Insurance Status, Cost as Barrier to Care, and Primary Care Provider

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Insurance Status, Cost as Barrier to Care, and Primary Care Provider Profile

Download an in-depth health indicator profile with additional analysis and findings on insurance status, cost as barrier to care, and primary care provider in Santa Barbara County.

Full Analysis

Having health insurance is a particular measure of a person’s ability to access health care. People without health insurance are less likely to have a usual source of health care and are more likely to miss routine medical visits, which can identify serious health conditions early or even prevent them entirely.

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.

Having a usual source of health care improves health outcomes, reduces disparities between groups, and can lower health care costs. Regular check-ups and screenings can help diagnose and attend to diseases at earlier, more treatable stages.1

Measure: Health Insurance

Having health insurance was based on responses to the question: “Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, government plans such as Medicare or Medi-Cal, or Indian Health Service?”

Findings from the 2019 Santa Barbara County CHNA

Santa Barbara County is below the Healthy People 2020 target of 100% insurance coverage in every demographic subgroup except for those age 65 and older. The percentage of those insured has remained flat since 2016 and most of the disparities observed in 2016 persist in 2019. Most impacted groups include those with less than a high school education, Hispanics, and those living in households with less than $35,000 annual income.

Additional insurance status, cost as barrier to care, and primary care provider findings from the 2019 Santa Barbara County CHNA can be found in the Insurance Status, Cost as Barrier to Care, and Primary Care Provider Indicator Profile. Follow this link to learn more about the methods for health indicator profile analysis.

Figure 1. 2019 Percentage of Adults That Have Health Insurance by Demographic Group

Figure 1. 2019 Percentage of Adults that Have Health Insurance by Demographic Group

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Measure: Cost as a Barrier to Care

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?” The Healthy People 2020 goal is to reduce the proportion of persons who are unable to obtain or delay in obtaining necessary medical care to 4.2%.

Findings from the 2019 Santa Barbara County CHNA

Santa Barbara County is significantly above the 2020 Healthy People target for all demographic groups except those age 65+ and those living in households with incomes $75,000 or greater. Most impacted subgroups include those reporting less than some college, those reporting less than $75,000 annual household income, those less than 65 years old, racial/ethnic groups other that non-Hispanic whites, and females.

Figure 3. 2019 Percentage of Adults Reporting Cost as a Barrier to Health Care by Demographic Group

Figure 3. 2019 Percentage of Adults Reporting Cost as a Barrier to Health Care by Demographic Group

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Measure: Primary Care Provider

Having a usual primary care provider was based on the following question: “Do you have one person you think of as your personal doctor or health care provider?” For those that answered “No,” the question was followed up with “Is there more than one, or is there no person who you think of as your personal doctor or health care provider?”

Findings from the 2019 Santa Barbara County CHNA

Santa Barbara County overall is significantly below the Healthy People 2020 target of having a health care provider and lower than California in almost every demographic group except for those age 65+. Hispanics fair significantly worse than non-Hispanics, those in the age group 18-44 fair worse than those older, those without a high school degree and those in the lowest income group reporting good or better health fair worse than those with higher education and income.

Figure 5. 2019 Percentage of Adults Reporting Access to a Health Care Provider by Demographic Group

Figure 5. 2019 Percentage of Adults Reporting Access to a Health Care Provider by Demographic Group

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Findings from the 2019 Santa Barbara County Listening Tour

Cottage Health and its partners heard from a wide array of leaders and community members through a Listening Tour focused on behavioral health. A full Listening Tour report related to insurance status, cost as barrier to care, and primary care provider can be found in the Insurance Status, Cost as Barrier to Care, and Primary Care Provider Indicator Profile.

Listening Tour participants describe their experiences while trying to access health care as being rife with obstacles. Given the high cost of living in Santa Barbara, many are forced to choose between health care and other necessities. People who find themselves “in the middle,” that is those who are not wealthy and do not qualify for programs designed for low-income individuals, are underinsured. And, still others are hesitant to seek care or may be excluded from programs due to their immigration status.

Quote from Latinx Community Member

“I think one of the biggest problems I’ve seen recently is that families who earn a little more money lose their Medi-Cal. They lose it by a dollar. They are two parents who are working two full-time jobs and they can no longer qualify with only two children. And I think that is bad because maybe you do earn more, but they are not realizing that we are living in a community that has such high rent. That the money goes away with the rent. The money goes to the children’s activities. Perhaps to food or other things they need. For that reason, they cannot receive aid or food or other resources because they don’t qualify by just a few pennies or a few dollars. They lose the resources they need for that reason.”

To overcome these obstacles to accessing care, Listening Tour participants recommend expanding access to health care across the board through better insurance plans accessible to all and reducing the cost of care. Moreover, the health care system must ensure that providers are trained in providing more bilingual services and culturally competent care to ensure that the care people are accessing is effective.


1 Office of Disease Prevention and Health Promotion. (2020). Access to Health Services. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services

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