Codes and Frequencies
For sample adults and sample children (and, prior to 2019, persons) who are currently covered by health insurance (specifically excluding armed forces members in 1997-1999), HINOTYR reports whether, in the past 12 months, there was any time the person did not have any health insurance coverage.
Thus, throughout the period, HINOTYR is asked of people (specifically excluding armed forces members in 1997-1999) who report currently having health insurance coverage via any of the following: private health insurance, including Medi-Gap; Medicare; Medicaid; Children's Health Insurance Program; Military health insurance (including Military Health Care/VA and TRICARE/CHAMPUS/CHAMP-VA); Indian Health Service; State-sponsored public health care coverage plans; and other government programs.
For 2000-2018, HINOTYR is not asked of people reporting only single service plan coverage.
Use of HINOTYR
According to the NCHS, HINOTYR should not be used to estimate the prevalence of uninsurance, due to data errors.
During the course of data editing, the National Center for Health Statistics (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 a card provided by the interviewer. Accordingly, the NCHS created a series of recoded insurance variables. For these recoded insurance variables, 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.
Because of errors in respondents' original (unedited) answers to questions about insurance coverage, the NCHS warns that "the variables HILAST and HINOTYR, which reflect periods of non coverage, cannot be used to estimate the rate of uninsurance."
Instead of using HINOTYR, researchers should use the health insurance recodes, estimating the rate of uninsurance as a residual, according to NCHS. Please see the variable description for HIPRIVATEE [Covered by private health insurance: Recode].
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.
The choices included:
- 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.
Respondents were consistently instructed to exclude private plans that "only provide extra cash while hospitalized," but the treatment of single service plans varied by year.
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)." Beginning in 1999, "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)."
Follow-up questions collected information about the names of coverage plans and confirmed the lack of any type of coverage for the uninsured.
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, in sequence, 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. Those who did acknowledge any such coverage were asked the question associated with HINOTYR, namely, "In the past 12 months, was there any time when [person] did not have any health insurance coverage?"
As noted in the description of the variable, the NCHS warns that HINOTYR "cannot be used to estimate the rate of uninsurance."
The variable is largely comparable for 1997 forward, with four exceptions:
- 1997-1999: As noted above, in this period the NHIS instrument specifically excludes armed forces members.
- 2000: The explicit exclusion of armed forces members, present in 1997-1999, was dropped beginning in this year.
- 2000-2018: In contrast to 1997-1999, the NHIS instrument explicitly instructs that people reporting only single service plan coverage not be asked this question.
- 2019 forward: In this period the NHIS instrument includes respondents who said they were covered by any kind of insurance or answered affirmatively to a probe on whether they had Medicare or Medicaid if they previously reported they did not have insurance coverage. Coverage by single service plans are asked as separate questions and do not impact whether a respondent was included for this period.
Throughout the period 1997 forward, the question associated with HINOTYR is asked of persons who report currently having health insurance coverage via any of the following: private health insurance, including Medi-Gap; Medicare; Medicaid; Children's Health Insurance Program; Military health insurance (including Military Health Care/VA and TRICARE/CHAMPUS/CHAMP-VA); Indian Health Service; State-sponsored public health care coverage plans; and other government programs.
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.
- 1997-1999: Persons who now have health insurance coverage, excluding persons in military families.
- 2000-2018: Persons who now have health insurance coverage.
- 2019-2021: Sample adults age 18+ and sample children age 0-17 who now have health insurance coverage.