. Yet, it can be difficult for applicants to enroll and to retain coverage. The Fund supported work that explored the barriers to coverage and identified possible solutions. Projects in this area included:
- A study by Beth Osthimer at the Children's Defense Fund showing how Medicaid, Child Health Plus, Family Health Plus, and the pregnancy care program have different eligible levels, enrollment processes, and reenrollment requirements, making it hard for families to comply with the rules.
- A study of facilitated enrollers showed that consumers find it difficult to navigate the enrollment process alone, and that facilitated enrollers are an important investment for the state to make.
- A study found that many children become disenrolled from Child Health Plus B who are financially still eligible to continue. Less than 7 percent of children who lost coverage were ineligible at the time of recertification.
Two programs in New York use government funding to simplify coverage or make it more affordable for small businesses and individuals. The Health Pass program is a purchasing consortium that streamlines enrollment and improves administrative efficiency for small businesses. Healthy New York offers a low-cost managed care plan to small businesses and individuals by cutting down on benefits and reinsuring high claims. Evaluations of these two publicâ€“private coverage programs identified opportunities for improvement:
Improving Linkages to Primary Care
Connecting people to care, regardless of health insurance, is a vital component of improving the health of New Yorkers. Projects in this area included:
- An initiative to connect schoolchildren and their families with a medical home.
- A second project helped children with asthma who have been heavy users of hospital services to get better care through the use of technology to communicate with nurses and doctors at the hospital.
Building upon past work by John Billings (Emergency Department Use in New York City: A Substitute for Primary Care? and Emergency Room Use: The New York Story), an initiative tested strategies to improve access to primary care and reduce non-urgent emergency department use. Billings' analyses showed that more than three-quarters of emergency department visits in the city were for problems that could have been handled in primary care settings. The Fund sought to identify and evaluate innovations in connecting emergency department users with a regular source of primary care.