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PubMed1988

Reverse targeting of preventive care due to lack of health insurance.

We analyzed patterns of receipt of preventive services among middle-aged women, with particular attention to health insurance coverage, based on data from the National Health Interview Survey. Lack of insurance was most prevalent among socioeconomically disadvantaged women at high risk for disease and was the strongest predictor of failure to receive screening tests. The relative risk of inadequate screening for uninsured compared with insured women was 1.60 (95% confidence interval [Cl], 1.40 to 1.83) for blood pressure checkups, 1.55 (95% Cl, 1.43 to 1.68) for cervical smears, 1.52 (95% Cl, 1.41 to 1.63) for glaucoma testing, and 1.42 (95% Cl, 1.33 to 1.51) for clinical breast examination. Controlling for demographic and health status variables did not diminish the effect of insurance coverage. We conclude that inadequate insurance coverage leads to "reverse targeting" of preventive care--that is, populations at highest risk are least likely to be screened. This compromises both the effectiveness and the cost-effectiveness of screening.

Black or African American↗

PubMed1986

The health insurance plight of patients with sickle cell disease.

Despite chronic illness that requires routine medical follow-up as well as occasional acute care and hospitalizations, many persons with sickle cell disease (SCD) are not getting the care that they need. The primary reason for lack of proper care is due to the patients' lack of health insurance coverage. This paper will examine the problem of health insurance coverage among persons with chronic illnesses using SCD as a model. It is speculated by the author that persons who suffer from other chronic illnesses may also experience similar problems in obtaining health coverage. Supporting data for this report are derived from a survey on the health insurance status of a randomly selected group of SCD patients treated at the Howard University Center for Sickle Cell Disease. This survey revealed that 20 percent of 70 adult and pediatric patient respondents had no form of health insurance coverage.

Adolescent↗

PubMedDate not supplied

Parental employment, family structure, and child's health insurance.

OBJECTIVE: To examine the impact of family structure on the relationship between parental employment characteristics and employer-sponsored health insurance coverage among children with employed parents in the United States. METHODS: National Health Interview Survey data for 1993-1995 was used to estimate proportions of children without employer-sponsored health insurance, by family structure, separately according to maternal and paternal employment characteristics. In addition, relative odds of being without employer-sponsored insurance were estimated, controlling for family structure and child's age, race, and poverty status. RESULTS: Children with 2 employed parents were more likely to have employer-sponsored health insurance coverage than children with 1 employed parent, even among children in 2-parent families. However, among children with employed parents, the percentage with employer-sponsored health insurance coverage varied widely, depending on the hours worked, employment sector, occupation, industry, and firm size. CONCLUSIONS: Employer-sponsored health insurance coverage for children is extremely variable, depending on employment characteristics and marital status of the parents.

Child↗

PubMed1997

Health insurance reform legislation.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA), enacted on August 21, 1996 (Public Law 104-19), provides for improved access and renewability with respect to employment-related group health plans, to health insurance coverage sold in connection with group plans, and to the individual market (by amending the Public Health Service Act). The Act's provisions include improvements in portability and continuity of health insurance coverage; combatting waste, fraud, and abuse in health insurance and health care delivery; promoting the use of medical savings accounts; improving access to long-term care services and insurance coverage; administrative simplification; and addressing duplication and coordination of Medicare benefits.

Career Mobility↗

PubMed2006

Access to health care after welfare reform.

This research uses data from a longitudinal statewide study of Oregon families leaving Temporary Assistance to Needy Families (TANF) to identify: 1) the trends in insurance coverage over time; 2) the role of health insurance coverage in predicting whether respondents received needed medical care; and 3) the relationship between access to care and physical and mental health. Data were obtained from 637 families seven months after leaving welfare for work; 552 of these families were re-interviewed one year later. The data reveal that 40% of TANF leavers were uninsured at wave 2 and suggest that significant access barriers exist, which may be associated with poor health outcomes.

Adult↗

PubMed1997

Children at risk: their health insurance status by state.

OBJECTIVE: To inform policymakers and child health advocates about children's health insurance coverage in each state as Congress debates proposals to restructure the Medicaid program amidst declining employer-based dependent health insurance coverage. METHODS: Multiple years of data from the March supplement of the Current Population Surveys were pooled to yield more reliable estimates of changes in children's health insurance coverage in each state from 1987 to 1993. RESULTS: Overall, the number of uninsured children grew by nearly 1 million between 1987 and 1993. The proportion of infants and children <7 years old without health insurance declined; the proportion of uninsured children between the ages of 7 and 22 increased. Between 1987-1990 and 1991-1993, six states experienced a significant increase in the number of uninsured children, only two states experienced a significant decrease in the number of uninsured children, although no progress was found in reducing the number of uninsured children in 43 states. Between 1987-1990 and 1991-1993, the proportion of children covered by employer-based private insurance decreased significantly in three-fourths of the states and the proportion of children with Medicaid coverage increased significantly in four-fifths of the states. CONCLUSIONS: In a period of fast-declining employer-based health insurance coverage for dependents, Medicaid expansions have worked to moderate the surge in the number of children without health insurance. Of the 30 million children without private health insurance in 1993, nearly 18 million were insured by Medicaid. As policymakers debate the future of the Medicaid program, they must consider seriously its role as the country's largest insurer of children's health and its efficacy as a vital safety net for the nation's children.

Adolescent↗

PubMed1999

Premium subsidies for health insurance: excessive coverage vs. adverse selection.

The tax subsidy for employment-related health insurance can lead to excessive coverage and excessive spending on medical care. Yet, the potential also exists for adverse selection to result in the opposite problem-insufficient coverage and underconsumption of medical care. This paper uses the model of Rothschild and Stiglitz (R-S) to show that a simple linear premium subsidy can correct market failure due to adverse selection. The optimal linear subsidy balances welfare losses from excessive coverage against welfare gains from reduced adverse selection. Indeed, a capped premium subsidy may mitigate adverse selection without creating incentives for excessive coverage.

Fees and Charges↗

PubMed2002

Employer offers, private coverage, and the tax subsidy for health insurance: 1987 and 1996.

Economists have long been interested in the effect of tax-based subsidies on private health insurance coverage. We examine this relationship using pooled data from the 1987 National Medical Expenditure Survey and the 1996 Medical Expenditure Panel Survey. Our main tax price elasticity estimates for employer offers and for private coverage are near the mid-point of the existing literature. However, these estimates may mask substantial differences in tax-price responsiveness across subsets of workers. Our more disaggregated analysis reveals tax price responsiveness to be significantly above average for low-income workers, workers with low health risks, and workers in small firms--precisely those groups whose continued participation in employment-related risk pooling is of greatest policy concern. In addition, we present family-level elasticities that allow for joint decision-making in two-worker families.

Adult↗

PubMed1997

Demographic profile of health-care coverage in America in 1993.

This study examined the distribution of health-care insurance coverage by race/ethnicity using data on gender, age, income, and education to identify segments of the population with and without health-care insurance in 1993. Among all groups, whites were more likely to have health-care insurance coverage than blacks or Hispanics. The data also were cross-classified by type of insurance coverage, including private, Medicare, and Medicaid. Whites were more likely than minorities to have private coverage, whereas minorities, socially disadvantaged persons in all groups, and the elderly were more likely to be covered by Medicare and Medicaid.

Adolescent↗

PubMedDate not supplied

Annual report on access to and utilization of health care for children and youth in the United States--2000.

OBJECTIVE: This report provides an update on insurance coverage, use of health care services, and health expenditures for children and youth in the United States. In addition, the report provides information on variation in hospitalizations for children from a new 22-state hospital discharge data source. METHODS: The data on insurance coverage, utilization, and expenditures come from the Medical Expenditure Panel Survey. The data on hospitalizations come from the Database for Pediatric Studies, which is part of the Healthcare Cost and Utilization Project. Both data sets have been prepared by the Agency for Healthcare Research and Quality. RESULTS: Few changes in insurance coverage occurred between 1996 and 1998. About two thirds of American children are covered by private insurance and 19% by public sources; the remaining 15% are uninsured. Of the 71.5% of children who have at least 1 doctor's office visit, the average number of visits was 3.9, but this ranged from 2.7 among the uninsured to 4.2 for those with private insurance. Slightly more than half of children had a prescription, and these averaged 5.4 prescriptions. The majority of children (85%) incur medical expenditures, averaging $1019 for children with any expenditure. Private health insurance was by far the largest payer of medical care expenses for children, even more so than among the general population. However, nearly 21% of expenditures for children's health care were paid out of pocket by children's families. The data also show substantial differences in average length of hospitalization across states, ranging from 2.7 to 4.0 days, and rates of hospital admission through the emergency department, which vary across states from 9% to 23%. Injuries are a major reason for hospitalization, accounting for 1 in 6 hospital stays among 10- to 14-year-olds. In the 10-17 age group, 1 in 7 hospital stays are due to mental disorders. Among 15- to 17-year-olds, more than one third of all hospital stays are related to childbirth and pregnancy. CONCLUSION: Children's use of health care services varies considerably by what type of health insurance coverage they have. Expenditures for children entail a substantial out-of-pocket component, which may be quite large for children with major health problems and which may represent a significant burden on lower-income families. Substantial variation in hospitalization exits across states.

Adolescent↗

PubMed2002

Exploring prescription drug coverage and drug use for older americans.

OBJECTIVE: To describe existing prescription drug insurance coverage for older Americans, to describe out-of-pocket payment levels per prescription associated with service benefit prescription drug plans used by older persons, and to examine the association of prescription drug coverage types with the reported use of prescription drugs by older persons. PATIENTS AND METHODS: Data were obtained from a national survey of 1570 community-dwelling older persons (>65 y) conducted in June 1998. A 2-part utilization model was estimated using logistic regression and ordinary least-squares regression. RESULTS: Data from 310 respondents were used for analysis. Overall, 66.1% of respondents reported having prescription drug insurance coverage. A majority (76.6%) of respondents having private drug coverage reported having a service benefit plan (requiring copayment or coinsurance amount to be paid for each prescription). The median copayment per brand name and generic prescription for persons reporting having coverage by service benefit plans was $10 and $5, respectively. CONCLUSIONS: Overall, a majority of older persons reported paying relatively small amounts out-of-pocket per prescription during 1998. Among persons who reported having drug insurance coverage, there were no statistically significant differences in the reported number of drugs used daily, regardless of out-of-pocket payment amount per prescription. Patient need and level of past drug use were significantly associated with both the likelihood of using any prescription drugs and the level of use among users. More research is needed to examine differences in drug expenditures and characteristics of drugs used across prescription drug insurance types for older persons.

Aged↗

PubMed1998

Insurance status among HIV+ Nebraskans.

OBJECTIVES: (1) To measure the rates of insurance in a population of HIV+ status. (2) To test an hypothesis that persons with AIDS are more likely to be uninsured than those who are HIV+ without AIDS. (3) To test the hypothesis that persons who are HIV+ experience difficulties maintaining their health insurance. METHODS: Clients of three service agencies were surveyed. Demographic information was used to eliminate duplicate responses. Of the potential 480 respondents, 238 returned the surveys, reflecting approximately 10% of the estimated number of HIV+ persons in Nebraska. Descriptive techniques were used to analyze the data, and chi-square techniques were used in group comparisons. RESULTS: Forty-three percent of the respondents were covered by private insurance, and 22% lacked any health insurance coverage. Persons with AIDS were less likely to have private insurance coverage and more likely to be receiving Medicaid coverage, but less likely to be uninsured. HIV+ test results contributed to a loss of insurance for 25 respondents, and HIV or AIDS positive was a reason for 29 respondents being denied insurance.

Chi-Square Distribution↗

PubMed2004

Summary health statistics for the U.S. population: National Health Interview Survey, 2002.

OBJECTIVES: This report presents both age-adjusted and unadjusted health statistics from the 2002 National Health Interview Survey (NHIS) for the civilian noninstitutionalized population of the United States, classified by age, sex, race and Hispanic or Latino origin, family income, poverty status, education, place of residence, region of residence, and, where appropriate, health insurance coverage. The topics covered are health status and limitations in activities, special education or early intervention services, injuries and poisonings, health care access and utilization, and health insurance coverage. SOURCE OF DATA: The NHIS is a household, multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics. In 2002, household interviews were completed for 93,386 persons living in 36,161 households, reflecting a household response rate of 89.6%. SELECTED HIGHLIGHTS: Nearly 7 in 10 persons were in excellent or very good health in 2002. About 34 million persons (12%) were limited in their usual activities due to one or more chronic health conditions, and about 4 million persons (2%) required the help of another person with activities of daily living. About 6% of children received special education or early intervention services. Among persons under age 65 years, about 40 million (17%) did not have any health insurance coverage. The most common reason for lacking health insurance was cost, followed by a change in employment.

Activities of Daily Living↗

PubMed2005

Summary health statistics for the U.S. population: National Health Interview Survey, 2003.

OBJECTIVES: This report presents both age-adjusted and unadjusted health statistics from the 2003 National Health Interview Survey (NHIS) for the civilian noninstitutionalized population of the United States, classified by age, sex, race and Hispanic or Latino origin, family income, poverty status, education, place of residence, region of residence, and where appropriate, health insurance coverage. The topics covered are health status and limitations in activities, special education or early intervention services, injuries and poisonings, health care access and utilization, and health insurance coverage. SOURCE OF DATA: The NHIS is a household, multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics. In 2003, household interviews were completed for 92,148 persons living in 35,921 households, reflecting a household response rate of 89.2%. SELECTED HIGHLIGHTS: Nearly 7 in 10 persons were in excellent or very good health in 2003. About 34 million persons (12%) were limited in their usual activities due to one or more chronic health conditions, and about 4 million persons (2%) required the help of another person with activities of daily living. About 6% of children received special education or early intervention services. Among persons under age 65 years, about 41 million (17%) did not have any health insurance coverage. The most common reason for lacking health insurance was cost, followed by a change in employment.

Activities of Daily Living↗

PubMed2002

Summary health statistics for the U.S. population: National Health Interview Survey, 1998.

OBJECTIVES: This report presents health statistics from the 1998 National Health Interview Survey (NHIS) for the civilian, noninstitutionalized population of the United States, classified by age, sex, race and Hispanic origin, poverty status, family income, education, place of residence, region of residence, and, where appropriate, health insurance coverage. The topics covered are health status and limitations of activity, injuries and poisonings, health care access and utilization, and health insurance coverage. SOURCE OF DATA: The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics, Centers for Disease Control and Prevention, and is representative of the civilian noninstitutionalized U.S. population. Data are collected during face-to-face interviews with adults present at the time of interview. Information about children and absent adults is obtained from an adult proxy respondent. HIGHLIGHTS: Nearly 40% of Americans reported having excellent health in 1998, while almost 9% reported having either fair or poor health. Fifteen percent of the U.S. population did not have any health insurance coverage in 1998. Nineteen percent of non-Hispanic black persons and 33% of Hispanics were uninsured in 1998, as opposed to 11% of non-Hispanic white persons. Further, 46% of poor Hispanics and 44% of near-poor Hispanics under age 65 years were uninsured; percents of uninsurance among poor and near poor non-Hispanic white and black persons under age 65 years were much lower. Lastly, 80% of non-Hispanic white persons under age 65 years had private health insurance coverage, as opposed to 55% of non-Hispanic black persons and 49% of Hispanics in this same age category.

Activities of Daily Living↗

PubMed2003

Summary health statistics for the U.S. population: National Health Interview Survey, 1999.

OBJECTIVES: This report presents health statistics from the 1999 National Health Interview Survey (NHIS) for the civilian noninstitutionalized population of the United States, classified by age, sex, race and Hispanic origin, poverty status, family income, education, place of residence, region of residence, and, where appropriate, health insurance coverage. The topics covered are health status and limitations of activity, injuries and poisonings, health care access and utilization, and health insurance coverage. SOURCE OF DATA: The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC), and is representative of the civilian noninstitutionalized U.S. population. Data are collected during face-to-face interviews with adults present at the time of interview. Information about children and absent adults is obtained from an adult proxy respondent. SELECTED HIGHLIGHTS: Nearly 40% of Americans reported having excellent health in 1999, while almost 9% reported having either fair or poor health. Fourteen percent of the U.S. population did not have any health insurance coverage in 1999. Eighteen percent of single race non-Hispanic black persons and 32% of Hispanics were uninsured in 1999, compared with 11% of single race non-Hispanic white persons. Further, 47% of poor Hispanics and 43% of near poor Hispanics under age 65 years were uninsured; percents of uninsurance among poor and near poor single race non-Hispanic white and black persons under age 65 years were much lower. Eighty percent of single race non-Hispanic white persons under age 65 years had private health insurance coverage, compared with 57% of single race non-Hispanic blacks and 49% of Hispanics in this same age category.

Absenteeism↗

PubMed1991

A determination of institutional and patient factors affecting uncompensated hospital care.

For this study, a sample of 985 patients classified as "charity" and "bad debt" cases in 1986 were identified from 28 Indiana hospitals. In a multiple regression model, insurance coverage, total hospital charge, pregnancy-related diagnoses, marital status, employment status, discharge status, urban location, and total hospital revenue were significant factors in predicting unpaid hospital bills, when controlling other demographic characteristics. Sixty percent had some form of insurance and were responsible for 40 percent of the uncompensated amount, justifying the need to examine the adequacy of patient insurance coverage. However, providing insurance coverage will not entirely eliminate the problem of uncompensated care; hospitals also need to increase collection efforts for all unpaid bills.

Adult↗

PubMedDate not supplied

Breast cancer treatment choice and mastectomy length of stay: a comparison of HMO and other privately insured women.

This study uses hospital discharge abstract data from five states (Massachusetts, New York, New Jersey, Maryland, and California) for two years (1988 and 1991) to investigate whether enrollment in an HMO affects nonelderly breast cancer patients' treatment choice (breast-conserving surgery or mastectomy) and hospital length of stay for women who have a mastectomy. Since HMO insurance creates financial incentives that differ from other types of insurance coverage, it is important to assess whether the type of insurance coverage affects the care received by breast cancer patients. Although the results vary from state to state, they suggest that HMO enrollees are less likely to receive breast-conserving surgery (relative odds =.93). However, an unambiguous interpretation of this findings requires better data on patients' opportunity costs and preferences, which also may vary with type of insurance coverage. Among women who had a mastectomy, HMO enrollment was generally associated with a 4.5% shorter average length of stay and a greater likelihood of a short stay (one or two days, relative odds = 1.21-1.29). A much higher proportion of mastectomy patients in California than in other states had a short stay. Follow-up of these women may indicate whether short stays lead to adverse long-term health effects.

Adult↗