Changes in health insurance coverage within rural and urban environments--1977 to 1987.

This study examines changes in the health insurance coverage of the nonelderly population in rural and urban areas between 1977 and 1987, using data from the National Medical Care Expenditure Survey (NMCES) and the National Medical Expenditure Survey (NMES). It was designed to test the hypothesis that differences in the rates of health insurance coverage in rural and urban areas have diminished over time, and to explore the composition of changes in coverage within rural and urban environments. The data suggest that the proportions of the populations that are without health insurance in rural and urban areas have converged since 1977. Although both rural and urban settings witnessed increases in the proportion of their populations without health insurance from any source, urban regions experienced a greater increase than did rural areas. These changes occurred among most subgroups within the population. In no subgroup did the percentage of the population without insurance in urban areas exceed that found in rural areas in either 1977 or 1987.

Playing by the rules and losing: health insurance and the working poor.

Using a sample of 7,734 employed adults from the National Medical Expenditure Survey, this research compares the sources of health insurance coverage and the antecedents of employer-sponsored insurance among the working poor to those at higher income thresholds. Concern with the working poor is warranted because they constitute the majority of the uninsured, they do not qualify for public health programs, and their health insurance benefits have eroded substantially. The data reveal that (1) the working poor are only one-third as likely to receive insurance from their employer as are the non-poor, and are over five times as likely to be without insurance from any source; (2) employment characteristics are critical antecedents of employer-sponsored insurance and, as a set, explain variation in coverage beyond that provided by human capital/socioeconomic factors; and (3) most employment characteristics have a similar effect on the odds of coverage across income categories, except for unionization and minimum wages. Implications for health care reform are addressed.

Health insurance coverage and use of services among low-income elders: does residence influence the relationship?

This research uses a nationally representative sample of 1,425 low-income elders from the 1987 National Medical Expenditure Survey (NMES) to assess the independent and interaction effects of health insurance coverage and residence on the use of seven health care services: doctor visits, visits to other personnel, telephone contact, emergency room visits, overnight hospital stays, outpatient visits, and prescription medicines. It is hypothesized that (a) elders without insurance to supplement Medicare; (b) those who lived in nonmetropolitan areas use fewer health services; and (c) insurance status and residence interact to influence use of health services, with nonmetropolitan elders using fewer services than those living in metropolitan areas, regardless of insurance type. Using multivariate statistical analyses with both main effects and interaction term models, the data indicate that the type of insurance that low-income elders have is associated with their use of health services, and that residence has only modest effect. Individuals who have Medicaid, and to a lesser extent private supplements, use services more frequently than do those without supplements. Finally, despite the hypothesis, residence does not interact with insurance status in influencing use of services; the relationship between insurance and use of services does not vary across area of residence. The data suggest that the ability to pay, rather than supply constraints associated with nonmetropolitan areas, are of primary importance in determining health care use among low-income elders.

Discrepancies in employer-sponsored health insurance among Hispanics, blacks, and whites: the effects of sociodemographic and employment factors.

Using a nationally representative sample of employed adults from the 1987 National Medical Expenditure Survey (NMES), this research explores differences in the incidence and predictors of employer-sponsored health insurance among Hispanics, blacks, and whites. The data suggest that: 1) whites are most likely, and Hispanics are least likely, to have employer-sponsored medical insurance in their own name, or in the name of another individual; 2) Hispanics are most likely, and whites are least likely, to be completely uninsured; and 3) the factors which increase the odds of receiving employer-sponsored coverage in one's own name are relatively similar across racial groups, though they differ substantially in magnitude.

Predicting the receipt of employer-sponsored health insurance: the role of residence and other personal and workplace characteristics.

Americans without health insurance constitute a significant public policy concern. Previous research has demonstrated that rural Americans are more likely to be without coverage. Beyond documenting this comparative disadvantage, however, current research has two specific deficiencies: studies have not examined whether the factors that predict the receipt of employer-sponsored health insurance are equivalent across residence categories, and few studies have used a multivariate framework to examine the predictors of the receipt of health insurance. Using data from the 1987 National Medical Expenditure Survey, the influence of residence is examined along with other variables known to be associated with an increased likelihood of receiving health insurance from an employer (specifically, seven employee and six workplace characteristics). At a bivariate level, an individual's place of residence did affect the probability of receiving health insurance from an employer, with nonmetropolitan workers least likely to receive such benefits. The influence of the employee and workplace characteristics on receipt of insurance, however, did not vary significantly by place of residence. In a multivariate model, six employee and six workplace characteristics were identified as significant predictors. These findings do not refute the existence of important residential differences in health insurance coverage, rather, they suggest that the differences are due to identifiable population and workplace characteristics that vary in their distribution by residence.

Perceptions of problems associated with aging: comparisons among four older age cohorts.

This research examines how the perceptions of aging and the concern over special problems faced by the aged vary among four age cohorts: the middle aged (55-64), the young old (65-74), the old (75-84), and the oldest old (85+). We hypothesized that the middle-aged cohort and the oldest-old cohort would be most pessimistic. The results support the hypothesis for the middle-aged group, but the oldest old were surprisingly optimistic in their view of aging. However, these perceptions by the oldest old cohort are more likely than the others' attitudes to depend on this group's assessment of their own personal problems.

Ethnicity of socioeconomic status? Health differences between elder Alaska Natives and whites.

We investigated self-reported health difference between elderly Alaska Natives and whites, and attempted to distinguish the effects of socioeconomic factors from other facets of ethnicity, upon health and physical well-being. Results indicate that elderly Alaska Natives suffer from a greater variety of impairments than do whites. Health differences disappear, however, in multivariate analyses that control for socioeconomic factors. Income, education, gender, and age appear to be more important determinants of health status among the elderly than ethnicity, per se.