DATE : April 28, 2022
IT IS BY now an axiom that Massachusetts residents have access to some of the best health care in the country. But actually getting that health care and being able to afford it may depend in large part on who you are and where you live.
New data released Thursday by the state’s Center for Health Information and Analysis looks at geographic disparities related to health insurance and health care access. It identified the South Coast region as an area with some of biggest challenges in health care access. For example, nearly one in seven South Coast residents reported difficulties accessing care either because they were uninsured or because a doctor wouldn’t take their insurance type.
Experts say there are many reasons for those disparities in a region primarily comprised of the cities of Fall River and New Bedford. “We’re older Gateway Cities here,” said David Borges, a principal at Springline Research Group who used to work for UMass Dartmouth and has done research for health systems around the South Coast. “Definitely the lower incomes, higher poverty levels, more immigrants with English as a second language all are issues that can be obstacles.”
The data make up the second in a series of reports published by CHIA, an independent public agency, looking at equity in health care. This one looks at equity through a geographic lens, based on survey data from 2015 to 2019.
On health insurance coverage, the report finds that most Massachusetts residents (93.3 percent) had continuous coverage throughout the past year. But the percentage was lowest, 89.4 percent, in the South Coast region. That translates to around 36,200 South Coast residents without continuous coverage.
South Coast residents also reported having the hardest time accessing care, with 31.2 percent saying they had difficulty accessing care at a clinic or doctor’s office. While the region’s residents did report visiting a doctor at high rates, many resorted to using the emergency room for care. The South Coast had the highest rate of residents relying on the emergency room for care – 23.4 percent, compared to 14 percent statewide.
Only 68.7 percent of South Coast residents visited a dentist in the prior 12 months, the lowest rate in the state.
South Coast residents also reported the highest rates in the state of unmet medical needs due to cost (31.3 percent) and the most medical debt or difficulty paying medical bills (27.2 percent).
Huong Trieu, senior director of research at CHIA, said the South Coast has statistically significant differences from other parts of the state.
“This is our first report that is focusing on a regional analysis, and I think we know these disparities exist in terms of coverage, access, affordability and use,” Trieu said. “I think this report would give policymakers and people interested in improving interventions or [creating] a more equitable health care system in the Commonwealth some data to look at and think about what are the differences that exist.”
Cheryl Bartlett, CEO of the Greater New Bedford Community Health Center and a former state public health commissioner, said myriad factors contribute to the disparity. There are a lot of immigrants without legal status in the region, who have fewer insurance products or resources available to them to pay for health care, she said. While there is a public health safety net, which pays for care for uninsured individuals, it can only be used with certain providers and services.
The region also has a lot of people working multiple jobs or transient jobs, who may not qualify for benefits through any one employer. Many work long hours in essential jobs and don’t have time or resources to sign up for insurance or get to appointments. There is also a lack of public transportation.
Bartlett said there is a growing Guatemalan community who speak the K’iche’ language, and language can be a barrier to getting care. Many individuals in the region have cultural barriers to trusting any kind of formal organized business.
In the health center’s pediatric practice, 70 percent of parents speak no English, which Bartlett said makes it hard to teach them how to care for their children’s medical needs. Many families have also been through trauma. “Pediatric providers talk to me about how it’s hard for them to do regular primary care when they have so much trauma and stress in their life,” Bartlett said.
Borges said many Gateway Cities share similar issues of high poverty rates, lower levels of educational attainment, and lots of non-English speakers, all factors that can create barriers to getting health care. People have trouble prioritizing health and wellness when they are focused on fulfilling their basic needs, like childcare, housing, and employment, he said. A lack of public transportation or childcare can be a barrier to getting to appointments. Many families are stressed by rising rents or are forced to accept substandard housing, which carries environmental risks.
“When you’re poor, you have a million other things to think about. It puts preventative health care lower on the list,” Borges said.
Borges said another problem is the quality of insurance many people can access – particularly when they are newer immigrants or employees working in industries like construction and fishing, which are prevalent in the region. “Some insurances are great, they cover a lot of things. Some insurance is just basic,” Borges said.
Shira Schoenberg is a reporter at CommonWealth magazine. Shira previously worked for more than seven years at the Springfield Republican/MassLive.com where she covered state politics and elections, covering topics as diverse as the launch of the legal marijuana industry, problems with the state's foster care system and the elections of U.S. Sen. Elizabeth Warren and Gov. Charlie Baker. Shira won the Massachusetts Bar Association's 2018 award for Excellence in Legal Journalism and has had several stories win awards from the New England Newspaper and Press Association. Shira covered the 2012 New Hampshire presidential primary for the Boston Globe. Before that, she worked for the Concord (N.H.) Monitor, where she wrote about state government, City Hall and Barack Obama's 2008 New Hampshire primary campaign. Shira holds a master's degree from Columbia University's Graduate School of Journalism.