IPUMS NHIS: descr: HIPRIVATEE

IPUMS NHIS

NHIS
MEPS

NATIONAL HEALTH INTERVIEW SURVEY

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HIPRIVATEE

Covered by private health insurance: Recode

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Description

For sample adults and sample children, HIPRIVATEE indicates whether the person currently had private health insurance coverage. Prior to 2019, this variable is available for all persons. Private health care plans may be provided in part or in full by an individual's employer or union, and they may also be purchased directly by a person.

HIPRIVATEE is a recoded variable created by the National Center for Health Statistics (NCHS) and included in the original NHIS public use data. HIPRIVATEE, like other recoded health insurance variables in these data, is based on responses to a series of questions and by editing carried out by the NCHS.

Definitions

The Field Representative's Manual for 1998 defines a private health insurance plan as "any type of health insurance, including Health Maintenance Organizations (HMOs), other than the public programs in categories (4) and (6)-(11)" (of the flash card used by respondents in that year to report their type(s) of insurance coverage). In other words, private health insurance is, in the NCHS, defined as insurance other than Medicare, Medicaid, Military health care/VA, CHAMPUS/TRICARE/CHAMP-VA, Indian Health Service, State-sponsored health plans, and health insurance from other government programs (including CHIP, the Children's Health Insurance Plan, which was added to the card in 1999).

The flash card specified distinct kinds of private health insurance coverage in certain years: private health insurance plan from employer or workplace; Medi-Gap (i.e., private health insurance purchased to supplement Medicare), and private insurance plan through a state or local government program or community program.

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This last category, which was first added to the card in 1998, was defined in the Manual for that year as follows:

Private Health Insurance Plan through a State or Local Government program or community Program is a type of private insurance for which state or local government or community effort pays for part or all of the cost of a private insurance plan, such as Blue Cross/Blue Shield. The individual may also contribute the cost of the health insurance and may receive a card such as a Blue Cross/Blue Shield card. A community program or effort may include a variety of mechanisms to achieve health insurance for persons who would otherwise be uninsured. An example would be a private company giving a grant to an HMO to pay health insurance coverage. (Beginning in 1999, the example changed to "a private company providing insurance for 500 uninsured children at little or no cost.")

Single service plans are another type of insurance usually classified as private health insurance, but single service plan coverage did not count as private insurance coverage in HIPRIVATEE.

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Single service insurance was first defined in the 1999 Field Representative's Manual as "health insurance coverage paid for by the individual that provides for only one type of service. Examples of SSPs are dental care, vision care, prescriptions, nursing home care, hospice care, accidents, catastrophic care, cancer treatment, AIDS care, and/or hospitalization."

Initially, the NHIS specifically directed respondents to exclude such private single service plans from their reports of private insurance coverage. In 1997-1998, the flashcard listing general types of insurance coverage and handed to respondents stated, "EXCLUDE private plans that only provide extra cash while hospitalized or pay for only one type of service (nursing home care, accidents, or dental care)." From 1999-2018, this policy changed. The category "Single Service Plan (e.g., dental, vision, prescriptions)" was added to the flash card, and the card directed respondents to "INCLUDE those that pay for only one type of service (nursing home care, accidents, or dental care), exclude private plans that only provide extra cash while hospitalized." Beginning in 2019, three separate questions were asked to determine if the respondent had single service plans for dental services, vision services, and prescriptions.

While information on most kinds of single service plans was collected in the survey from 1999 forward, these privately purchased single service health insurance plans were not treated as "private insurance coverage" in HIPRIVATEE. As the Field Representative's Manual for 2001 forward explained, "In trying to determine the appropriate type of health care coverage that an individual has, it is important to remember that for purposes of this survey, Single Service Plans are not considered private health insurance and should not be recorded as such."

2001 marked the first year that the Field Representative's Manual provided guidance to interviewers on recording responses relating to two other types of private insurance coverage--COBRA and TCC--that were included in HIPRIVATEE (under the subheading, "Private Health Insurance Plan from employer or workplace").

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The Manual's discussion of COBRA and TCC was as follows:

If a respondent indicates that he/she is covered by COBRA (the Consolidated Omnibus Budget Reconciliation Act of 1985) or by TTC (Temporary Consolidation of Coverage), this should be coded as a Private Health Insurance Plan from employer or workplace. COBRA provides a bridge between health plans for qualified workers, their spouses and their dependent children when their health insurance might otherwise be cut off. Under this act, if a person voluntarily resigns from a job or is terminated for any reason other than 'gross misconduct' they are guaranteed the right to continue in their former employers group health insurance plan as an individual or family health care coverage for up to 18 months at one's own expense. In some cases, a spouse and dependent children are also eligible for COBRA coverage for as long as three years.

The TCC program is similar to COBRA. This program is available to federal employees. If a person loses Federal Employees Health Benefit (FEHB) coverage because of separation from federal service, they may enroll under the TCC provision of FEHB law to continue coverage for up to 18 months at their own expense in a FEHB plan. Family members who lose coverage because they are no longer eligible may enroll under TCC to continue FEHB coverage for up to 36 months at their own expense.

Data Collection Process

In the survey for 1997 forward, interviewers first asked, "Are you covered by health insurance or some other kind of health care plan?" Respondents were instructed to "Include health insurance obtained through employment or purchased directly as well as government programs like Medicare and Medicaid that provide medical care or help pay medical bills." In 1997-2003 the survey form instructed interviewers to only read the preceding statement "if necessary."

Individuals who had an affirmative response to the preceding question were asked, "What kind of health insurance or health care coverage do you have?" Respondents selected the appropriate response from a card listing various types of insurance coverage.

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The categories listed were:

Private health insurance (2004 forward)

Private health insurance plan from employer or workplace (1997-2003)

Private health insurance plan purchased directly (1997-2003)

Private health insurance plan through a State or local government program or community program (1998-2003)

Medicare (1997 forward)

Medi-Gap (1997 forward)

Medicaid (1997 forward)

CHIP (Children's Health Insurance Program) (1999 forward)

Military Health Care/VA (1997-2003)

Military Health Care (CHAMPUS/TRICARE/CHAMP-VA) (1997-2018)

Military related health care: TRICARE (CHAMPUS)/VA health care/CHAMP-VA (2019 forward)

Indian Health Service (1997 forward)

State-sponsored health plan (1997 forward)

Other government program (1997 forward)

Single Service Plan (e.g., dental, vision, prescriptions) (1999-2018)

No coverage of any type (2000 forward)

Respondents could pick more than one type of insurance and interviewers were instructed to mark all that applied.

Instructions regarding single service plans changed over time.

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Respondents were consistently instructed to exclude private plans that "only provide extra cash while hospitalized." In 1997-1998 respondents were also instructed to "EXCLUDE private plans that ... pay for only one type of service (nursing home care, accidents, or dental care)." Between 1999 and 2018, "Single Service Plan" was added as a possible response, and, consequently, the instructions were changed to read, "INCLUDE those [private plans] that pay for only one type of service (nursing home care, accidents, or dental care)." Beginning in 2019, respondents were asked three separate questions to determine if they had single service plans for dental services, vision services, and/or prescriptions.

Follow-up questions collected information about the names of coverage plans and confirmed the lack of any type of coverage for the uninsured.

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In follow-up questions, interviewers recorded the names of up to four private health insurance plans. If the person was reported as covered by CHIP (beginning in 2000), by a state-sponsored health plan, or by another public program (other than Medicaid) that paid for health care, the interviewer recorded the name of that plan. The placement and wording of these questions about the names of specific government health care plans varied across years.

For persons initially reported as not having health care coverage of any kind, interviewers asked whether the person had Medicare coverage, Medicaid coverage, coverage via a Medicaid program or non-Medicaid state-sponsored health insurance program with the appropriate name for the state, CHAMPUS or CHAMPVA coverage, or any private insurance. For those who acknowledged any such coverage, the interviewer repeated the series of questions mentioned above to determine the specific type of coverage.

Data Editing and Recoding

During the course of data editing, the NCHS discovered many errors in the responses to questions about insurance coverage. Often, respondents misclassified the type of insurance they had. This might be shown, for example, by a mismatch between the verbatim name of an insurance plan and the type of insurance coverage the person selected from the categories on the card.

Accordingly, the NCHS created a series of recoded insurance variables. For these recoded insurance variables, such as HIPRIVATEE, the data are back-edited, taking into account such factors as the proper classification of the verbatim names of insurance plans and responses to questions about why insurance coverage had stopped. The NCHS strongly advises analysts to use these recoded insurance variables as a more reliable source of information about the types of insurance coverage than is provided by respondents' original and unedited answers about their insurance type.

Related Variables[show more]

In addition to HIPRIVATEE, IPUMS NHIS contains other recoded insurance variables.
These are: HIHSE (Covered by Indian Health Service: Recode); HIMILITE (Covered by military health insurance: Recode); HICHIPE (Covered by Children's Health Insurance Program: Recode); HIMCAIDE (Covered by Medicaid: Recode); HIMCAREE (Covered by Medicare: Recode); HISTATEE (Covered by other state-sponsored health plan: Recode); HIOTHGOVE (Covered by other government program: Recode); and HINOTCOVE (No coverage of any type: Recode).

Comparability

The basic meaning of this variable and its universe are consistent over time. Comparability may, however, be limited by changes in the questions used to gather the information used for back-editing the data, by changes in the back-editing procedures used by the NCHS, and by the 2019 redesign.

The NHIS questionnaire was substantially redesigned in 2019 to introduce a different data collection structure and new content. For more information on changes in terminology, universes, and data collection methods beginning in 2019, please see the user note.

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