Codes and Frequencies
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Description
For persons in families with at least five comprehensive private insurance plans, HI5HMO indicates whether the fifth plan mentioned was a health maintenance organization (HMO). This variable is similar to HI5HMOCOVR (Health insurance plan 5: HMO coverage recode), but HI5HMO has not been recoded. HI5HMO reports the verbatim response to the yes/no question, "Is this (name) plan a Health Maintenance Organization or HMO?"
Related variables
Please use the IPUMS NHIS drop-down menus and search function for other related variables.
Definitions
In all years, if respondents were unsure what an HMO was, interviewers provided a definition for them. This definition varied slightly between 1986 and 1989 forward, but this does not greatly affect comparability.
[show more]The 1986 Field Representative's Manual, provided a detailed definition of HMOs, and that definition was not substantially changed through 1996. The 1986 definition was as follows:
Health Maintenance Organization (HMO) : A health care plan that delivers comprehensive, coordinated medical services to enrolled members on a prepaid basis. There are three basic types of HMOs:
- Group/Staff HMO: Delivers services at one or more locations through a group of physicians that contracts with the HMO to provide care or through its own physicians who are employees of the HMO.
- An Individual Practice Association (IPA): Makes contractual arrangements with doctors in the community, who treat HMO members out of their own offices.
- Network HMO: Contracts with two or more group practices to provide health services.
An HMO directly provides its members with most or all of their health care, while traditional health insurers simply process claims. An HMO assumes responsibility for providing treatment as well as paying the bills.
Details about the characteristics of private insurance plans (such as in HI5HMO) relate to plans for all family members in the household. To ascertain whether a person is covered by Plan 5, researchers must also use the variable HI5PCOV (Health Insurance Plan 5: Person's Coverage Status).
Information was collected on up to four private plans in 1992 and on up to five plans per family in 1986 and 1989.
[show more]Thus, information about participation in an HMO through the family's private insurance plan(s) may appear in multiple variables: HI1HMO, HI2HMO, HI3HMO, HI4HMO, and HI5HMO. Likewise, the complementary variables HI1PCOV , HI2PCOV, HI3PCOV, HI4PCOV, and HI5PCOV indicate coverage status for the individual under each plan.
Users may prefer to use the constructed variable HIPTYPER, which was created by the IHIS staff and which indicates whether the person was covered by any plan that was an HMO.
Users are strongly encouraged to review the user notes Insurance Data Collection and Private Insurance Definitions.
Comparability
This variable is comparable for 1989 forward, but changes in the definition of private insurance somewhat reduce comparability with 1986. In 1986, respondents were not explicitly told to exclude single service plans when asked about insurance coverage, whereas for 1989 forward, they were explicitly told to exclude such plans.
HI5HMO is not fully comparable with reported HMO coverage for 1997 forward or with the recoded variable HI5HMOCOVR since the latter reflect edits based on the plan name. Because of the editing process that NCHS used to verify insurance status for 1997 forward, users should be cautious in analyzing type of insurance plan (e.g., HMO, FFS, PPO, etc.) status over time. The pre-1997 variables, such as HI5HMO, reflect reporting of private coverage that has not been verified for accuracy (i.e., not been subject to NCHS editing).
Universe
- 1986;1989: Persons covered by health insurance plan (excluding plans that paid for only one type of service), other than Medicare, that pays any part of hospital, doctor's, surgeon's, or dentist's bill.
Availability
- 1986, 1989
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Weights
- 1986, 1989 : PERWEIGHT