A majority of Iowans enrolled by the state health insurance program IowaCare say they have significant or chronic health issues, according to a survey done by the University of Iowa's Public Policy Center.

The survey results show that more than 60 percent of respondents report three or more chronic physical health problems, while 40 percent rated their own health as fair or poor. Also, one-third of respondents reported fair-to-poor mental and/or emotional health. Dental health was rated fair or poor by 61 percent of the IowaCare enrollees surveyed.

The findings come as the IowaCare program expires at the end of this year, replaced by the Iowa Health and Wellness Plan, which will provide broader insurance coverage to roughly 150,000 poor Iowans. About 70,000 people are covered through IowaCare.

Patients with significant and chronic health concerns often require coordinated care from a variety of care providers. The IowaCare program assigns enrollees to one of five different primary-care based medical homes, based on county of residence.

Overall, respondents reported continuity of care at their assigned medical home, and expressed satisfaction with their care and communication from care providers, but level of satisfaction varied in each region. Enrollees reported dissatisfaction in regard to access to health care after regular office hours, receiving timely feedback about care and follow-up appointments, and support for self-management of their illness. Lack of access to after-hours care resulted in many visits to hospital emergency rooms that should otherwise have taken place at a clinic or doctor’s office.

Finally, almost half of IowaCare enrollees who responded to the survey reported unmet needs in prescription medications and dental and mental health care. Less than one half had had a preventive care visit in the previous six months, yet only one in five reported an unmet need for such care. The Iowa Health and Wellness Plan incentives of premium waivers for prevention and wellness activities may encourage this population to more regularly pursue preventive care or wellness activities.

With IowaCare enrollees making up a significant portion of the population to be covered by the Iowa Health and Wellness Plan to be enacted on Jan. 1, 2014, the results of this survey can help with adjusting for the new plan, specifically in the areas of dental care, mental health care, and prescription medication support, according to Peter Damiano, director of the Public Policy Center and lead author of the survey. It is also important to address issues regarding access to timely care, and assess the capacity of medical home sites to manage increases in patient encounters, Damiano adds.

Other authors on the study, all from the Public Policy Center, are Suzanne Bentler, Elizabeth Momany, Ki Park, and Erin Robinson.