Cost as a Barrier to Care
Lack of health insurance is one barrier to accessing health care, but even people who do have health insurance sometimes delay care because cost is a barrier. Delays in needed care increase the risk of diagnosing diseases at a later stage, disrupt management of diseases and conditions, and can lead to preventable hospitalizations (HP 2020 Access).
Findings in Santa Barbara County
Measure
Cost as a barrier to health care was based on the following question: “Was there a time in the past 12 months when you needed to see a doctor, but could not because of cost?” In addition to cost, other barriers to care were assessed with the following question: “During the past 12 months, did you delay or not get medical care you felt you needed— such as seeing a doctor, a specialist, or other health professional?”
Of all survey respondents, 19.1% answered yes to this question. This is a more accurate comparison to the HP 2020 Target, which assesses the percentage of people “unable to obtain or delayed in obtaining necessary medical care."
Table 15. Percentage of Adults Who Did Not Receive Health Care Because of Cost and Healthy People 2020 Target
| 2016 Santa Barbara
BRFSS | California* | Health People 2020
Target |
|---|
|
%(95% CI) |
% (95% CI) |
|---|
| Overall |
6.9 (5.3 -8.5) |
13.5 (12.6–14.5) |
|---|
| Male |
6.9 (4.3-9.5) |
11.6 (10.4–12.9) |
|---|
| Female |
6.9 (4.9-8.9) |
15.3 (13.9–16.6) |
|---|
|
|
|
4.2** |
|---|
| Hispanic |
7.0 (4.3-9.7) |
19.5 (17.6–21.3) |
|---|
| Non-Hispanic White |
7.7 (5.4-10.0) |
9.0 (8.0–10.0) |
|---|
| Other |
NA |
NA |
|---|
*2014 Behavioral Risk Factor Surveillance System
**Target slightly different than data presented: "Unable to obtain or delayed in obtaining necessary medical care."
NA = Not Available; estimates derived from fewer than 50 respondents were suppressed due to unreliability of the estimates.
Figure 44. Percentage of Adults Who Did Not Receive Health Care Because of Cost in Santa Barbara County, by Age and Sex
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Figure 45. Percentage of Adults Who Did Not Receive Health Care Because of Cost in Santa Barbara County, by Race/Ethnicity, Educational Attainment, and Income
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Health Disparities
The goal for HP 2020 is to reduce the percent of adults who did not receive needed health care to 4.2%. Adults in California failed to receive health care due to cost at 3 times this rate, whereas 6.9% of Santa Barbara County adults report not receiving health care because of the cost. This rate is relatively consistent across gender and age. However, there are disparities in care by age, educational attainment and income.
Factors and Health Outcomes Associated with Cost Barriers to Care
Figure 50 presents various individual, social, and environmental factors associated with cost barriers to care for people with such barriers, compared to all Santa Barbara County residents, and to Californians as a whole.
Figure 46. Health and Risk Factors of Adults in Santa Barbara County Who Did Not Receive Health Care Because of Cost (36.3%), Compared With All Santa Barbara County Adults and Californians* as a Whole
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*Data for California are not available for all indicators
The chart shows that twice as many Santa Barbara County adults with cost barriers to care reported being in fair to poor health compared to the county and state as a whole. This is one of the few indicators associated with poor mental health: more than 30% of adults who did not receive care due to cost reported 15 or more days of poor mental health in the past 30 days. They also reported higher rates of housing and food insecurity, and a higher percentage was covered by Medicaid/Medi-Cal.
Key Opportunities for Population Health Improvement
What Businesses Can Do
What Healthcare Providers Can Do
What Individuals Can Do
