WeinickView Graph # 1 OVERVIEW Why Are We Concerned About Uninsured Children? Measurement Issues Who Are the Uninsured Children? Eligibility for and Availability

Weinick View Graph # 1

OVERVIEW

Why Are We Concerned About Uninsured Children?

Measurement Issues

Who Are the Uninsured Children?

Eligibility for and Availability of Coverage


WHY ARE WE CONCERNED ABOUT UNINSURED CHILDREN?

Equity and Efficiency

Impact on Access to Health Care

Impact on Use and Expenditures

Impact on Health Status and Health Outcomes


EQUITY AND EFFICIENCY ISSUES

Equity Issues

- Fairness

- Equitable standard of access

Efficiency Issues

- Efficiency gains (e.g., risk pooling)

- Resource costs (e.g., delayed care)


IMPACT ON ACCESS TO HEALTH CARE

Usual Source of Health Care

Level of Services

Quality, Continuity, and Satisfaction With Care


HEALTH INSURANCE AND ACCESS TO CARE

Percent with No Usual Source of Care

20.2

10.0

5.6

0

5

10

15

20

25

Uninsured Public Private


HEALTH INSURANCE AND USUAL SOURCE OF CARE SITE

Percent with Office-Based Usual Source of Care

68.574.8

86.7

0

25

50

75

100


Source: Weinick, Weigers, and Cohen, 1998 (1996 MEPS)


HEALTH INSURANCE AND BARRIERS TO CARE

Percent of Families Experiencing Barriers to Care

23.4

12.2

7.0

0

5

10

15

20

25

30

One or more membersuninsured

All members publicinsurance

All members privateinsurance

Source: Weinick, Zuvekas, and Drilea 1997 (1996 MEPS)


IMPACT ON ACCESS TO HEALTH CARE

Uninsured Children Are Less Likely to Have a Usual Source of Health Care Than Insured Children, and Are Less Likely to Have an Office-Based Usual Source of Care

Uninsured Families Report More Barriers to Obtaining Needed Care, and Are More Likely to Report That They Are Unable to Afford Needed Care Than Insured Families


IMPACT ON USE AND EXPENDITURES

Use of Any Services

Use of Specific Services

Proportion of Expenditures Paid Out-of-Pocket


HEALTH INSURANCE AND PHYSICIAN CONTACT

Percent of Children with Any Physician Contact

54.0

72.677.3

0

25

50

75

100


Source: Monheit and Cunningham, 1992 (1987 NMES)


HEALTH INSURANCE AND WELL-CHILD VISITS

Percent of Children with Well-Child Visits

48.556.4

64.7

31.438.0

47.5

0

25

50

75


Any visits Recommended visits

Source: Short and Lefkowitz, 1992 (1987 NMES)


IMPACT ON USE AND EXPENDITURES

Uninsured Children Use Fewer Health Care Services Than Insured Children

Uninsured People Spend a Greater Proportion of Their Income on Health Care Services Than the Privately Insured (Taylor and Banthin 1994)


IMPACT ON HEALTH STATUS AND HEALTH OUTCOMES

Adverse Health Outcomes Appear to Be Related to Being Uninsured

Avoidable Hospitalizations for a Variety of Conditions Are More Common Among the Uninsured Than the Privately Insured

Uninsured Newborns Are More Likely to Have Adverse Outcomes Than the Privately Insured

Source: Office of Technology Assessment, 1992; Weissman, Gastonis, and Epstein, 1991


IMPACT ON HEALTH STATUS AND HEALTH OUTCOMES

The Uninsured Are More Likely to

- Experience avoidable hospitalizations

- Be diagnosed at later stages of disease

- Be hospitalized on an emergency or urgent basis

- Be more seriously ill upon hospitalization

- Die upon hospitalization

Source: Office of Technology Assessment, 1992


WHY DO WE CARE ABOUT MEASUREMENT ISSUES?

Different methods can yield very different estimates


DEFINING HEALTH INSURANCE

Current Population Survey Counts As Insured:

- Department of Veterans Affairs health care

- Some children who are “categorically eligible” for Medicaid

- Children of adults covered by Medicaid as automatically covered themselves

- Some single service or supplemental coverage


DEFINING HEALTH INSURANCE

Medical Expenditure Panel Survey

- Only counts comprehensive physician and hospital coverage as insurance

- not single-service or Medigap plans

- Counts insurance coverage by Medicaid

- not service provision through IHS, VA, etc.


TIME PERIOD

At a Point in Time?

During a Particular Period?

- One month

- One quarter

- Six months

- One year

- Other


DEFINING WHO IS UNINSURED

Uninsured for:

- The whole period

- Some minimum part of the period

- At any time during the period


DATA COLLECTION

How Are Respondents Contacted?

- Phone or in-person?

- Prospective or retrospective?

How Often Are Respondents Contacted?

- What is the recall period?


MEASUREMENT ISSUES

When Comparing Estimates Check

- Definitions

- what is health insurance?

- who is uninsured?

- Time period

- Data collection methods

Before Concluding That Estimates of Uninsured Children Are

The Same or Are Different


WHO ARE THE UNINSURED CHILDREN?

How Many Children Are Uninsured?

What Are Their Characteristics?

- Age

- Race

- Family structure

- Parents’ education

- Parents’ employment status

- Where children live


HOW MANY CHILDREN ARE UNINSURED?

Health Insurance Status ofChildren Under Age 18

63.8%

15.4%

20.8%

UninsuredPublicPrivate


HEALTH INSURANCE AND AGE

Percent Uninsured by Age

13.215.5

17.9

0

5

10

15

20

25

Less than 6 6-12 13-17

Source: Weinick, Weigers, and Cohen 1998 (1996 MEPS)


HEALTH INSURANCE AND RACE

Percent Uninsured

27.7

17.6

12.3

0

5

10

15

20

25

30

Hispanic Black White


HEALTH INSURANCE AND FAMILY STRUCTURE

Single-Parent Families

38.7%

19.8%

41.5%

UninsuredPublicPrivate

Two-Parent Families

73.7%

13.6%

12.7%


HEALTH INSURANCE AND PARENTS’ EDUCATION

Percent Uninsured by Parents' Education

28.5

17.9

10.1

0

5

10

15

20

25

30

35

<12 years 12 years >12 years



HEALTH INSURANCE AND PARENTS’ EMPLOYMENT

Percent Uninsured by Parents' Employment

15.819.1

11.4

0

5

10

15

20

25

0 1 2Number of parents employed



HEALTH INSURANCE AND WHERE CHILDREN LIVE

Percent Uninsured by Metropolitan Statistical Area Status

14.0

20.7

0

5

10

15

20

25

30

MSA Non-MSA



WHO ARE THE UNINSURED CHILDREN?

Uninsured Children Are Disproportionately Likely to

- Be ages 13-17

- Be Hispanic

- Live in single-parent families

- Have parents with little education

- Live without employed parents

- Live outside of MSAs


ELIGIBILITY FOR AND AVAILABILITY OF COVERAGE

Private Insurance

- Offers of insurance

- Take-up rates

Public Insurance

- Eligibility

- Coverage

- Take-up rates


PRIVATE INSURANCE: OFFER RATES

Percent of All Workers Offered Employment-Related Coverage

72.475.4

50

55

60

65

70

75

80

1987 1996

Source: Cooper and Schone 1997 (1987 NMES and 1996 MEPS)


PRIVATE INSURANCE: TAKE-UP RATES

Percent of Workers Offered Insurance who are Policyholders

88.3

80.1

75

80

85

90

95

1987 1996

Source: Cooper and Schone 1997 (1987 NMES and 1996 MEPS)


PUBLIC INSURANCE: ELIGIBILITY

29.5% of All Children Are Estimated to Be Medicaid Eligible

- 33.7% of children ages 0-12 are estimated to be eligible

- 20.2% of children ages 13-18 are estimated to be eligible

Source: Selden, Banthin, and Cohen 1998 (1996 MEPS)


INSURANCE COVERAGE OF CHILDREN ELIGIBLE FOR MEDICAID

Private25.9%

Medicaid51.9%

Uninsured22.2%



MEDICAID TAKE-UP RATES AMONG ELIGIBLE CHILDREN

Percent of Children Without Private Coverage who Enrolled in Medicaid

70.0 73.2

59.1

0

20

40

60

80

100

All children Ages 0-12 Ages 13-18



SUMMARY

Why Are We Concerned About Uninsured Children?

- Health insurance has a considerable impact on:

- equity and efficiency

- access to health care

- use and expenditures

- health status and health outcomes


SUMMARY (CONT.)

Measurement Issues

- Use caution when interpreting estimates

- Definitions, time periods, and survey methods may differ


SUMMARY (CONT.)

Who Are the Uninsured Children?

- Certain groups are at greater risk

- Usually those who are most vulnerable to a variety of adverse outcomes


SUMMARY (CONT.)

Eligibility for and Availability of Coverage

- Many workers who have employer-sponsored coverage available to them do not take it

- Many children who are eligible for Medicaid remain uninsured


REFERENCES

Cooper, P.F. and B.S. Schone. 1997. “More Offers, Fewer Takers for Employment-Based Health Insurance: 1987 and 1996.” Health Affairs 16(6): 142-149.

Monheit, A. and P. Cunningham. 1992. “Children Without Health Insurance.” The Future of Children 2(2): 154-170.

Office of Technology Assessment. 1992. Does Health Insurance Make a Difference? Background Paper. Washington, DC: Congress of the United States.

Selden, T.M., J.S. Banthin, and J.W. Cohen. 1998. “Medicaid’s Problem Children: Eligible But Not Enrolled.” Health Affairs 17(3): 192-200.

Short, P. and D. Lefkowitz. 1992. “Encouraging Preventive Services for Low-Income Children: The Effect of Expanding Medicaid.” Medical Care 30(9): 766-780.

Taylor, A. and J. Banthin. 1994. Changes in Out-of-Pocket Expenditures for Personal Health Services: 1977-1987. National Medical Expenditure Survey Research Findings 21. Rockville, MD: Agency for Health Care Policy and Research (AHCPR Pub. No. 94-0065).

Weigers, M.E., R.M. Weinick, and J.W. Cohen. 1998. Children’s Health 1996. MEPS Chartbook No. 1. Rockville, MD: Agency for Health Care Policy and Research (AHCPR Pub. No. 98-0008).

Weinick, R.M., M.E. Weigers, and J.W. Cohen. 1998. “Children’s Health Insurance, Access to Care, and Health Status: New Findings.” Health Affairs 17(2): 127-136.

Weinick, R.M., S.H. Zuvekas, and S.K. Drilea. 1997. Access to Health Care--Sources and Barriers, 1996. MEPS Research Findings No. 3. Rockville, MD: Agency for Health Care Policy and Research (AHCPR Pub. No. 98-0001).

Weissman, J.S., C. Gastonis, and A.M. Epstein. 1991. “Rates of Avoidable Hospitalizations by Insurance Status in Massachusetts and Maryland.” Paper presented at the annual meeting of the Association for Health Services Research, San Diego, CA, 1-3 July.

Documents

WeinickView Graph # 1 OVERVIEW Why Are We Concerned About Uninsured Children? Measurement Issues Who Are the Uninsured Children? Eligibility for and Availability