Codes and Frequencies
For persons in families with at least one private insurance plan, HINAME1 is a recoded variable that indicates whether the first plan mentioned was a fee-for-service (FFS, such as "Blue" plans) or was some type of managed care plan (e.g. health maintenance organization (HMO), preferred provider organizations (PPO), or point-of-service (POS) plans), or a fee-for-service plan (FFS), or a single service plan (for 1993-1996), or some other form of health insurance.
The word "name" is used in the label of this variable because the plan type was determined based on the verbatim response to a question on the plan name. Interviewers were specifically instructed to record the name of the plan, and not the type of plan; responses were matched against a master list and recoded to the type by NCHS staff. Respondents were asked "What the complete name of the first plan?" If necessary, interviewers asked, "Do you have your health plan card or something with the plan name on it?"
The 1993Field Representative's Manual, the first year for which definitions of insurance types were available, provided the following definitions, which were unchanged through 1996:
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.
In 1997, Field Representative's Manual provided the following definition, which was read to respondents if necessary.
"Health Maintenance Organizations, or HMOs, and Individual Practice Associations, or IPAs, are plans whose members are required to use only those doctors who work for or in association with the plan. Sometimes members may choose to go to doctors not associated with the plan, but usually at greater cost to the member. Generally, members do not have to submit claims for costs of medical care services."
The 2002 Manual provided the following terms:
Fee-For-Service: These are the "traditional kind of health care policy. Insurance companies pay fees for the services provided to the insured people covered by the policy. This type of health insurance offers the most choices of doctors and hospitals. You can choose any doctor you wish and change doctors at any time. You can go to any hospital in any part of the country. With fee-for-service, the insurer only pays part of your doctor and hospital bills. A fee-for-service plan pays for covered services after the services have been received. This is also known as an indemnity plan."
IPA: "a type of HMO that contracts directly with physicians in independent practices; and/or contracts with one or more associations of physicians in independent practices or multi-specialties. The plan is predominately organized around solo/single practices."
PPOs or Preferred Provider Organizations : "a form of managed
care, although not a "traditional" HMO. Enrollees in PPOs are encouraged to use designated, or preferred health providers. Financial incentives for individuals include lower payments or coinsurance, and maximum limits on out-of-pocket costs for in- network use. PPOs are less restrictive than HMOs in that visits to specialists are not dependent upon authorization by a member's primary care physician. Unlike HMOs, out of network usage is allowed by PPOs, although at a higher cost to the enrollee."
POS, or Point of Service Plans: "a form of managed care, although not a "traditional" HMO. POS plans allow for "opt-out", or out-of-network coverage, but accompanied by strong economic incentives to the enrollees to use network providers. POS plans usually use gatekeepers for referrals to specialists within the network. It is this attitude that most readily distinguishes a POS plan from a PPO."
Single Service Plan (SSP) : "a 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."
Please use the IPUMS NHIS drop-down menus and search function for other related variables.
For 1992 to 1996
Details about the characteristics of insurance plans (such as HINAME1) reflect plans for any family member in the household. In order to determine if the person (rather than someone else in the family) was covered by this plan, analysts should use the variable HI1PCOV (Health Insurance Plan 1: Person's Coverage Status), which indicates whether the person was covered by the plan.
Information was collected on up to four private plans.
Thus, information about the type of insurance the person is also provided in: HINAME2 through HINAME4. Likewise, the complementary variables HI1PCOV through HI4PCOVindicate coverage status for the individual under each plan.
Details about the characteristics of private insurance plans relate to plans for all household family members. (Proxy reporting was allowed, so one person might provide this information for all family members). Information was collected on up to four plan types; for 2004 forward, data is publicly available for only two plans. Users are strongly encouraged to review the user notes Insurance Data Collection and Private Insurance Definitions.
Persons with three or more plans have a "yes" response to the HIPRIVGT2 variable (available for 2004 forward). Additional information for the third and fourth plans for a person is available through a Data Research Center.
This variable is not entirely comparable over time. For 1993 to 1996, persons with private insurance, which included single service plans, were asked about the plan name. Only those with plans that paid for a variety of services were asked about whether the plan was an HMO. In 1992 and for 1997 forward, those with single service plans did not receive this question.
For 1997 forward, details of private plans also reflect back editing by the NCHS staff, who verified the accuracy of the reported type of insurance coverage (e.g., whether the plan reported by the family was private coverage).
Because these caveats limit comparability, users may wish to exercise caution when examining changes in type of plan for years prior to 1997 with 1997 forward.
- 1992: Persons with a health insurance plan that pays for any part of a hospital or doctor bills (but not plans that pay for only type of service).
- 1993: Persons in quarters 3 or 4 covered by a private health insurance plan including single service plans.
- 1994-1996: Persons covered by a private health insurance plan including single service plans.
- 1997: Persons with at least 1 health insurance plan obtained through their employer or workplace or purchased directly, or Medi-gap.
- 1998-2003; 2004-2007: Persons with at least 1 health insurance plans obtained through work, purchased directly, or through a State or local government or community program or Medigap.