Health Insurance Coverage Among North Dakotans May 10, 2004 Alana Knudson, PhD Kyle Muus, PhD Mike Cogan, MA

North Dakota Phone Survey Partners Development Geographic Groups Descriptive Statistics

North Dakota Phone Survey Collaborative Endeavor North Dakota Department of Health University of North Dakota Center for Rural Health UND Social Science Research Institute Mathematica Policy Research, Inc.

Survey Development Review of national literature Review of CPS and CDC survey results Review of existing state surveys Review of previous state results Customize survey to address North Dakota concerns Survey instrument developed by SSRI

Respondents Three population groups Urban (greater than 16,718) Bismarck, Fargo, Grand Forks & Minot Large Rural (5,000 to 16,717) Devils Lake, Dickinson, Jamestown, Minot AFB, Valley City, Wahpeton, & Williston Small Rural (under 5,000) Remainder of the state

Overview of Survey Findings

Gender

Age

Health Insurance Coverage

Number of Health Insurance Policy Types Per Person

Is there a particular doctor you see?

How many miles do you travel to receive health care services?

When was the last time you received a routine check up?

Are you confident that you can get health care when you need it?

How many times have you visited the doctor in the past 6 months?

How would you describe your health?

What is your marital status?

What is your level of education?

What is your employment status?

Do you have more than one paying job?

Is this job permanent, temporary or seasonal?

Prior Active Duty in the Military?

North Dakotas Underinsured

UNDERINSURANCE Situations where: a) too few services are covered or the coverage is inadequate; b) the amount of out-of-pocket expenses, regardless of family income, is excessive; c) some combination of the above..cost-sharing places such an economic hardship on the insured that its presumed benefits are lost Based on economic, experiential & attitudinal factors

Typical Characteristics of the Underinsured Self-employed, PT employees, and FT employees of small companies Aged and Fair/poor health status Ethnic minorities Below 200% of poverty level

Economic Conditions Out-of-pocket expenses, with or without regard to family income, are excessive Out-of-pocket expenses >10% of income Inadequate insurance against large bills The financial impact of serious illness Unable to obtain needed health care due to economic reasons <200% of poverty level & their employer makes no contribution

Experiential Measures Too few services are covered Ineligible for or cannot afford certain plan benefits of interest Pre-existing condition prevents person from obtaining coverage Coverage prevents them from reaching their health potential Waiting periods before a condition is covered Difficulty in obtaining referrals Basic health needs (prenatal, immunizations, etc.) are not covered

Attitudinal Factors Insurance is perceived to be inadequate Quality of care is considered inadequate Desired services are not included in the plan

Needed to see a doctor but could not because of the cost (past 12 months) ND Source: BRFSS, 2000

Estimated Annual Out-of-Pocket Medical Expenses for the Past Year Range=$2-100,000; Mean=$1496; Median=$400

Health Underinsurance* in ND * Annual out-of-pocket >10% of median annual household income TargetTargets Household

Health Underinsurance* of Target, by Age Group *Annual out-of-pocket >10% of median annual household income

Health Underinsurance* by Gender * Annual out-of-pocket >10% of median annual household income FemalesMales

Health Underinsurance* by Race/Ethnicity *Annual out-of-pocket >10% of median annual household income

Underinsurance* by geographic group *Annual out-of-pocket >10% of median annual household income

Where do the underinsured reside?

Health Underinsurance* of Target, by Income Level *Annual out-of-pocket >10% of median annual household income

Health Underinsurance* of Targets Household, by Income *Annual out-of-pocket >10% of median annual household income

Health Underinsurance* of Target, by Policy Type *Annual out-of-pocket >10% of median annual household income

Underinsurance* by Employment Status *Annual out-of-pocket >10% of median annual household income

Self-Perceived Health Status, Insured versus Underinsured* * Annual out-of-pocket >10% of median annual household income InsuredUnderinsured

North Dakotas Uninsured

What is percentage and number of the uninsured in North Dakota? 8.2% of North Dakotans are uninsured 51,920 people Similar to the population of Bismarck

How does North Dakotas uninsured percentage compare with the U.S.?

Who are the uninsured by gender?

Health Uninsurance* by Race/Ethnicity

What is the percentage of uninsured in each geographic group?

Where do the uninsured reside?

Who are the uninsured by age?

Among the uninsured, have you ever been insured?

Marital Status

Household Income by Insurance Status

Educational Level

Employment Status

Types of Employment

Firm Size

Are you offered health insurance through employer or union?

Do you have access to health insurance through your spouse?

Why not buy insurance on your own?

Would you enroll in Medicaid if eligible?

Describe your health…

North Dakotans Indicating A Regular Place for Health Care

Where do people seek health care?

Are you confident that you can get health care when you need it?

Percent of Population With Dental Care Insurance

For more information contact: Center for Rural Health UND School of Medicine and Health Sciences Grand Forks, ND