|
|
|||||||||
|
Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail. Health Insurance Coverage and Receipt of Preventive Health Services -- United States, 1993In 1992, an estimated 38.5 million U.S. residents aged less than 65 years did not have health insurance (1). Efforts by states to expand health-care coverage will require surveillance for and state-specific information about coverage for acute care and the receipt of preventive services. This report summarizes state-specific and aggregated data from the 1993 Behavioral Risk Factor Surveillance System (BRFSS) regarding the status of health insurance coverage and the receipt of preventive health services among adults aged 18-64 years. In addition, findings from the analysis of supplemental questions added to the BRFSS in Minnesota are included that address health-care utilization, source of health-care coverage, and coverage of children. In 1993, the District of Columbia and all states except Wyoming participated in the BRFSS, a population-based, random-digit-dialed telephone survey of adults aged greater than or equal to 18 years (2). All persons responding to the BRFSS questionnaire were asked whether they had health-care coverage *, which of selected preventive health services they had received, if they had a usual place of medical care, and how they perceived their health status. This analysis specifically examined preventive health services targeted by the national health objectives for the year 2000 (i.e., cholesterol screening, breast and cervical cancer screening, and colorectal cancer screening) (3). The use of these services, the perception of health status, and absence of a usual place of medical care were compared between persons who were insured and uninsured by calculating crude prevalence ratios and adjusted odds ratios (i.e., adjusted for age, race, education level, employment status, and income level). For this analysis, sample estimates were statistically weighted to reflect the noninstitutionalized civilian population in each state, and standard errors were calculated using SESUDAAN. Health Insurance Coverage for Persons Aged 18-64 Years Of the 102,263 persons who participated in the 1993 BRFSS, 81,794 persons aged 18-64 years responded to the question about health-care coverage. Of these respondents, 16% reported they were uninsured at the time of interview Table_1. The percentages of persons who reported being uninsured ranged from 7% in Hawaii to 26% in Louisiana Table_1. The prevalence of being uninsured was higher among persons in states in the West (20%; 95% confidence interval {CI}=19%-21%) and South (19%; 95% CI=18%-19%) than in the Northeast (14%; 95% CI=13%-15%) or Midwest (12%; 95% CI=11%-13%). ** The prevalence of being uninsured was highest among men (18%), persons aged 18-24 years (27%), those with less than a high school education (35%), those with an annual household income less than $10,000 (39%), blacks (21%), Hispanics (34%), and persons who were unemployed (44%) Table_2. Compared with women who were insured, women who were uninsured were twofold more likely to report having no usual place of medical care (10% versus 18%), at least 50% less likely to have had both a mammogram and a clinical breast examination during the previous 2 years (69% versus 35%), and less likely to report having had a digital rectal examination during the previous 2 years (51% versus 29%) or ever having had a proctoscopy examination (32% versus 22%) Table_3. The prevalences of self-perceived health status were similar among women who were insured and uninsured. When compared with men who were insured, uninsured men were two times more likely to report having no usual place of medical care (18% versus 41%) and half as likely to report having had their cholesterol checked (65% versus 36%) or having had a digital rectal (51% versus 27%) or a proctoscopy examination (38% versus 20%). The prevalences of self-perceived health status were similar among men who were insured and uninsured. Minnesota-Specific Data for Persons Aged 18-64 Years The Minnesota Department of Health asked all respondents 12 supplemental questions about health insurance coverage. Among the 2494 persons who were insured, 1852 (75%; 95% CI=73%-77%) reported their employer was their primary source of coverage for health insurance. Overall, 9% (95% CI=8%-10%) of employed persons were uninsured and 20% (95% CI=15%-25%) of those employed in service occupational groups were uninsured. In addition, 44% (95% CI=37%- 50%) of uninsured persons and 21% (95% CI=19%-23%) of insured persons reported no visits to a physician during the previous year. Of the 253 persons who were uninsured, 178 (69%; 95% CI=63%- 75%) reported the primary reason they lacked health insurance was cost. In addition, of the 102 uninsured persons with children, 53 (53%; 95% CI=35%-55%) reported that their children did not have health-care coverage. Reported by: N Salem, PhD, Minnesota Dept of Health. BRFSS coordinators S Jackson, MPA, Alabama; P Owen, Alaska; B Bender, Arizona; J Senner, PhD, Arkansas; B Davis, PhD, California; M Leff, MSPH, Colorado; M Adams, MPA, Connecticut; F Breukelman, Delaware; C Mitchell, District of Columbia; D McTague, MS, Florida; E Pledger, MPA, Georgia; F Newfield, MPA, Hawaii; C Johnson, MPH, Idaho; B Steiner, MS, Illinois; R Guest, MPA, Indiana; P Busick, Iowa; M Perry, Kansas; K Bramblett, Kentucky; D Hargrove-Roberson, MSW, Louisiana; D Maines, Maine; A Weinstein, MA, Maryland; R Lederman, MPH, Massachusetts; H McGee, MPH, Michigan; E Jones, MS, Mississippi; J Jackson-Thompson, PhD, Missouri; P Smith, Montana; S Huffman, Nebraska; E DeJan, Nevada; K Zaso, MPH, New Hampshire; G Boeselager, MS, New Jersey; P Jaramillo, MPA, New Mexico; C Maylahn, MPH, New York; G Lengerich, VMD, North Carolina; D Young, MS, North Dakota; E Capwell, PhD, Ohio; N Hann, MPH, Oklahoma; J Grant-Worley, Oregon; J Romano, MPH, Pennsylvania; J Hesser, PhD, Rhode Island; M Lane, MPH, South Carolina; B Miller, South Dakota; D Ridings, Tennessee; R Diamond, MPH, Texas; R Giles, Utah; R McIntyre, PhD, Vermont; S Carswell, MA, Virginia; K Holm, MPH, Washington; F King, West Virginia; E Cautley, MS, Wisconsin. Behavioral Risk Factor Surveillance Br, Office of Surveillance and Analysis, National Center for Chronic Disease Prevention and Health Promotion, CDC. Editorial NoteEditorial Note: This report documents substantial variation in the state-specific prevalences of persons who report being uninsured. In addition, persons who were uninsured were less likely to have recently received preventive health services or have a regular place of medical care. The 1993 BRFSS findings are consistent with results from previous national studies indicating that uninsured persons are less likely to receive preventive health services (4). Lack of health-care coverage also has been associated with delayed medical care and use of fewer medical services (5,6). The findings in this report indicate that uninsured persons are more likely to be younger, less educated, of races other than white, unemployed, and of low income. These persons are less likely to engage in preventive practices that can be effectively encouraged in the primary health-care setting. Because lack of insurance is associated with limited access to important preventive health-care services, improvements in health insurance coverage through health-care reform at the state level may improve access to preventive health services. The state-added questions from Minnesota are assisting in identifying uninsured groups and estimating the percentage of children who are uninsured. These findings are critical for targeting specific populations that are uninsured and developing health-care reform and managed-care strategies. The findings in this report are subject to at least three limitations. First, because the BRFSS includes only households with a telephone, these findings probably underestimate the prevalence of being uninsured among persons not residing in households with telephones (e.g., persons living below the poverty level, less educated persons, and unemployed persons). Second, nonrespondents or refusals in households with a telephone may be younger and less educated persons who are more likely to be uninsured. Third, because estimates are based on self-reported data, responses cannot be validated and are subject to recall bias. The BRFSS can be used to provide routinely available, timely, state-specific data on health insurance coverage and receipt of preventive health services that may be used to monitor the progress of health-care reform efforts in each state. This information may assist state planners in evaluating progress toward the national health objectives for the year 2000 related to chronic diseases and disabling conditions. In addition, the BRFSS enables states to add specific questions, such as those included in Minnesota, to expand health-related information for use in planning and evaluating state-based strategies for all groups. References
* All respondents were asked, "Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs (health maintenance organizations), or government plans such as Medicare?" Persons who reported having no health-care coverage at the time of the interview were considered to be uninsured. ** West=Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, and Washington; South=Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; Northeast=Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; and Midwest=Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin. Table_1 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size. TABLE 1. Weighted percentage of persons aged 18-64 years who were uninsured *, by state and sex -- Behavioral Risk Factor Surveillance System, United States, + 1993 ========================================================================================================== Total Men Women ----------------------------- ------------------ ----------------- Sample State size & % (95% CI @) % (95% CI) % (95% CI) -------------------------------------------------------------------------------------------------- Alabama 1694 13.1 (+/-1.7%) 12.4 (+/-2.7%) 13.7 (+/-2.3%) Alaska 1383 17.0 (+/-3.0%) 21.4 (+/-4.7%) 11.9 (+/-3.2%) Arizona 1277 19.8 (+/-3.4%) 22.4 (+/-5.6%) 17.0 (+/-3.8%) Arkansas 1327 19.9 (+/-2.6%) 22.1 (+/-4.1%) 17.8 (+/-2.9%) California 3071 21.3 (+/-2.0%) 24.1 (+/-3.1%) 18.4 (+/-2.3%) Colorado 1526 18.3 (+/-2.2%) 18.3 (+/-3.3%) 18.3 (+/-3.0%) Connecticut 1425 11.5 (+/-2.0%) 14.4 (+/-3.3%) 8.7 (+/-2.1%) Delaware 1707 15.0 (+/-2.0%) 16.7 (+/-3.1%) 13.3 (+/-2.3%) District of Columbia 1249 10.1 (+/-1.9%) 8.4 (+/-2.5%) 11.5 (+/-2.8%) Florida 2276 21.3 (+/-2.0%) 22.0 (+/-3.0%) 20.7 (+/-2.6%) Georgia 1815 14.9 (+/-1.9%) 14.8 (+/-2.9%) 15.0 (+/-2.5%) Hawaii 1830 6.9 (+/-1.4%) 8.1 (+/-2.3%) 5.7 (+/-1.6%) Idaho 1444 17.9 (+/-2.6%) 19.6 (+/-4.3%) 16.1 (+/-2.8%) Illinois 1720 11.6 (+/-1.8%) 11.6 (+/-2.7%) 11.6 (+/-2.2%) Indiana 1633 14.1 (+/-1.9%) 14.7 (+/-3.0%) 13.5 (+/-2.5%) Iowa 1359 11.1 (+/-1.9%) 10.6 (11.5%) 2.4 (+/-2.7%) Kansas 1170 11.8 (+/-2.1%) 12.7 (+/-3.2%) 11.0 (+/-2.7%) Kentucky 1822 19.9 (+/-2.2%) 19.5 (+/-3.1%) 20.3 (+/-2.8%) Louisiana 1312 25.6 (+/-2.7%) 26.5 (+/-4.3%) 24.8 (+/-3.5%) Maine 971 15.8 (+/-2.6%) 17.6 (+/-4.1%) 14.1 (+/-3.5%) Maryland 3560 11.7 (+/-1.3%) 12.7 (+/-2.0%) 10.8 (+/-1.6%) Massachusetts 1282 10.1 (+/-1.9%) 11.1 (+/-2.9%) 9.1 (+/-2.4%) Michigan 1999 11.4 (+/-1.6%) 12.6 (+/-2.5%) 10.3 (+/-2.0%) Minnesota 2747 9.0 (+/-1.2%) 10.2 (+/-1.8%) 7.9 (+/-1.5%) Mississippi 1268 19.4 (+/-2.6%) 18.9 (+/-3.9%) 19.9 (+/-3.3%) Missouri 1167 14.4 (+/-2.3%) 14.4 (+/-3.4%) 14.4 (+/-2.9%) Montana 939 19.2 (+/-2.8%) 21.8 (+/-4.4%) 16.5 (+/-3.4%) Nebraska 1365 11.4 (+/-1.9%) 12.0 (+/-2.9%) 10.9 (+/-2.4%) Nevada 1507 21.7 (+/-2.4%) 22.2 (+/-3.7%) 21.1 (+/-3.1%) New Hampshire 1234 12.6 (+/-2.1%) 13.5 (+/-3.1%) 11.7 (+/-2.8%) New Jersey 1227 11.5 (+/-2.1%) 13.4 (+/-3.5%) 9.6 (+/-2.4%) New Mexico 1059 23.8 (+/-3.1%) 26.7 (+/-4.7%) 20.8 (+/-3.7%) New York 1922 16.5 (+/-2.0%) 18.8 (+/-3.1%) 14.4 (+/-2.5%) North Carolina 1864 14.3 (+/-1.8%) 13.4 (+/-2.6%) 15.2 (+/-2.5%) North Dakota 1378 12.8 (+/-1.9%) 15.2 (+/-3.0%) 10.4 (+/-2.4%) Ohio 1065 11.7 (+/-2.3%) 13.5 (+/-3.7%) 9.9 (+/-2.7%) Oklahoma 1148 21.8 (+/-2.7%) 22.8 (+/-4.4%) 20.8 (+/-3.5%) Oregon 2362 19.2 (+/-1.8%) 19.4 (+/-2.5%) 18.9 (+/-2.4%) Pennsylvania 1868 12.6 (+/-1.8%) 13.6 (+/-2.7%) 11.8 (+/-2.4%) Rhode Island 1438 12.0 (+/-2.1%) 15.3 (+/-3.4%) 8.7 (+/-2.4%) South Carolina 1679 18.7 (+/-2.7%) 20.2 (+/-4.3%) 17.3 (+/-3.0%) South Dakota 1383 12.8 (+/-2.1%) 13.6 (+/-3.1%) 11.9 (+/-2.6%) Tennessee 2447 15.1 (+/-1.6%) 16.0 (+/-2.4%) 14.4 (+/-2.0%) Texas 2078 23.4 (+/-2.4%) 23.9 (+/-3.5%) 22.9 (+/-2.9%) Utah 1507 15.6 (+/-2.0%) 17.9 (+/-3.3%) 13.2 (+/-2.4%) Vermont 1550 16.4 (+/-2.2%) 18.1 (+/-3.4%) 14.7 (+/-2.7%) Virginia 1480 13.7 (+/-2.0%) 11.8 (+/-2.8%) 15.7 (+/-2.8%) Washington 2182 16.4 (+/-1.8%) 18.8 (+/-2.8%) 14.0 (+/-2.3%) West Virginia 1819 19.5 (+/-2.1%) 20.3 (+/-3.3%) 18.7 (+/-2.6%) Wisconsin 1259 12.4 (+/-2.1%) 13.3 (+/-3.2%) 11.5 (+/-2.8%) -------------------------------------------------------------------------------------------------- * Persons who reported having no health-care coverage at the time of the interview were considered to be uninsured. + Excludes Wyoming. & Excludes persons who said they did not know or refused to state whether they had health-care coverage. @ Confidence interval. ========================================================================================================== Return to top. Table_2 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size. TABLE 2. Weighted percentage of persons aged 18-64 years who reported being uninsured *, by selected sociodemographic characteristics and by sex -- Behavioral Risk Factor Surveillance System, United States, + 1993 ============================================================================================ Women Men ----------------------------- --------------------------- Sample Sample Characteristic size % (95% CI &) size % (95% CI) ------------------------------------------------------------------------------------------ Age group (yrs) 18-24 5,432 23.5 (+/-1.8%) 4,457 29.7 (+/-2.3%) 25-34 12,482 16.5 (+/-1.1%) 9,728 21.5 (+/-1.4%) 35-44 12,669 13.2 (+/-0.9%) 10,128 13.5 (+/-1.0%) 45-54 8,672 11.9 (+/-1.1%) 6,818 10.7 (+/-1.1%) 55-64 6,660 10.6 (+/-1.1%) 4,748 9.7 (+/-1.3%) Education level @ Less than high school 4,906 33.1 (+/-2.1%) 3,591 37.2 (+/-2.8%) High school 16,008 17.0 (+/-0.9%) 11,647 21.1 (+/-1.2%) Some college 13,581 12.9 (+/-0.9%) 9,757 15.7 (+/-1.2%) College graduate 11,378 6.8 (+/-0.8%) 10,845 7.7 (+/-0.8%) Race/Ethnicity ** Asian/Pacific Islander 1,189 16.6 (+/-4.1%) 974 17.2 (+/-4.1%) Black, non-Hispanic 4,864 20.0 (+/-1.6%) 2,869 22.7 (+/-2.1%) White, non-Hispanic 36,468 12.6 (+/-0.5%) 29,368 14.5 (+/-0.7%) Hispanic ++ 2,549 31.3 (+/-2.8%) 1,944 36.5 (+/-3.6%) Employment status @ Employed for wages 27,786 11.3 (+/-0.6%) 24,943 13.5 (+/-0.8%) Self-employed 3,114 20.1 (+/-2.1%) 4,762 26.1 (+/-1.9%) Unemployed 2,524 39.4 (+/-3.1%) 1,888 49.0 (+/-3.4%) Other && 12,454 17.0 (+/-1.0%) 4,256 16.8 (+/-3.0%) Total annual household income @ <$10,000 5,456 36.8 (+/-2.1%) 2,475 43.8 (+/-3.1%) $10,000-19,000 8,252 29.3 (+/-1.6%) 5,483 38.2 (+/-2.2%) $20,000-34,999 11,835 12.4 (+/-1.0%) 9,723 16.5 (+/-1.3%) >=$35,000 15,775 4.2 (+/-0.6%) 15,293 6.4 (+/-0.7%) Total 45,915 15.2 (+/-0.5%) 35,879 17.5 (+/-0.7%) ------------------------------------------------------------------------------------------ * Persons who reported having no health-care coverage at the time of the interview were considered to be uninsured. + Excludes Wyoming. & Confidence interval. @ Excludes unknowns. ** The number of persons in other racial groups was too small to provide reliable estimates. ++ Persons of Hispanic origin may be of any race. && Includes students, homemakers, persons unable to work, and retired persons. ============================================================================================ Return to top. Table_3 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size. TABLE 3. Weighted percentage of respondents who reported fair or poor health, having no usual place of medical care, and having obtained selected preventive health services related to year 2000 national health objectives, by sex and status of health insurance coverage at the time of interview, -- Behavioral Risk Factor Surveillance System, United States, * 1993 ================================================================================================================================== Women Men ------------------------------------------ --------------------------------------- Characteristic Insured Uninsured OR + (95% CI &) Insured Uninsured OR (95% CI) ------------------------------------------------------------------------------------------------------------------------------ Self-perceived fair or poor health @ 9.5% 17.7% 1.1 (1.0-1.3) 8.1% 13.8% 1.2 (1.1-1.5) Had no usual place for medical care @ 10.2% 26.2% 2.6 (2.3-2.9) 18.1% 40.5% 2.4 (2.2-2.7) Had Papanicolaou smear during previous 3 years @ 86.9% 73.7% 0.5 (0.5-0.6) --- --- --- --- Had cholesterol screening during previous 5 years @ 69.3% 43.9% 0.5 (0.5-0.6) 65.0% 35.5% 0.5 (0.5-0.6) Had both a clinical breast examination and a mammogram during previous 2 years ** 69.4% 34.6% 0.3 (0.3-0.4) --- --- --- --- Had a digital rectal examination during previous 2 years ** 51.2% 28.8% 0.5 (0.4-0.7) 50.5% 26.7% 0.5 (0.4-0.7) Ever had proctoscopy ** 32.0% 22.2% 0.7 (0.5-0.9) 37.9% 20.0% 0.5 (0.4-0.7) ------------------------------------------------------------------------------------------------------------------------------ * Excludes Wyoming. + Odds ratio. The multivariate model is adjusted for age, race/ethnicity, education level, employment status, and income level. & Confidence interval. @ Persons aged 18-64 years. ** Persons aged 50-64 years. ================================================================================================================================== Return to top. Disclaimer All MMWR HTML versions of articles are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the electronic PDF version and/or the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices. **Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.Page converted: 09/19/98 |
|||||||||
This page last reviewed 5/2/01
|