1. This research is funded in part through a U.S. Health Resources and Services Administration, State Planning Grant to the Hawaii State Department of Health, Prime Contract No. 1 P09 OA 00046-01. Sub-Contract Research Corporation of the University of Hawaii, Project No. 659075. Research conducted by the University of Hawaii, Social Science Research Institute in collaboration with the Hawaii State Department of Health, Hawaii Institute for Public Affairs/Hawaii Uninsured Project and the Hawaii Health Information Corporation. Summarizing Qualitative Research with the Uninsured in Hawai'i Heather Young Leslie D. William Wood Carol Murry J.D. Baker With: Jill McGrath Jones, Jin Young Choi & Evern Williams University of Hawai`i at Mānoa Hawai`i Coverage for All Project IV Technical Workshop 26 September 2003 Who’s Out There?

2. 26 September 2003 Preliminary results. Please do not quote. Methodology Data Collection: Multiple Researchers, pre-arranged interviews Locally based intermediaries set up interviews Long, semi-structured in-situ “field” interviews, 5 islands: Hawai‘i, Kaua‘i, Maui, Moloka‘i and O’ahu. Digital Audio recorded interviews, Detailed field notes Post interview: summaries, impressions and concerns

3. 26 September 2003 Preliminary results. Please do not quote. Methodology Data Management & Analysis Prioritization system for selective transcription Coding of summaries & transcripts using ATLAS/ti Hermeneutic model building, based on Grounded Theory Identification of key Issues, conceptual Themes and possible recommendations for ensuring “Coverage for All”

4. 26 September 2003 Preliminary results. Please do not quote. Where did we interview?

5. 26 September 2003 Preliminary results. Please do not quote. Who did we talk to? 190 people 96 Men, 94 Women Multi-ethnic Age Range from 18 – 74 18 had ‘some’ military connection 5 Islands, 39 locations 5,098 minutes interview time, median length 35 mins 42 non-recorded interviews Total estimated interview time: 6,554 minutes

6. 26 September 2003 Preliminary results. Please do not quote. What are their lives like? Accommodation Homeless : 9% (17) Temporary Abode: 13% (25) Squatters: 3% (6) Rent or Own Home: 75% (141) Family 35% (67) people were responsible for 149 dependents. 65% (123) had no dependents

7. 26 September 2003 Preliminary results. Please do not quote. What are their lives like? Occupation (n=190) Working at all: 53% (100) Self-employed: 22% (41) Multiple Jobs: 13% (24) Under-employed: 26.5% (26) Retired & working: 2.6% (5) Retired & not working: 7.9% (15) Student: 4% (8)

8. 26 September 2003 Preliminary results. Please do not quote. What are their lives like? Morbidity Substance Abuse: 17.4% (33) Disability or Chronic Condition: 35% (67) Of 190 people, 100 suffered some condition that made it difficult to work, and that meant their social needs overlapped with their medical system needs

9. 26 September 2003 Preliminary results. Please do not quote. Results 185+ codes (so far) in the interview data. At the end of the data collection & analysis process, key issues & themes previously reported are confirmed. The following are some of the more compelling & resonant themes & issues

10. 26 September 2003 Preliminary results. Please do not quote. Results: Key Themes Stoicism & Self-Recrimination Gambling on Health & Ostriching, Paid for Naught Quest = Burden & Bureaucracy = Confusion Can’t Pay, Can’t Comply Coverage Means Confidence Self-Medication & Auto-Dentistry Inalienable Right & State Responsibility

11. 26 September 2003 Preliminary results. Please do not quote. Results: Key issues Affordability Alienation Accessibility Equity Preconditions & Pay-downs Social Safety Net State Responsibility

12. 26 September 2003 Preliminary results. Please do not quote. Results Ideals of Health Insurance Coverage: Emergency & catastrophic coverage, with no lifetime cut-offs or preconditions Public health, mental health & preventative medicine (rural areas especially) Dental (Not just extractions) Drugs (including prophylactic & harm- reduction,) Culturally competent & flexible

13. 26 September 2003 Preliminary results. Please do not quote. Some Next Targets Information about coverage & eligibility to be more accessible & flexible, less bureaucratic, with multi-lingual, ongoing & creative outreach Disability ‘spend downs’ & precondition problems Dental, mental & rural area access Premium costs closer to other household utilities, sliding scale premiums, rewards & grace periods for low-users who become unemployed Coverage for under-employed, exempted categories and multiple-job workers

14. 26 September 2003 Preliminary results. Please do not quote. After all the talk… The greatest costs of living in Hawai’i are housing, education, transport and health benefits. In the normal day-to-day life, health insurance is less immediately a need. Thus while needed and desired, pragmatic consumers prioritize health premiums last in tight economic conditions. Cost of premiums and lack of clear information were clearly major deterrents for the 190 people we spoke with. Any unmitigated premium increases will likely result in more uninsured in Hawai’i