Abstract
ObjectiveThis study applied the vulnerability framework and examined the combined effect of race and income on health insurance coverage in the US.Data sourceThe household component of the US Medical Expenditure Panel Survey (MEPS-HC) of 2017 was used for the study.Study designLogistic regression models were used to estimate the associations between insurance coverage status and vulnerability measure, comparing insured with uninsured or insured for part of the year, insured for part of the year only, and uninsured only, respectively.Data collection/extraction methodsWe constructed a vulnerability measure that reflects the convergence of predisposing (race/ethnicity), enabling (income), and need (self-perceived health status) attributes of risk.Principal findingsWhile income was a significant predictor of health insurance coverage (a difference of 6.1–7.2% between high- and low-income Americans), race/ethnicity was independently associated with lack of insurance. The combined effect of income and race on insurance coverage was devastating as low-income minorities with bad health had 68% less odds of being insured than high-income Whites with good health.ConclusionResults of the study could assist policymakers in targeting limited resources on subpopulations likely most in need of assistance for insurance coverage. Policymakers should target insurance coverage for the most vulnerable subpopulation, i.e., those who have low income and poor health as well as are racial/ethnic minorities.
Highlights
It is well-known that in the United States there are significant racial and income disparities in health insurance coverage
Compared with previous studies using the vulnerability concept to evaluate the quality of primary care experienced by health center patients [11,12,13], our study provided additional contribution to the literature by advancing the knowledge of the combined effect of race and income on health insurance coverage which could assist policymakers in targeting limited resources on subpopulations likely most in need of assistance for insurance coverage
Data Data for this analysis came from the Household Component (HC) of the 2017 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the civilian noninstitutionalized population of the United States, that was publicly available for download
Summary
It is well-known that in the United States there are significant racial and income disparities in health insurance coverage. Lee et al International Journal for Equity in Health (2021) 20:96 income was associated with lower health insurance coverage rate [1, 3, 4]. People in households with an annual income of $150,000 or more had a higher percentage of insurance coverage (96.8%) than people in households with income of less than $25,000 (86.2%). Another method to assess income level is income-to-poverty ratio. People in higher income-to-poverty ratio groups had higher health insurance coverage rates in general. People living at or above 400% of poverty had higher coverage (96.6%) than people living below 100% of poverty (83.7%)
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