Access to Health Care

Of all the forms of injustice, inequality in health care is the most shocking and inhumane.

—Dr. Martin Luther King, Jr.

Access to comprehensive, quality health services is necessary for health equity and a healthy quality of life for individuals in our community. Access to health care can impact physical, social and mental health, disease and disability prevention and life expectancy, among other things.

In order to achieve this, individuals must gain entry into the health care system, find a health care location with their needed services and find a provider with whom they can communicate and trust. Each of these actions come with unique barriers that can hinder access to care.

Barriers to services include lack of availability, high cost and lack of insurance coverage. Uninsured people are less likely to receive medical care, more likely to die early and more likely to have poor health status. Current policy efforts focus on the provision of insurance coverage as the principal means of ensuring access to health care among the general population (1).

Insurance Coverage

Definition

This indicator is the percentage of Tulsa County residents who had health care coverage in 2018, based on American Community Survey 5-year estimates. The percentages of the population with insurance coverage rates are shown by county and by region within the county in terms of gender, race, ethnicity, citizenship status, disability status and employment status.  

Insurance coverage is also broken out by gender, race/ethnicity, citizenship status, disability status, employment status and age groups for Tulsa County as a whole and for each region, showing percentages insured for children under 19, adults 19-64, and the total population.  Adults 65 and over are not shown, as all adults in this age group should have health care coverage due to Medicare. 

Medicaid enrollment is also presented as a separate indicator.  


How are we doing?

In 2015, 83.4 percent of Tulsa County residents had insurance coverage (16.6 percent uninsured).  The percentages of those with insurance coverage in Tulsa County from 2015 to 2018 were very close to those of Oklahoma overall.  Both locations had much lower percentages of those with insurance coverage then for the US as a whole.  All three locations showed increases in the percentages of those who had insurance coverage from 2015 to 2018.  

In terms of regions within Tulsa County, all regions showed at least small increases in the percentages of those with insurance coverage from 2015 to 2018.  However, the percentages of those with insurance coverage are noticeably lower for the populations in the North Tulsa, East Tulsa and Downtown regions. The three regions with the highest percentages of people with insurance coverage are the Jenks/Bixby, South Tulsa and Owasso/Sperry regions.

Insurance Coverage by Gender



In 2018, females had slightly higher percentages of those with insurance coverage than did males in the US, Oklahoma and in Tulsa County.  This was true in all of the regions of the Tulsa County area, as well.  

The graph below illustrates the breakdown of gender for Tulsa County and the 8 regions.  It is clear here as well that the highest percentages of those with insurance for both males and females are the Jenks/Bixby, South Tulsa and Owasso/Sperry regions.  Females in the Owasso/Sperry region had the highest percentage of those insured in 2018 at 91.4 percent, and the North Tulsa region had the lowest percentage of males with insurance coverage at 73.8 percent.  

Insurance Coverage by Race and Ethnicity



In 2018, the racial populations with the highest percentage of those who had some type of health insurance in Tulsa County were Asian and Caucasians (86 and 88.5 percent respectively).  This pattern was true for the state of Oklahoma and for the US as a whole; however, the percentages in Tulsa County were slightly lower than those for Oklahoma and the US.  The racial population with the lowest percentage of individuals with some type of health insurance in all three locations are those who report being "some other race," with 59.8 percent in Tulsa County; 68.7 percent in Oklahoma and 78.7 percent in the US.  

The racial categories have been narrowed down when examined at a regional level within Tulsa County, as some of the categories have very small numbers in some regions.  The graph below shows the breakdowns of race/ethnicity by Tulsa County regions.  In the North Tulsa, Owasso/Sperry, Midtown, Downtown and East Tulsa regions, the Asian populations have the highest percentages of people with some type of health insurance.  In the Sand Springs/West Tulsa, South Tulsa and Jenks/Bixby regions, the Caucasian populations have the highest percentages of individuals with some kind of health insurance coverage.


Insurance Coverage by Citizenship Status

In terms of insurance coverage by citizenship status, Tulsa County had the lowest percentages of individuals who are non-citizens but have some type of health insurance coverage in 2017 and 2018 (45.0 percent and 47.5 percent respectively) compared to Oklahoma (48.9 percent in 2017, 51.1 percent in 2018) and the US overall (63.2 percent 2017, 66.1 percent 2018).  However, the percentages of individuals with non-citizen status who had some type of health insurance coverage increased slightly in all three locations from 2017 to 2018.  

Across the two-year period in the Tulsa County regions, three regions had higher percentages of people with non-citizen status who were reported to have some form of health insurance; Jenks/Bixby, Owasso/Sperry and South Tulsa.  This was consistent across the two-year period.  Two Tulsa County regions had the lowest percentages of those with non-citizen status who had insurance coverage both years; East Tulsa (31.9 percent 2017, 35.1 percent 2018) and North Tulsa (27.3 percent 2017, 28.3 percent 2018).  The percentages across all regions increased slightly from 2017 to 2018.

Insurance Coverage by Disability Status


The percentages of individuals with a disability who have insurance coverage were high for Tulsa County, Oklahoma and the US for both 2017 and 2018.  Tulsa County and Oklahoma were slightly lower than the US, but were close to 90 percent coverage for both years.  The percentages of individuals with a disability who had insurance coverage remained relatively unchanged from 2017 to 2018 for all three locations.  

In terms of regionally, the regions with the lowest percentages of individuals with a disability who have insurance coverage were the Downtown region (78.2 percent 2017 and 79.2 percent 2018) and the North Tulsa region (81.3 percent 2017 and 82.1 percent 2018); however both of these regions were close to 80 percent coverage for this population.   As was true for the larger geographical regions (Tulsa County, Oklahoma and the US), the percentages of people who had a disability and had insurance coverage remained relatively stable across Tulsa County regions from 2017 to 2018.  

Insurance Coverage by Employment Status


In the US overall in 2017, 66.1 percent of those who were reportedly unemployed had some form of insurance coverage.  This percentage rose to 70.3 percent in 2018.  For Tulsa County and Oklahoma over the same time period, the percentages were lower, with Oklahoma at 47.3 percent in 2017 and 49.0 percent in 2018 and Tulsa County at 49.4 percent in 2017 and 50.5 percent in 2018.  The percentage for the US rose about 3.5 percentage points from 2017 to 2018, but the percentages for Tulsa County and Oklahoma remained relatively unchanged.

Across Tulsa County regions, the Downtown region (24.5 percent in 2017 and 30.2 percent in 2018) and the North Tulsa region (39.4 percent in 2017 and 42.2 percent in 2018) had the lowest percentages of those who were unemployed with any insurance coverage during the time period examined.  The Jenks/Bixby and Owasso/Sperry regions had the highest percentages of those who were unemployed and had some type of insurance coverage, although both of those regions showed very slight decreases from 2017 to 2018 (Jenks/Bixby from 59.7 percent in 2017 to 58.0 percent in 2018, and Owasso/Sperry from 66.0 percent in 2017 to 62.6 percent in 2018).


Insurance Coverage for Children Under 19*

 In 2015, 91.7 percent of Tulsa County children under 18* had some type of health insurance coverage. This was higher than Oklahoma (90.8 percent), but lower than the US (93.5 percent). In 2018, 92.5 percent of children under 19 had some type of coverage.  Again, as in 2015, this percentage was slightly higher than that of Oklahoma overall (91.9 percent), but slightly lower than that for the US (94.8 percent).  

Across Tulsa County regions, the percentages of children under 18/under 19 who have some type of insurance coverage were high for all.  The region with the lowest percentages of children with insurance consistently from 2015 to 2018 was the East Tulsa region (87.9 percent in 2015 and 90.1 percent in 2018).  The regions with the highest percentage of insured children consistently across the time period were the Downtown, Jenks/Bixby, Midtown, and Owasso/Sperry regions.  The zip code with the highest percentage of insured children was the Downtown region (although this region had small numbers in this age category.)  

*Please note that in 2017, the age breakdowns in the ACS 5-year estimates on insurance coverage changed from "Under 18" and "18 to 64" to "Under 19" and "19 to 64."  So while the patterns in the data remain the same, the numbers are calculated using slightly different populations before 2017 and from 2017 onward.


Insurance Coverage for Adults 19–64*

In 2015, 76.8 percent of Tulsa County adults 18-64 had some type of healthcare insurance coverage. This was almost identical to Oklahoma (76.6 percent), but lower than the US (81.9 percent). In 2018, the percentage of adults 19-64* with insurance coverage showed the same pattern, with Tulsa County (80.1 percent) having a slightly higher percentage than Oklahoma (79.6 percent), but a lower percentage than the US overall (86.8 percent).  

The Tulsa County region with the consistently highest percentage of insurance coverage for adults 18-64/19-64* was the Downtown region (around 97 percent over the years examined).  The region with the consistently lowest percentage of adults 18-64/19-64* was the East Tulsa region; although the percentages here are still quite high, around 90 percent across the four years examined.   

*Please note that in 2017, the age breakdowns in the ACS 5-year estimates on insurance coverage changed from "Under 18" and "18 to 64" to "Under 19" and "19 to 64."  So while the patterns in the data remain the same, the numbers are calculated using slightly different populations before 2017 and from 2017 onward.


Medicaid Enrollment

Definition

Medicaid is an entitlement program that provides medical benefits to low-income individuals and families who have inadequate or no health insurance. This indicator is presented as the percentage of the population enrolled in Medicaid in fiscal year 2018, and over the time period 2011 to 2018.

Why is this indicator important?

Medicaid provides health coverage for certain low-income individuals, such as families and children, pregnant women, the elderly and people with disabilities.  It covers one in five Americans, including two in five children and three in five nursing home residents (2). Medicaid coverage of children and pregnant women has led to increased access to care and improved child health and birth outcomes. Relative to the uninsured, adults with Medicaid have increased access to preventive and primary care, reduced out-of-pocket burdens, and they are less likely to forgo care due to cost.  However, provider shortages and low provider participation in Medicaid, particularly among specialists, are a major concern (3).

How are we doing?

Tulsa County had 165,085 unduplicated Medicaid enrollees during fiscal year 2018 which represents 25.7 percent of the total population. This was very similar to Oklahoma (26.1 percent) and higher than the U.S in 2017 (23 percent, latest data available). However, U.S. data is based on enrollment at a specific point (June of fiscal year) and may not encompass all unduplicated clients over the year.

Overall, about two-thirds of Medicaid enrollees in Tulsa County were children (66.1 percent). Females made up over half of enrollees (59.8 percent). Caucasians accounted for 59.9 percent of Medicaid enrollees in Tulsa County, followed by blacks (19.8 percent). About 20 percent of Medicaid enrollees were Hispanic (22.9 percent). This data is for fiscal year 2018.

The Tulsa County regions that have consistently had the highest percentages of Medicaid enrollees were the East Tulsa region and the North Tulsa region.   

Providers

Definition

A list of Tulsa County physicians and dentists and their location of practice was obtained from the database ReferenceUSA. ReferenceUSA is an internet-based reference service that compiles data from a number of sources including state licensing information. Data was obtained on June 19, 2018.

Why is this indicator important?

For many people, having good access to health care means having a regular doctor, being able to schedule timely appointments and being able to find new doctors when needed. Good access to doctors is especially important for people with Medicare—seniors and adults with permanent disabilities—because they are significantly more likely than others to need health care services (4).

How are we doing?

Based on 2018 population estimates, there was a rate of 4.9 physicians and dentists per 1,000 population in Tulsa County. Address mapping of these physicians and dentists showed that the largest numbers of providers were located in zip code 74104. This zip code contains two hospitals: St. John Medical Center and Hillcrest Medical Center. The Downtown region had the highest rate of physicians and dentists per 1,000 population, followed closely by the Midtown region. The North Tulsa region had the lowest rate of physicians and dentists, and the Jenks/Bixby region had a rate only slightly higher.

Within Tulsa County, 87.3 percent of providers were physicians or surgeons, while 11.7 percent were dentists. The top specialties among providers were Family Practice (11.6 percent), Internal Medicine (7.8 percent), and General Dentistry (7.5 percent).

Emergency Department Visits

Definition

This indicator is the number of emergency department (ED) visits to the nine Tulsa County hospitals by Tulsa County residents in 2018*. It is presented as a rate per 1,000 population. It is important to note that while all of the hospitals are in Tulsa County, there may be patients from outside counties. Overall Tulsa County rates reflect these additional individuals. Regional and zip code rates are calculated using only those individuals who reside in that zip code. 

*It should also be noted that Tulsa County began switching to a different reporting system for this indicator during 2018.  For this reason, there were only data for 6 of the 9 hospitals that had historically reported through the Tulsa Area Syndromic Surveillance System (TASSS).  Emergency Department visits after 2018 will be reported using the ESSENCE program.   


Why is this indicator important?

Lack of access to adequate and timely health care services can lead to increased use of the hospital ED as a source of primary care. According to the CDC, uninsured adults were more likely than those with private health insurance or a public health plan to visit the emergency department due to having no other place to go. This can place unnecessary strain on the hospital ED (5).


How are we doing?

In 2014, over 316,000 visits were made to the nine Tulsa County EDs for an approximate overall rate of 514.1 visits per 1,000 population. In 2018, the rate was 408.3.  This is likely an underestimate for county residents due to missing data for 3 of the area hospitals for 2018.  

However, in spite of the missing data from three of the area hospitals for 2018, the graph to the right clearly illustrates the regions within Tulsa County that have consistently had the highest rates of Emergency Department visits since 2014.  The three regions that stand out on this indicator are the Downtown, the East Tulsa and the North Tulsa regions. 

Explore the Data



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