We often hear about the 41 or 46 million Americans who do not have insurance (especially if you read my other diaries; lol). But where do these statistics come from? How are thye measured? Why the different numbers from different sources? What are the characteristics of the uninsured and how do they differed from the insured. Do the uninsured really get less care (yes) and are they really sicker (yes) than the insured?
How about you?
- Do you have health insurance? If so what kind?
- Do you have a regular souce of care that you know of and would go to?
- Was there a time in the past 12 months when you needed to see a doctor but could not because of cost?
Once again we are going to ask Kossacks to answer for themselves, both out of interest in our community, and as a way to discuss the subject generally for America.
And as before, hopefully, if this poll is posted up in the "Recommended Diary" section, ideally for as long as 24 hours in all continental time zones, we will get a large, valid and representative sample of us.
Update: Some commentary discusses Bush's proposal, so I am going to be blogwhore my diary on that subject from yesterday.
It is important to note that none of these surveys gets at the QUALITY or CONTENT of the coverage... how high is the deductible, how easy is it to get an appointment, what is out-of-coverage and what do they make you pay out of pocket for, do they pay upfront, how easy to get reimbursed...? That said here are some examples of the insurance coverage numbers:
- 41 to 46 million with no insurance now; at single point during year.
- 51 to 67 million with no insurance at some point during year.
- 22 to 44 million uninsured over entire year.
- By any method, any survey, numbers increasing during 2000-2005.
- Nationally, 41.1 percent of adults without health insurance coverage, compared to 9.2 percent of adults with health insurance coverage, were unable to see a doctor when needed due to cost in the past 12 months.
- Nationally, compared to 15.5 percent of adults with health insurance coverage, 56.8 percent of adults without health insurance coverage do not have a personal doctor or health care provider.
- Nationally, 22.5 percent of uninsured adults self-report a health status of ‘fair’ or ‘poor’ (versus ‘good,’ ‘very good,’ or ‘excellent’), compared to 11.6 percent of insured adults.
- Across the U.S., uninsured adults of same appropriate age groups are less likely to have received recommended cancer screenings.
- 14.8% of even adults 50-64 had no health insurance over a two year period.
Much more at Cover the Uninsured
So where do these numbers come from? There are different federal surveys, using different methods, by different agencies. Here are the mains ones:
BRFSS: the Behavioral Risk Factor Surveillance System is the world’s largest, on-going telephone health survey system, tracking health conditions and risk behaviors in the United States yearly since 1984. Conducted by the 50 state health departments as well as those in the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands with support from the CDC, BRFSS provides state-specific information about issues such as asthma, diabetes, health care access, alcohol use, hypertension, obesity, cancer screening, nutrition and physical activity, tobacco use, and more. Federal, state, and local health officials and researchers use this information to track health risks, identify emerging problems, prevent disease, and improve treatment.
Some states sample at the county level allowing for even smaller area information.
Here are the basic health insurance and access questions from this most utilized source:
- Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?
- Yes
- No
- Don’t know / Not sure
- Refused
This is the insurance question, and it does not get into type, source or quality.
- Do you have one person you think of as your personal doctor or health care provider?
If "No," ask: "Is there more than one, or is there no person who you think of as your personal doctor or health care provider?"
- Yes, only one
- More than one
- No
- Don’t know / Not sure
- Refused
We sometimes refer to this as whether you have a "medical home"; that you know that you have a regular source of care. It is a measure to get a sense of whether you have regular source for access to care itself, separate from whether you have health insurance per se.
- Was there a time in the past 12 months when you needed to see a doctor but could not because of cost?
- Yes
- No
- Don’t know / Not sure
- Refused
While question 2 ask about access in a general way, question 3 gets at the worst case scenario!
- About how long has it been since you last visited a doctor for a routine checkup? A routine checkup is a general physical exam, not an exam for a specific injury, illness, or condition.
- Within past year (anytime less than 12 months ago)
- Within past 2 years (1 year but less than 2 years ago)
- Within past 5 years (2 years but less than 5 years ago)
- 5 or more years ago
- Don’t know / Not sure
- Never
- Refused
Question 4 gets at access and utilization for general primary preventive care.
The best analyses and reports from BRFSS on this topic come from "Cover the Uninsured" a project of the Robert Wood Johnson Foundation. It is "nice" mainstream program that supports doing the most we can with existing programs and goes for very incremental "solutions" including alas the phony "grand coalition compromise".
However they do a very good job of analysis analysis:
In particular, this document, the Coverage Gap (pdf) is the best single source of information for a comprehensive State-by-State analysis on access to health care by people who do and do not have health care coverage.
Others include:
There are even helpful Guides to Finding Health Insurance Coverage in Your State. If this is personally a problem for you, family or friends, you may also want to see my earlier diary on how to get free or low cost care.
NCHS and NHIS: A very separate Center of Centers for Disease Control and Prevention, the National Center for Health Statistics, does many many other health surveys. One of them is the National Health Interview Survey (NHIS) which is done as a very detailed in person interview. The health care access, utilization and insurance questions are on pages 97-132 of the PDF file.
The survey method is a complex multistage cluster sample, and does not allow for breakdown by individual state. It does allow greater cross-tabs with other health related variables than the other surveys, and has the advantages (and disadvantages) of being in much greater detail and in person interviewer with greater verification.More information and reports can be found here.
NHIS reports and information can be found here.
The Census Bureau also asks about health insurance coverage in its Current Population Survey (CPS). It asks not only whether insured but what kind by the following categories. This amounts to a more detailed equivalent to the BRFSS question 1, but they do not ask any equivalent of the BRFSS access and utilizations questions 2, 3, or 4.
The Census CPS question and categories are the ones we will use in this dKos poll:
Employment-based health insurance is coverage offered through one’s own employment or a relative’s. It may be offered by an employer or by a union.
Direct-purchase health insurance is coverage though a plan purchased by an individual from a private company.
Medicare is the Federal program which helps pay health care costs for people 65 and older and for certain people under 65 with long-term disabilities.
Medicaid is a program administered at the state level, which provides medical assistance to the needy. Families with dependent children, the aged, blind, and disabled who are in financial need are eligible for Medicaid. It may be known by different names in different states.
SCHIP is the State Children’s Health Insurance Program, is a program administered at the state level, providing health care to low-income children whose parents do not qualify for Medicaid. SCHIP may be known by different names in different states
TRICARE or CHAMPUS is a military health care program for active duty and retired members of the uniformed services, their families, and survivors.
CHAMPVA is a medical program through which the Department of Veterans Affairs helps pay the cost of medical services for eligible veterans, veteran‘s dependents, and survivors of veterans.
VAMC provides medical assistance to eligible veterans of the Armed Forces.
Other State-specific or city-specific plan: Some states have their own health insurance programs for low-income uninsured individuals. These health plans may be known by different names in different states.
Indian Health Service (IHS) is a health care program through which the Department of Health and Human Services provides medical assistance to eligible American Indians at IHS facilities. In addition, the IHS helps pay the cost of selected health care services provided at non-IHS facilities.
For the true data geek there is even a discussion about the differences in methods here.
So... How about you? Do you have health insurance? If so what kind?