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Foregoing Health Care

Delaying or not receiving health care


Poverty, unemployment, and a lack of access to health insurance can all affect one’s ability to afford personal healthcare costs. For people without health insurance, this lack of healthcare access can seriously affect life stability and mental health as well as physical health outcomes. People without health insurance are more likely to die early and have poor health status. In addition, infectious diseases that go untreated can also increase health risks for the larger community. Uninsured people often postpone getting health care, have difficulty obtaining care when they ultimately seek it, and may have to bear the full brunt of healthcare costs. According to one study, uninsured families can afford to pay for only 12% of hospitalizations that they experience. Even for people with healthcare insurance, high premiums and out-of-pocket payments can be a significant barrier to accessing needed medical treatment and preventive care. Almost 50% of personal bankruptcy filings in the United States are due to medical expenses.


For a detailed explanation of how to access CHIS data, see Appendix C.

How to Use AskCHIS to Find Information on Foregoing Health Care

STEP 01. Log in to your account.

STEP 02. Pick the geographic area that you want to explore. Choose the Bay Area Regional Health Inequities Initiative (BARHII) region—all the Bay Area counties plus Santa Cruz County. When you are finished, press the “Select” button.

STEP 03. To find those who delayed medical care, choose “Access & Utilization.” Under that, choose “Delay of Care.” The topics available for “Delay of Care” will populate on the right side of the page. Select the first topic, “Delayed or didn’t get other medical care.”

STEP 04. The next page asks you to compare by other groups or conditions. For now we are skipping comparing, so we press the “Population” button at the top. Here you can choose to limit the data by age, race/ethnicity, gender, and/or federal poverty level factor for the household. We limit to adults under 65 years only by entering 18 and 64 in the age boxes. When ready, press the green button, “Get Results.” The results are displayed for the most recent year the data are available. In this case, the data display for 2011–2012. The result is that 15.2% of adults delayed or didn’t get medical care.

STEP 05. We can further refine this by pooling together multiple years. To do this, hover over “Time Period” and click “Pool Data Together” and choose the years you want. In this case we chose 2009 and 2011–2012. The results are again displayed, this time showing 15.7% of adults delayed or didn’t get medical care.

Other indicators available in AskCHIS include “Delayed or didn’t get prescription medicine” and from 2001, the reasons that health care or medications were delayed.


Prescription Drug Discount Card
Napa County Public Health Department

In 2009, Napa County Public Health Department helped to launch and promote a prescription drug discount card under a program sponsored by the National Association of Counties (NACo). The program helps consumers cope with the high cost of prescription drugs by offering an average of 22% off retail prices of commonly prescribed drugs.

All Napa County residents, regardless of age, immigration status, income, or existing health coverage, may use the prescription discount card. There is no enrollment form, no membership fee, and no restrictions or limits on frequency of use. Cardholders and their families may use the card any time their prescriptions are not covered by insurance.

Napa County Public Health Department targeted promotion efforts to uninsured and underinsured residents of the county by holding information sessions with groups representing senior citizens, such as the local chapter of American Association of Retired Persons; providing outreach materials to all programs within the Health and Human Services Agency and to local non-profits serving indigent and other at-risk populations; and through information distributed to the local news media.

Healthy San Francisco
San Francisco County Department of Public Health

Launched in 2007, Healthy San Francisco (HSF) is a program designed to make healthcare services available and affordable to uninsured San Francisco residents. Operated by the San Francisco Department of Public Health, HSF is available to all San Francisco residents regardless of immigration status, employment status, or pre-existing medical conditions. The program currently provides health coverage to over 50,000 uninsured San Francisco residents.
HSF was launched after the passage of the Health Care Security Ordinance, which required employers with 20 or more employees to satisfy an employer spending requirement in one of three ways: 1) make payments for health, dental, and/or vision insurance for employees; 2) contribute to a city option; or 3) make contributions to programs that reimburse employees for out-of-pocket health care costs.

Employees of employers that contribute to the city option and who meet program eligibility requirements are invited to apply for HSF. Employees who are not eligible for HSF are assigned medical reimbursement accounts to pay for out-of-pocket medical expenses. While Healthy San Francisco provides basic and ongoing medical care, the program is not health insurance. Therefore, if employers offer health insurance they should not drop it. People who qualify for Healthy San Francisco include the following:

+ A San Francisco resident.

+ Uninsured for the last 90 days.

+ Not eligible for public insurance programs such as Medi-Cal or Healthy Families.

+ Between the ages of 18 and 64 years.

+ Living within program income guidelines.


Agency for Healthcare Research and Quality. 2012. 2012 National Healthcare Disparities Report: http://www.ahrq.gov/research/findings/nhqrdr/nhdr12/chap9.html. Accessed October 2014.

Alexander GC, Casalino LP, Meltzer DO. 2003. Patient–Physician Communication about Out-of-Pocket Costs. JAMA 290(7):953-958.

Chappel A, Kronick R, Glied S. 2011. The Value of Health Insurance: Few of the Uninsured Have Adequate Resources to Pay Potential Hospital Bills. ASPE Research Brief. Washington, DC: U.S. Department of Health and Human Services. http://aspe.hhs.gov/health/reports/2011/ValueofInsurance/rb.pdf. Accessed June 2013.

Durham J, Owen P, Bender B, et al. 1998. Self-assessed health status and selected behavioral risk factors among persons with and without healthcare coverage—United States, 1994-1995. MMWR 47(9):176-180.

Hadley J. 2007. Insurance Coverage, Medical Care Use, and Short-term Health Changes Following an Unintentional Injury or the Onset of a Chronic Condition. JAMA 297(10):1073-1084.

Institute of Medicine. 2004. Insuring America’s Health: Principles and Recommendations.

Jacoby M, Sullivan T, Warren E. 2000. Medical Problems and Bankruptcy Filings. Norton’s Bankruptcy Law Adviser 5:1-12.