Florence CS, Thorpe KE; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1998; 15: 81-2.
Tulane University, New Orleans, LA, USA.
RESEARCH OBJECTIVES: In this paper, we estimate the influence of economic, demographic and health care cost variables on the likelihood of having insurance coverage during the 1990s. During the recent economic recovery, the economy has returned to pre-recession levels of employment, but the percentage of adults with employer-sponsered insurance (ESI) has not returned to pre-recession levels, and the percentage of adults without health insurance coverage continues to climb. In order to better understand these puzzling trends, we examine the relative impact of changes in various factors that influence the percentage of adults with ESI and the percentage without insurance coverage. STUDY DESIGN: We use regression models to estimate the effects of income, family structure, industry and intensity of employment, and other factors on: (1) the likelihood of having ESI coverage and (2) the likelihood of being uninsured. We employ pooled cross-sectional data on 158,213 adults from the 1991 to 1996 March supplements to the Current Population Survey (CPS). Unlike previous studies, we allow the effect of industry of employment to vary over time in order to control for the possibility that the relationship between type of employment and the likelihood of insurance coverage changed. Our methods also account for the change in the health insurance questions in the 1995 CPS. PRINCIPAL FINDINGS: Our results indicate that the most important factor affecting changes in health insurance coverage was an increase in the percentage of families with income below 200 percent of the poverty line. We estimate that between 1990 and 1993, the share of the adult population with ESI decreased from 68.5 percent to 65.8 percent. By 1995, 66.2 percent of adults had ESI. Meanwhile, the percentage of adults without health insurance increased from 16.8 percent in 1990 to 18.6 percent in 1993. By 1995, 18.9 percent of adults had no health insurance. If all other factors are held constant, the increase in low-income families decreased the percentage of adults with ESI by 2.6 percent and increased the percentage of adults without health insurance by 1.5 percent. Other factors which had a substantial negative effect on ESI coverage and a positive effect on the uninsurance rate were increases in health care costs and changes in the industry of employment. CONCLUSIONS: While the general state of the economy has improved through the 1990s, the number of low-income families has increased, and this has had a large negative effect on health insurance coverage for the non-elderly adult population. In addition, increasing health care costs and changes in industry of employment continue to have a negative effect on employer based health insurance coverage. These factors have combined to keep ESI coverage from returning to pre-recession levels. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: In order to improve access to health care, policy makers should understand the factors underlying the decline in employer based insurance and the increase in the uninsured. It is important to recognize that the major factors contributing to the decline in health insurance coverage are broad economic changes that cannot be directly addressed by health policy makers. Therefore, policy interventions, such as Kassebaum-Kennedy portability law, or the narrowly targeted expansions of government health insurance that have been recently proposed, may have a limited effect in increasing the percentage of adults without health insurance.
Publication Types:
Keywords:
- Adult
- Aged
- Budgets
- Costs and Cost Analysis
- Data Collection
- Demography
- Employment
- Health Care Costs
- Humans
- Income
- Industry
- Insurance Coverage
- Insurance, Health
- Medically Uninsured
- Poverty
- economics
- hsrmtgs
Other ID:
UI: 102234149
From Meeting Abstracts