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2001 CHAP
Telephone Survey
Who Are the Uninsured?
The uninsured are similar to
insured Sedgwick County residents in terms of education and
minority status, however the two groups are demographically
dissimilar in terms of income and age. Education was measured and
compared categorically in three strata, less than high school
education, a high school education, and more than high school
education. There were nonsignificant differences in the numbers
of respondents in each level of education, which suggests that in
this sample, level of education is not associated with having or
not having insurance. Less than five percent of the uninsured had
a high school education or less (see
Figure 5).
In the 2001 survey, the ethnicity
of the overall sample is predominantly Caucasian (85%); therefore,
it is not surprising that the uninsured are predominantly
Caucasian as well. Due to small sample among minorities, ethnic
status was collapsed into minority versus non-minority groups to
assess group differences. The insured versus uninsured are
similar in terms of minority and non-minority representation (see
Figure 6). . In addition, nearly 70% of the uninsured group was
female, which may be related to the high representation of women
in the sample.
With respect to income, 16% of the
uninsured earned more than $50,000 and less than 7.0 % earned
$25,000 or less annually, whereas 20% of the insured earned
$50,000 or more, and 23% earned less than $25,000 (see
Figure
7).
In terms of employment, approximately 15% of the uninsured work
full-time, and 12% work part-time (see
Figure 8).
Respondents who were uninsured
are younger than those adults who are insured. The average age of
uninsured respondents was 34 years (SD=10.5) while insured
respondents had a mean age of 42 years (SD=10.5). The majority of
the uninsured are aged 18-44 years (86.7%) and more than 50% are
between 18-34 years old (see
Figure 9). This finding is
consistent with the 1996 survey results.
What are the
Reasons for Being Uninsured?
Respondents were asked, “when
thinking of themselves or those living in their household, is
there a reason or reasons that they didn’t have health insurance,”
the most frequent response was that insurance is too expensive
(premium is too costly). In fact, nearly 65% of those who
responded to the query reported they couldn’t afford health care
insurance. Another eight percent reported that health insurance
wasn’t offered through their workplace. The occupations of the
uninsured mirror that of the uninsured. The uninsured work in
general services (14.5%), as homemakers (13.3%), in health care
services (10.8%), trade (10.8%), professional services (9.6%), and
manufacturing (9.6%). Approximately 10% of the uninsured work in
government, military, construction or transportation and public
utility occupations. Over 50% of the uninsured report it is a
major or somewhat of a major problem not being able to afford
health insurance.
Only two percent of uninsured
responded that they could get free or inexpensive care from the
hospital or clinic. A large majority of the uninsured report they
receive their medical care at a particular physician’s office
(65%) or HMO group office (4.8%), while 7.2% receive care at a
hospital outpatient department, and 4.8% seek care at an emergency
department. The most frequent reason for seeking care is for
illness (45.8%), for an annual physical exam (16.9%), for advice
(10.8%), or for injury (7.2%). Chronic illness was reported by
six percent of the uninsured as a reason they seek medical
services. Medical visits related to dependents’ care comprised
8.4% of reasons for seeking medical care. Over 50% of the
uninsured reported between one and three medical visits per year,
while 25% reported four to eight visits, and nearly 11% reported
nine or more doctor visits in one year. However, 26% of the
uninsured state that they’ve had no medical visit due to cost.
When asked how much they were
requested to pay at the time of an office visit, over 36% of the
uninsured stated they paid $10 or less, whereas 30% paid between
$11 and $20. An additional 13.3% reported paying between $21 -
$40 for an office visit and nearly 16% paid more than $40. With
respect to dental care, nearly 54% of the uninsured indicate it is
a major or somewhat of a major problem to afford dental care.
Over 70% of the uninsured
reported their out-of-pocket costs for office visits were less
than $500 per year, whereas 13.3% indicated their out-of-pocket
expenses were between $500 and $1,500 per year, and another 12.0%
had costs of more than $1,500 paid out-of-pocket. Statistics are
similar for prescription medications and emergency department
visits. The majority of respondents report out-of-pocket expenses
are less than $500 per year (85.5%). Over 70% of the uninsured
report out-of-pocket emergency department costs of less than $500
per year. For dependent out-of-pocket expenses, less than 10% of
the uninsured report expenses that exceed $500 per year, whereas
for prescription medications, only 2.4% of the uninsured have
out-of-pocket expenses that exceed $500 per year.
Are
the Uninsured in Worse Health than the Insured?
Health status
of the insured versus uninsured was compared. In response to the
question, “Would you say that, in general, your health is
excellent, very good, good, fair, or poor?” there was no
statistical difference in health status perceptions between the
uninsured and insured (see Figure 9). When comparing results of
the 1996 and 2001 telephone survey results, between 11% and 15%
rated their health as fair or poor, 27% and 29% rated their health
as good, and about 55% judged their health as excellent or very
good. Using the Mann-Whitney U test, mean differences in
self-reported health ratings were nonsignificant (z = -1.746,
p=NS) between the insured and uninsured. This finding may be
partially explained by the overall younger age of the uninsured.
Figure 10 provides a comparison of health status by insurance
status for respondents aged 18-64 years. The graph shows a higher
percentage of insured versus uninsured respondents rate their
health status as excellent and very good, whereas an equal or
greater number of uninsured respondents rate their health as fair
or poor.
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