Codes and Frequencies
HIPCARER is a recoded variable created by the IPUMS NHIS staff, which indicates, for all persons with at least one private health insurance health plan, whether they had at least one private plan that was paid for by Medicare.
Rationale for Inquiry
Having a private plan paid for by the government program Medicare may seem counter-intuitive. Private insurance paid for by Medicare includes Medicare Private Fee-for-Service Plans, in which Medicare pays a set amount of money every month to the private insurance company, in order to provide health care coverage to people with Medicare on a fee-for-service basis. In such cases, the insurance company, rather than the Medicare Program, decides how much the individual pays for the services. Users can find more information on such plans at Medicare program's website at www.medicare.gov.
Data Collection Process
Information was collected on up to four private plans per family; for 2004 forward, only data on plans one and two are publicly available. Therefore, for 1997 to 2003, HIPCARER indicates whether the person had any one of four plans paid for by Medicare; for 2004 forward, it indicates whether the person had any of two plans paid for by Medicare.
Changes in the number of insurance plans considered should have little effect on the results for HIPCARER.
Persons with three or more plans have a "yes" response in HIPRIVGT2 (available for 2004 forward). Analysis by IHIS staff indicates that a very small number of persons (around 0.2 percent of the total number of individuals with private health insurance per year for 2004 to 2009) had three or more private insurance plans.
For all years from 1997 forward, interviewers first asked whether the person was covered by any kind of health insurance or some other kind of health care plan.
For 1997 to 1999, only people with an affirmative answer to this initial question have responses to follow-up questions about their kind of health insurance and the details of coverage; for 1997 to 1999, those who did not say "yes" are coded NIU (not in universe) for follow-up questions on insurance characteristics. Beginning in 2000, the response "no insurance" was included as a valid response to the initial question. Thus, for 2000 forward, the universe for follow-up questions on insurance coverage type and details was "all persons" (including those with an affirmative response to HINONE or "no insurance").
For each private insurance plan, respondents were asked, "Who pays for this plan?" and handed a card that listed various responses (including Medicare). Respondents could pick all that applied.
For 1997 forward, the NHIS Field Representative Manuals defined private health insurance to be any type of health insurance, including Health Maintenance Organizations (HMOs), other than the public programs of 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, for 1999 forward).
For 2001 forward, the Manuals indicated that insurance coverage through COBRA (the Consolidated Omnibus Budget Reconciliation Act of 1985) or by
TCC (Temporary Continuation of Coverage) should be classified as private health insurance (obtained through an employer or workplace).
For 1997 forward, the definition of private insurance remained largely the same, and consistently excluded single service plans. Over a longer time span, the definition and data collection process for private insurance changed greatly (as is documented in the User Notes on "Changes in the Definition of Private Insurance" and "Changes in the Data Collection Process").
HIPCARER is largely comparable over time.
The reduction in the number of plans for which data are publicly available has little effect on comparability, given the rarity of persons with more than 2 private insurance plans.
As new insurance programs became available, additions were made to the response categories for the question about who paid for private insurance plans.
The categories of self or family (living in the household), employer or union, someone outside the household, Medicare, and Medicaid were available for all years. For 1999 forward, respondents could report payment by the Children's Health Insurance Program. From 1998 forward, the category "state or local government or community program" was used in place of the 1997 category of "government program."
Errors in the reported type of insurance coverage, evidenced by a mismatch between the verbatim name of an insurance plan and the category chosen by the respondent from a flashcard, were corrected by NCHS staff, who reclassified some survey participants. Such back-editing of insurance data was initiated in 1997 and thus applies across all years of data for HIPCARER, raising no comparability problems for that variable.
- 1997-2018: Persons who are covered by a general private health insurance plan (excludes single service plans)
- 1997-2018 : PERWEIGHT