Descriptive Title: Proportion of the population covered by health insurance

Geographic Unit of Analysis: Public Use Microdata Area (PUMA)

Percent of population with health insurance
Public Use Microdata Area % with health insurance MOE*
2201 (Seacliff, Richmond, Presidio, Presidio Heights, Western Addition) 89.9% 4.3%
2202 (Marina, Pacific Heights, Russian Hill, North Beach, Nob Hill, Chinatown) 90.9% 4.6%
2203 (Financial District, Downtown/Civic Center, South of Market, Mission Bay, Mission, Potrero Hill) 81.3% 0.4%
2204 (Bernal Heights, Castro/Upper Market, Noe Valley, Haight Ashbury) 89.2% 2.7%
2205 (Outer Sunset, Parkside, Inner Sunset, Twin Peaks) 92.1% 3.9%
2206 (Parkside, Lakshore, Oceanview, Outer Mission, West of Twin Peaks, Diamond Heights/Glen Park) 90.6% 3.4%
2207 (Bayview, Excelsior, Visitacion Valley, Crocker Amazon) 83.9% 3.2%
* MOE = 90% margin of error

Why Is This An Indicator Of Health and Sustainability?

According to the Institute of Medicine, uninsured children and adults do not receive the care they need. Consequently, they suffer from poorer health and development, and are more likely to die prematurely than those with coverage. Annually, 18,000 premature deaths are attributable to lack of health coverage. A high proportion of uninsured individuals can adversely affect the overall health status of the community, the financial stability of its members, health care institutions and providers, and the access of its residents to certain services, such as emergency departments and trauma centers.a

Interpretation and Geographic Equity Analysis

This indicator shows the percentage of residents with health insurance in San Francisco according to the 2009 American Community Survey.  All ages are included. The map and table present data by Public Use Microdata Areas, or PUMAs. 

According to the 2009 ACS, the eastern/southeastern half of San Francisco has substantially lower rates of health insurance coverage than the western and northern sections of the city.  Specifically, PUMA 2205, which includes Outer Sunset, Parkside, Inner Sunset, and Twin Peaks has the highest average rate of coverage at 92.1%, whereas PUMA 2203, which includes the Financial District, Downtown/Civic Center, South of Market, Mission Bay, Mission, and Potrero Hill has the lowest average rate of coverage at 81.3%.  

According to the 2009 American Community Survey, the citywide average rate of health insurance coverage is 88.3%, which means that 11.7% of the total population is uninsured, or 94,908 individuals.   Due to the availability of the public insurance programs including MediCal, Medicare, Healthy Families, CHIP, etc), children under 18 years old (4.8%) and adults over 65 years old (1.1%) are less likely to be uninsured than those who are 18-64 years old (15.1%).  

By comparison, the 2009 California Health Interview Survey (CHIS) estimates that the citywide average rate of health insurance coverage is 92.1%, which means that 8.9% of the total population is uninsured, or 65,000 individuals (64,000 of whom are under age 65).  According to the 2009 CHIS survey, 62.5% of individuals who have health insurance receive their insurance through their employer (476,000 of 761,000), 7.9% obtain health insurance through privately purchased insurance, and 29.7% obtain health insurance from publicly funded programs including Medicare, MediCal, Healthy Families/CHIP and other public programs.     

In 2007, San Francisco launched a new program to increase access to health care for San Francisco residents ages 18 to 64 called Healthy San Francisco (HSF).  HSF is not an insurance product and access is limited to care provided in the city and county of San Francisco.  Starting in 2008, all covered employers were required to make health care expenditures for their covered employees, either through the purchase of health insurance, contribution to the city’s health access plan (which funds HSF), or contribution to a health care savings account.

For information on employer obligations and the Health Care Security Ordinance, visit: http://www.sfgov.org/site/olse_index.asp?id=45168. For information Healthy San Francisco, visit: http://www.healthysanfrancisco.org/

According to the 2010-2011 Healthy San Francisco Annual report, over 100,000 uninsured residents enrolled into HSF since its inception, or over 12% of the city’s population, and 54,348 uninsured adult residents were enrolled at the end of fiscal year 2010-2011.  The report noted that HSF participants utilize primary care at the same rate as the national Medicaid population (3 office visits per year) and that HSF participants rate of hospital readmission (9%) and rate of emergency department use for avoidable conditions (9%) were half the rate of comparable national and State Medi-Cal averages respectively for adults. 

Methods

In San Francisco, PUMAs are geographically contiguous census tracts that contain a population of 100,000.  PUMAs are used for this indicator because the lowest geographical level that the American Community Survey provides this data is the PUMA. We are unaware of any other data sources that present health insurance rates at the sub-county level.  

For this indicator all members of the civilian non-institutionalized population were included. The Census Bureau defines health insurance coverage to include plans and programs that provide comprehensive health coverage. This includes both private and public plans, like MediCal and MediCare. Plans that provide insurance for specific conditions or situations such as cancer and long-term care policies are not considered coverage. Likewise, other types of insurance like dental, vision, life, and disability insurance are not considered health insurance coverage. People who had no reported health coverage, or those whose only health coverage was Indian Health Service, were considered uninsured.

Limitations

As noted above, in 2009, the majority of insured residents (62.5%) obtained their health insurance from their employer while roughly one in three residents obtained health insurance from public programs.  Since 2009, there have been significant layoffs and budget cuts to public programs which may have impacted the number of people covered through their employer and demand for public program participation.  The 2010 passage of the Patient Protection and Affordable Care Act could result in increased funding for public programs, however the constitutionality of the proposed program is currently being debated in court. 

Improved financial access to medical care is just one component of improved utilization of medical care services. Other factors such as transportation to and from the health facility, cultural competency or cultural humility of health care providers, hours of operation, length of reimbursement, cultural and linguistic competency of administrative and intake staff, availability of child care, employer requirements are among many factors impeding care.

Data Source

Health insurance map and table:  American Community Survey – 1 Year Estimate, 2009.

Health insurance source estimates:  2009 California Health Interview Survey. For additional information, please visit: http://www.chis.ucla.edu/

Map and tables prepared by City and County of San Francisco, Department of Public Health, Environmental Health Section using ArcGIS software.

Map and table data is presented by PUMA.

Detailed information regarding census data, geographic units of analysis, their definitions, and their boundaries can be found at the following links:

Interactive boundaries map

http://sfindicatorproject.org/resources/data_map_method

  1. Institute of Medicine, 2004. Project on the Consequences of Uninsurance: An Overview. http://www.iom.edu/Object.File/Master/17/736/Fact%20sheet%20overview.pdf