Health Insurance Coverage for Families with Children
Paulin, Geoffrey D., Dietz, Elizabeth M., Monthly Labor Review
Health insurance coverage is an important ingredient in the maintenance of good health. This is particularly true for families with children. According to Peter J. Cunningham and Alan C. Monheit, children in families without health insurance coverage are "at a disadvantage regarding access to, quality of, and continuity of health care."(1) Judith D. Kasper finds that uninsured children under 18 are less likely to see a physician at least once during the past year, and are less likely to visit a physician for an immunization or general checkup.(2) Such regular, preventive medical care is especially important for children who, in general, are more prone to illness than adults. Without preventive care, families may face large medical expenses as their children grow up.
Additionally, health care costs have risen substantially in recent years. Data from the Consumer Price Index show that the price of medical care has risen at a much higher rate than for all other goods and services. From 1989-94, the medical care index increased 41.3 percent, compared with 18.2 percent for all items less medical care. In 1993, the Nation's health care costs rose to $884.2 billion, up 7.8 percent from 1992.(3) A recent article by Geoffrey D. Paulin and Wolf D. Weber suggests that as a result of these large increases, the direct costs of funding health care have been shifting from business and government to families, thus affecting their expenditures for nonhealth items.(4)
Meanwhile, in 1992, more than 8 million American children under age 18 had no health insurance coverage of any kind.(5) While many of the poorest families receive health insurance in the form of government-provided medicaid benefits(6) the percentage of children without public or private health insurance coverage grew by more than 40 percent between 1977 and 1987.(7)
This study identifies families with children that have full health insurance coverage, partial coverage, and no coverage. It examines the demographic characteristics of each insurance group, types of policies held, health care expenditure patterns for each group, and the relationship between the family's demographics and the probability of being in a particular "coverage group."
Background. According to Gloria J. Bazzoli,(8) studies examining the health insurance status of individuals in an attempt to measure medical indigence have generally defined medical indigence as the "lack of public or private health insurance coverage. The rationale behind this definition is that the uninsured are entirely responsible for their own medical expenses. If they experience a costly illness, they are less likely to be able to afford necessary treatment than similarly ill individuals with insurance coverage."(9) Bazzoli also describes a study in which the author examines "underinsurance," a status that "depends upon the probability that an individual will experience large out-of-pocket expenses due to a costly illness."(10)
In a subsequent study, Richard D. Miller,(11) uses data from the 1987 Consumer Expenditure Interview Survey to identify medically uninsured consumer units(12) rather than uninsured individuals. Miller uses a binomial logit model to estimate the relationships between various independent variables and the probability that a family has inadequate coverage--that is, the probability of having at least one member of the consumer unit who lacks health insurance coverage.
A later paper by Elizabeth M. Reise(13) which examines only families with children, divides the sample into three groups: those with full health insurance coverage (that is, all members are covered), partial health insurance coverage (that is, at least one, but not all, members are covered) and no health insurance coverage (that is, no member is covered). Reise uses an ordered multinomial logit to examine the probability of being in each group. Reise's paper is important because it distinguishes between those families with no (or at most very limited) health insurance coverage and those families with at least some health insurance coverage. …