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

2. WeinickView Graph # 2 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

3. WeinickView Graph # 3 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)

4. WeinickView Graph # 4 IMPACT ON ACCESS TO HEALTH CARE Usual Source of Health Care Level of Services Quality, Continuity, and Satisfaction With Care

5. WeinickView Graph # 5 HEALTH INSURANCE AND ACCESS TO CARE

6. WeinickView Graph # 6 HEALTH INSURANCE AND USUAL SOURCE OF CARE SITE Source: Weinick, Weigers, and Cohen, 1998 (1996 MEPS)

7. WeinickView Graph # 7 HEALTH INSURANCE AND BARRIERS TO CARE Source: Weinick, Zuvekas, and Drilea 1997 (1996 MEPS)

8. WeinickView Graph # 8 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

9. WeinickView Graph # 9 IMPACT ON USE AND EXPENDITURES Use of Any Services Use of Specific Services Proportion of Expenditures Paid Out-of-Pocket

10. WeinickView Graph # 10 HEALTH INSURANCE AND PHYSICIAN CONTACT Source: Monheit and Cunningham, 1992 (1987 NMES)

11. WeinickView Graph # 11 HEALTH INSURANCE AND WELL-CHILD VISITS Source: Short and Lefkowitz, 1992 (1987 NMES)

12. WeinickView Graph # 12 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)

13. WeinickView Graph # 13 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

14. WeinickView Graph # 14 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

15. WeinickView Graph # 15 WHY DO WE CARE ABOUT MEASUREMENT ISSUES? Different methods can yield very different estimates

16. WeinickView Graph # 16 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

17. WeinickView Graph # 17 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.

18. WeinickView Graph # 18 TIME PERIOD At a Point in Time? During a Particular Period? - One month - One quarter - Six months - One year - Other

19. WeinickView Graph # 19 DEFINING WHO IS UNINSURED Uninsured for: - The whole period - Some minimum part of the period - At any time during the period

20. WeinickView Graph # 20 DATA COLLECTION How Are Respondents Contacted? - Phone or in-person? - Prospective or retrospective? How Often Are Respondents Contacted? - What is the recall period?

21. WeinickView Graph # 21 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

22. WeinickView Graph # 22 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

23. WeinickView Graph # 23 HOW MANY CHILDREN ARE UNINSURED?

24. WeinickView Graph # 24 HEALTH INSURANCE AND AGE Source: Weinick, Weigers, and Cohen 1998 (1996 MEPS)

25. WeinickView Graph # 25 HEALTH INSURANCE AND RACE

26. WeinickView Graph # 26 HEALTH INSURANCE AND FAMILY STRUCTURE

27. WeinickView Graph # 27 HEALTH INSURANCE AND PARENTS’ EDUCATION Source: Weinick, Weigers, and Cohen 1998 (1996 MEPS)

28. WeinickView Graph # 28 HEALTH INSURANCE AND PARENTS’ EMPLOYMENT Source: Weinick, Weigers, and Cohen 1998 (1996 MEPS)

29. WeinickView Graph # 29 HEALTH INSURANCE AND WHERE CHILDREN LIVE Source: Weinick, Weigers, and Cohen 1998 (1996 MEPS)

30. WeinickView Graph # 30 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

31. WeinickView Graph # 31 ELIGIBILITY FOR AND AVAILABILITY OF COVERAGE Private Insurance - Offers of insurance - Take-up rates Public Insurance - Eligibility - Coverage - Take-up rates

32. WeinickView Graph # 32 PRIVATE INSURANCE: OFFER RATES Source: Cooper and Schone 1997 (1987 NMES and 1996 MEPS)

33. WeinickView Graph # 33 PRIVATE INSURANCE: TAKE-UP RATES Source: Cooper and Schone 1997 (1987 NMES and 1996 MEPS)

34. WeinickView Graph # 34 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)

35. WeinickView Graph # 35 INSURANCE COVERAGE OF CHILDREN ELIGIBLE FOR MEDICAID Private 25.9% Medicaid 51.9% Uninsured 22.2% Source: Selden, Banthin, and Cohen 1998 (1996 MEPS)

36. WeinickView Graph # 36 MEDICAID TAKE-UP RATES AMONG ELIGIBLE CHILDREN Source: Selden, Banthin, and Cohen 1998 (1996 MEPS)

37. WeinickView Graph # 37 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

38. WeinickView Graph # 38 SUMMARY (CONT.) Measurement Issues - Use caution when interpreting estimates - Definitions, time periods, and survey methods may differ

39. WeinickView Graph # 39 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

40. WeinickView Graph # 40 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

41. WeinickView Graph # 41 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.