Health Insurance Coverage Rates Research Articles

O06.5 An Exploratory Evaluation of Universal Opt-Out Chlamydia Testing During Clinical Encounters For Young Women in the United States

BackgroundChlamydia testing rates are low, with only about a third of sexually active young women tested at clinical encounters. Even fewer sexually active female adolescents are tested. Interventions to increase...

The Determinants of Rising Inequality in Health Insurance and Wages: An Equilibrium Model of Workers' Compensation and Health Care Policies

Over the last 30 years in the U.S., less educated workers have experienced a sharp decline in health insurance coverage rate and stagnant wage growth. In contrast, more educated workers' health insurance coverage rate has stayed relatively stable and their wages have rapidly grown. This paper investigates the determinants of the increase in inequality in health insurance coverage and wages by estimating an overlapping generations equilibrium model of labor and health insurance markets' demand and supply. The estimated model is used to quantify the effects of changes in aggregate factors (including rising cost of medical care services, Medicaid eligibility expansion, skill-biased technological changes in the labor market, and changes in the labor force composition) on the inequality of health insurance coverage and wages. I find that the interaction between the rising cost of medical services and labor market technological change is the most important determinant of the widening gap of health insurance coverage.

Uninsurance and its Correlates among Poor Adults with Disabilities

States must offer Medicaid coverage to low-income adults with disabilities; however, they have discretion in the design of eligibility criteria and enrollment processes. Using the American Community Survey, we examined the health insurance status of adults enrolled in the Supplemental Security Income (SSI) disability program including (1) the national rate of health insurance coverage; (2) state rates of uninsurance and Medicaid; and (3) the correlates of uninsurance. Uninsurance and Medicaid rates varied across states from 1% to 12% and from 63% to 91%, respectively. Nationally, 5% of the SSI population was uninsured; 77% was enrolled in Medicaid. Limited English proficiency, Black race, lack of U.S. citizenship, and residence in a state that used an enrollment process and/or eligibility criteria distinct from the SSI program were associated with uninsurance. As states streamline Medicaid enrollment processes to meet requirements of the Affordable Care Act, they should consider the needs of this vulnerable population.

Characteristics of Adult Psychiatric Patients With Stays of 24 Hours or More in the Emergency Department

This study identified characteristics of adult psychiatric patients who remained for 24 or more hours in the emergency departments of general hospitals in Massachusetts. Data were collected starting in June 2008 on a prospective cohort of 1,076 patients who presented for emergency psychiatric evaluation at one of five hospitals. A total of 90 patients (8%) stayed 24 or more hours (median=31 hours). More than 90% (N=1,018) of all patients had health insurance. Characteristics associated with extended stays included homelessness, transfer to another hospital, public insurance, and use of restraints or sitters (p<.05). The two academic medical centers had higher proportions of extended-stay patients than the three community hospitals (12% and 15% versus 1%, 7%, and 7%, respectively; p<.001). Despite overall high rates of health insurance coverage, publicly insured patients waited longer than those with private insurance. Future reforms of Massachusetts' mandatory health insurance program should consider treatment capacity as well.

Declines in Employer‐Sponsored Insurance between 2000 and 2008: Examining the Components of Coverage by Firm Size

To examine trends in employer-sponsored health insurance coverage rates and its associated components between 2000 and 2008, to provide a baseline for later evaluations of the Affordable Care Act, and to provide information to policy makers as they design the implementation details of the law. Private sector employer data from the 2000, 2001, and 2008 Medical Expenditure Panel Survey-Insurance Component (MEPS-IC). We examine time trends in employer offer, eligibility, and take-up rates. We add a new dimension to the literature by examining dependent coverage and decomposing its trends. We investigate heterogeneity in trends by firm size. The MEPS-IC is an annual survey, sponsored by the Agency for Healthcare Research and Quality and conducted by the U.S. Census Bureau. The MEPS-IC obtains information on establishment characteristics, whether an establishment offers health insurance, and details on up to four plans. We find that coverage rates for workers declined in both small and large firms. In small firms, coverage declined due to a drop in both offer and take-up rates. In the largest firms, offer rates were stable and the decline was due to falling take-up rates. In addition, enrollment shifted toward single coverage and away from dependent coverage in both small and large firms. For small firms, this shift was due to declining offer and take-up rates for dependent coverage. In large firms, offers of dependent coverage were stable but take-up rates dropped. Within the category of dependent coverage, the availability of employee-plus-one plans increased in all firm size categories, but take-up rates for these plans declined in small firms.

Health Insurance Coverage Rates In 9 Provinces In China Doubled From 1997 To 2006, With A Dramatic Rural Upswing

We examined the distribution of health insurance in China during 1997-2006, a period when government interventions were implemented to improve access to health care. We analyzed data from a survey that follows households in nine provinces that are home to more than 40 percent of China's population. The analysis shows that the percentage of individuals with insurance increased from 24 percent in 1997 to 28 percent in 2004 and then rose dramatically, to 49 percent in 2006. Rural and urban levels of insurance coverage became more similar, reflecting a dramatic upswing in coverage in rural areas that is likely to have benefited millions of rural Chinese. At the same time, the analysis suggests that health insurance reimbursement rates to consumers for inpatient care might have declined in rural villages. Because reimbursement and other insurance characteristics affect health care use, future efforts to reduce rural-urban disparities should address the quality of health insurance and the level of reimbursement in addition to coverage rates.

The Effect of Triple Helix System and Habitat on Regional Entrepreneurship: Empirical Evidence from the U.S.

The ‘triple helix’ of the university–industry–government relationship and habitat are accepted as important determinants of innovation and entrepreneurship. However, empirical explorations of the effects of these variables and their interrelationships on regional entrepreneurial activities are highly limited. To fill this gap, we investigate the effect of the triple helix system and habitat on birth and death rates of U.S. firms at the state level. As expected, we find that industrial R&D expenditure plays an important role in promoting regional firm birth. However, university and government R&D also generate a synergistic effect that indirectly influences regional firm birth rates. In addition, we find that the synergy between university and industrial R&D enhances the sustainability of firms, while the interactions between (1) university and government R&D and (2) government and industrial R&D are associated with an increase in firm death. Other factors linked to more favorable conditions for firm formation include higher educational attainment in a region, lower tax rate, and habitat factors affecting quality of life, such as lower housing prices and higher rates of health insurance coverage. In regions with high entrepreneurial activity, we find positive synergistic effects of the interactions between (1) university and government R&D and (2) university and industrial R&D on firm birth rate, suggesting that university R&D plays an important role as an ‘entrepreneurial mediator’ among the three spheres in the triple helix system. In low entrepreneurial regions, the only triple helix system factors significantly influencing firm birth rate were tax rate. This finding suggests that the independent and interdependent components of the triple helix system and habitat are less powerful in low entrepreneurial regions.

Where Would You Rather Live If You Were Insured? Assessing Community Uninsurance Spillover Effects on the Insured

This study sought to understand the cost, quality of, and access to health care for the insured population in the context of spillover effects resulting from community-level uninsurance. We examined the health care access, quality, and cost experienced by insured Latina mothers in two communities, Minneapolis, Minnesota and McAllen, Texas. These communities differ substantially by the size of the local population without health insurance coverage. Four focus groups were conducted with insured Latina mothers who were caring for at least one child in their household. Eleven and thirteen mothers participated in each community, respectively. The experiences of the insured population in McAllen were substantially different from the experiences of the insured population in Minneapolis. The perceptions of health care quality and access by insured Latina mothers were substantially lower in McAllen while out-of-pocket costs were perceived to be higher in Minneapolis. Our study provides key insights about the US health care system and the role that the relative size of the local uninsured population may have in impacting the health care experiences of the insured. Health insurance coverage rates are expected to increase substantially across US communities within the next few years but local health care system challenges related to cost, quality, and access will remain for both the insured and the uninsured.

The effect of the triple helix system and habitat on regional entrepreneurship: Empirical evidence from the U.S.

The ‘triple helix’ of the university–industry–government relationship and habitat are accepted as important determinants of innovation and entrepreneurship. However, empirical explorations of the effects of these variables and their interrelationships on regional entrepreneurial activities are highly limited. To fill this gap, we investigate the effect of the triple helix system and habitat on birth and death rates of U.S. firms at the state level. As expected, we find that industrial R&D expenditure plays an important role in promoting regional firm birth. However, university and government R&D also generate a synergistic effect that indirectly influences regional firm birth rates. In addition, we find that the synergy between university and industrial R&D enhances the sustainability of firms, while the interactions between (1) university and government R&D and (2) government and industrial R&D are associated with an increase in firm death. Other factors linked to more favorable conditions for firm formation include higher educational attainment in a region, lower tax rate, and habitat factors affecting quality of life, such as lower housing prices and higher rates of health insurance coverage. In regions with high entrepreneurial activity, we find positive synergistic effects of the interactions between (1) university and government R&D and (2) university and industrial R&D on firm birth rate, suggesting that university R&D plays an important role as an ‘entrepreneurial mediator’ among the three spheres in the triple helix system. In low entrepreneurial regions, the only triple helix system factors significantly influencing firm birth rate were tax rate. This finding suggests that the independent and interdependent components of the triple helix system and habitat are less powerful in low entrepreneurial regions.

Coverage, Utilization, and Health Outcomes of the State Children's Health Insurance Program

This paper uses data from the National Survey of America's Families (1997-2002) to explore the links between eligibility for the State Children's Health Insurance Program (SCHIP), health insurance coverage, medical care utilization, and health outcomes. We find that SCHIP significantly increased health insurance coverage rates for American children between 1997 and 2002, with most of the gains in coverage for older children. Higher coverage rates translated into increased utilization of the types of medical care that would be expected to improve children's health, such as well-child doctor visits. The effects of SCHIP eligibility expansions on health outcomes, however, are relatively small.

The Impact of Tort Reform on Private Health Insurance Coverage, February 2010

This study evaluates tort reform’s impact on private health insurance coverage. Tort reform may reduce costly damage awards and defensive medicine. On the other hand, tort reform may increase health care costs by reducing doctors’ caretaking or increasing questionable treatments. Reducing health care costs should increase health insurance coverage rates, while cost increases should decrease coverage rates. We find that between 1981 and 2007 damage caps, collateral source reform, and joint-and-several liability reform increased health insurance coverage among price-sensitive groups between one-half and one percentage points each. We conclude that tort reform reduces health care costs, at least for price-sensitive groups.

Heterogeneity in Health Insurance Coverage Among US Latino Adults

ObjectiveWe sought to determine the differences in observed and unobserved factors affecting rates of health insurance coverage between US Latino adults and US Latino adults of Mexican ancestry. Our hypothesis was that Latinos of Mexican ancestry have worse health insurance coverage than their non-Mexican Latino counterparts.MethodsThe National Health Interview Survey (NHIS) database from 1999–2007 consists of 33,847 Latinos. We compared Latinos of Mexican ancestry to non-Mexican Latinos in the initial descriptive analysis of health insurance coverage. Disparities in health insurance coverage across Latino categories were later analyzed in a multivariable logistic regression framework, which adjusts for confounding variables. The Blinder-Oaxaca technique was applied to parse out differences in health insurance coverage into observed and unobserved components.ResultsUS Latinos of Mexican ancestry consistently had lower rates of health insurance coverage than did US non-Mexican Latinos. Approximately 65% of these disparities can be attributed to differences in observed characteristics of the Mexican ancestry population in the US (e.g., age, sex, income, employment status, education, citizenship, language and health condition). The remaining disparities may be attributed to unobserved heterogeneity that may include unobserved employment-related information (e.g., type of employment and firm size) and behavioral and idiosyncratic factors (e.g., risk aversion and cultural differences).ConclusionsThis study confirmed that Latinos of Mexican ancestry were less likely to have health insurance than were non-Mexican Latinos. Moreover, while differences in observed socioeconomic and demographic factors accounted for most of these disparities, the share of unobserved heterogeneity accounted for 35% of these differences.

Effects of Health Insurance on Perceived Quality of Care Among Latinos in the United States

ABSTRACTBACKGROUNDThere is suggestive evidence that lower rates of health insurance coverage increases the gaps in quality and access to care among Latinos as compared with non-Latino whites. In order to examine these potential disparities, we assessed the effects of insurance coverage and multiple covariates on perceived quality of care.OBJECTIVETo assess the distribution of perceived quality of care received in a national Latino population sample, and the role of insurance in different patient subgroups.DESIGNTelephone interviews conducted between 2007 and 2008 using the Pew Hispanic Center/Robert Wood Johnson Foundation Latino Health Surveys (Waves 1 and 2).PARTICIPANTSRandomly selected Latino adults aged ≥18 years living in the United States.MEASUREMENTSPearson χ2 tests identified associations among various demographic variables by quality of care ratings (poor, fair, good, excellent) for the insured and uninsured (Wave 1: N = 3545). Subgroup analyses were conducted among Wave 2 participants reporting chronic conditions (N = 1067). Bivariate and multivariate analyses were conducted to estimate the effects of insurance, demographic variables and consumer characteristics on quality of care.RESULTSInsurance availability had an odds ratio of 1.47 (95% CI, 1.22–1.76) net of confounders in predicting perceived quality of care among Latinos. The largest gap in rates of excellent/good ratings occurred among the insured with eight or more doctor visits compared to the uninsured (76.2% vs. 54.6%, P < .05).CONCLUSIONSFuture research can gain additional insights by examining the impact of health insurance on processes of care with a refined focus on specific transactions between consumers and providers’ support staff and physicians guided by the principles of patient-centered care.

Health Care Coverage and the Health Care Industry

We examined rates of uninsurance among workers in the US health care workforce by health care industry subtype and workforce category. We used 2004 to 2006 National Health Interview Survey data to assess health insurance coverage rates. Multivariate logistic regression analyses were conducted to estimate the odds of uninsurance among health care workers by industry subtype. Overall, 11% of the US health care workforce is uninsured. Ambulatory care workers were 3.1 times as likely as hospital workers (95% confidence interval [CI]=2.3, 4.3) to be uninsured, and residential care workers were 4.3 times as likely to be uninsured (95% CI=3.0, 6.1). Health service workers had 50% greater odds of being uninsured relative to workers in health diagnosing and treating occupations (odds ratio [OR]=1.5; 95% CI=1.0, 2.4). Because uninsurance leads to delays in seeking care, fewer prevention visits, and poorer health status, the fact that nearly 1 in 8 health care workers lacks insurance coverage is cause for concern.

The Work/Health Insurance Nexus: A Weak Link for Mexican-origin Men.

OBJECTIVES: The employment based health insurance system of the United States means that those individuals who are disadvantaged in the labor market are also disadvantaged in terms of health insurance coverage. The Mexican-origin population has historically been disadvantaged in both domains. We examine the extent to which low rates of health insurance coverage among Mexican-origin adult male workers are the result of overrepresentation in the types of employment in which coverage is low for everyone. METHODS: We use logistic regression models to analyze data from 80,827 employed Mexican-origin, African American, and non-Hispanic white men in the 2004 and 2006 Current Population Surveys. RESULTS: The results suggest that although such overrepresentation contributes to low rates of coverage among Mexican-origin workers, even within employment sectors, industries, and occupations Mexican-origin workers are less likely to have coverage than non-Hispanic whites or African Americans. CONCLUSIONS: These results make it clear that the health insurance vulnerabilit y of the Mexican-origin population reflects multiple barriers to coverage in addition to those related to employment.

Cancer Screening in US Workers

Regular cancer screening can prevent the development of some cancers and increase patient survival for other cancers. We evaluated the reported cancer screening prevalence among a nationally representative sample of all US workers with data from the 2000 and 2005 Cancer Screening Supplements of the National Health Interview Survey. Overall, workers with the lowest rates of health insurance coverage (in particular, Hispanic workers, agricultural workers, and construction workers) reported the lowest cancer screening. There was no significant improvement from 2000 to 2005.

Persistent Disparities in Health Insurance Coverage: Hispanic Children, 1996 to 2005

To identify how health insurance coverage trends changed for Hispanic children between 1996 and 2005. Data from the Current Population Survey Annual Social and Economic Supplement were analyzed to determine health insurance coverage rates for Hispanic children and logistic regression was used to determine the role of race/ethnicity on health insurance status, adjusting for citizenship status, child characteristics, migration status, and geography. The proportion of uninsured Hispanic children decreased significantly. However, the increased likelihood of a Hispanic child being uninsured relative to non-Hispanic White children did not change during this period. Expansions in public health insurance programs between 1996 and 2005 increased health insurance coverage for Hispanic children but disparities between Hispanic and non-Hispanic White children persist.

Race, Ethnicity and the Dynamics of Health Insurance Coverage

Using matched data from the 1996 to 2004 Current Population Survey (CPS), we examine racial patterns in annual transitions into and out of health insurance coverage. We first decompose racial differences in static health insurance coverage rates into group differences in transition rates into and out of health insurance coverage. The low rate of health insurance coverage among African-Americans is due almost entirely to higher annual rates of losing health insurance than whites. Among the uninsured, African-Americans have similar rates of gaining health insurance in the following year as whites. Estimates from the matched CPS also indicate that the lower rate of health insurance coverage among Asians is almost entirely accounted for by a relatively high rate of losing health insurance. In contrast to these findings, differences in health insurance coverage between Latinos and whites are due to group differences in both the rate of health insurance loss and gain. Using logit regression estimates, we also calculate non-linear decompositions for the racial gaps in health insurance loss and gain. We find that two main factors are responsible for differences in health insurance loss between working-age whites and minorities: job loss and education level. Higher rates of job loss account for 30 percent of the health insurance gap for African-Americans and Asians, and 16 percent of the health insurance gap for Latinos. Lower levels of education explain roughly 15 percent of the gap for African-Americans and Latinos (Asians' higher levels of education serve to close the gap). Higher rates of welfare and SSI participation among African-Americans also serve to widen the gap in health insurance loss by 8 percent.

Breast cancer screening among Chamorro women in California

Background: This study evaluated breast cancer-related knowledge, attitudes and behaviors among Chamorros in San Diego, California and compared mammogram use between those affiliated with the military and others. Methods: A survey was administered to 110 self-reported Chamorro women. Inclusion criteria included being self-reported Chamorro woman >40 years with no history of breast cancer. Approximately equal proportions of participants with (52%) and without (48%) military affiliation were recruited to test the assumption that use of mammography differed between the two groups. Descriptive statistics and bivarate analyses were conducted. Results: Of the 110 respondents, 42% had at least some college education, 41% had household incomes of at least $50,000, and 87% reported having health insurance. Approximately 93% reporting ever having a mammogram and 75% reported having it within the past 2 years. The difference between mammography use among women with and without military affiliation was not significant (85% versus 72%; p = 0.11). However, women with military insurance (95%) were more likely than others (74%) to have had a mammogram within that time frame ( p = .05). Other factors associated with higher mammography use included reporting better access to medical care ( p = .03), receiving a recommendation for mammography from a health care provider ( p = .002), and knowledge that cancer can be cured if detected early ( p = .01) and that women should get a mammogram yearly ( p = .01). Conclusion: Chamorro women in San Diego have relatively high rates of mammography use. This finding may be due, in part, to the relatively high rates of health insurance coverage (particularly military insurance) among these women.

Women’s Health Insurance Coverage 1980–2005

In the fragmented US health insurance system, women's health insurance coverage is an outcome both of changes in the availability of private and public health insurance and of changing patterns of labor force participation and household formation. Over the past 2 decades, women's socioeconomic circumstances have changed and public policy around health insurance coverage for low-income women has also undergone substantial modification. This study examines the roles of these changes in circumstances and policy on the level and composition of women's health insurance. Using the Census Bureau's March Current Population Survey 1980-2005, the government's principal source of nationally representative labor market and health insurance data, we examine how changes in marriage, full-time and part-time labor force participation, and public policy around coverage affected the level and source of women's health insurance coverage over 3 periods: 1980-1987, 1988-1994, and 1995-2005. Health insurance coverage rates have fallen for both women and men since 1980. What makes women different is that, in addition to the decline in coverage, the composition of health insurance coverage for women has also changed markedly. More women now obtain health insurance on their own, rather than as dependents, than did in 1980. A larger fraction of insured women are now enrolled in Medicaid than were in 1980. Women's routes to coverage have changed as their social and economic circumstances have changed and as policy, especially Medicaid policy, has evolved. Women's channels for obtaining health insurance coverage are more fragmented than those of men. The availability of multiple sources of coverage, and the possibility of moving amongst them, have not, however, insulated women from the overall declines in health insurance coverage caused by the rising cost of private health insurance.