Codes and Frequencies
For sample adults and sample children (and, before 2019, all persons), HIPRIVATE is a recoded variable created by the IPUMS NHIS staff, which indicates whether the person was covered by a comprehensive private health insurance plan. For all years, those with single service plans only (i.e., those that paid for one type of care, such as nursing home care, accidents, or dental care) are not considered to have private health insurance. However, private plans that pay extra cash while hospitalized were considered to be health insurance until 1989.
For all years except 1990-1996, insurance coverage refers to coverage at the time of the survey; for 1990-1996, the reference period is the previous month.
Changing Definition of Private Health Insurance
Along with changes in question order and wording, the definition of private insurance changed over time, to reflect the changes in the availability of different types of private coverage and issues of interest. Users are strongly encouraged to review these changes in the User Notes Changes in Insurance Data Collection and Changes in the Definition of Private Insurance. A summary of such changes is provided below.
For 1976-1989, plans that only provide extra cash while the person was hospitalized were considered to be health insurance. However, the Field Representative's Manuals for these years instructed interviewers to exclude other forms of single service plans, such as "[those covering] dread diseases (cancer, polio), plans that pay only for accidents, plans that pay only for dental bills, [and] "income maintenance" (which pay a fixed amount both in and out of the hospital). Interviewers were also instructed to exclude public programs, including Medicaid, Medicare, public welfare, "Crippled Children's Program," care given to military personnel, and veterans' benefits.
For 1976 to 1992, the survey questions on private insurance asked about coverage for hospital, surgeon or doctor's bills. For 1986 and 1989, the question also included coverage for dentists' bills. The1986 Manual defined dental coverage as "any insurance which pays all or part of a dentist's bill for any dental services other than oral surgery." The 1989 and 1992 Manuals noted that dental coverage had to be part of a comprehensive plan, and not a single service plan, to count. For 1989 and 1992, single service plans were not considered to be private health insurance.
For 1993 to 1996, the Manuals instructed interviewers to consider single service plans as a form of private health insurance.
For 1997 forward, private health care plans are any insurance other than public programs. Such plans may be provided in part or in full by an individual's employer or union, and they may also be purchased directly. For 1997-2018, respondents were asked what kind of health insurance they had and shown a flashcard that listed types of insurance coverage. For 2019 forward, interviewers read the listed types of insurance coverage. Respondents could pick more than one type of insurance, and interviewers were instructed to mark all that applied.
Beginning in 2004, the Field Representative's Manuals instructed interviewers to treat COBRA and TCC coverage as private insurance. The Manuals discussion of COBRA and TCC was as follows:
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.
The survey questions collecting information about private insurance coverage changed over time.
- Is anyone in the family covered by hospital insurance, that is, a health insurance plan which pays any part of a hospital bill?
- Is anyone in the family now covered by a health insurance plan which pays any part of hospital, doctor or surgeon's bill?
- (Not counting Medicare) is anyone in the family now covered by a health insurance plan which pays any part of hospital, doctor or surgeon's bill?
- Health insurance can also be obtained privately or through a current or former employer or union. Was anyone in the family covered by private health insurance or by membership in a health maintenance organization in (month)?
- (Not counting the government health programs we just mentioned,) In (month) was anyone in the family covered by a private health insurance plan? Do NOT include plans that pay for ONLY ONE type of service, such as nursing home care or accidents.
- (Not counting the government health programs we just mentioned,) In (month) was anyone in the family covered by a private health insurance plan?
- 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)
For 1997 to 1999, only persons with an affirmative answer to the initial question about having insurance have responses to follow-up questions about the type of health insurance and the details of coverage; for 1997 to 1999, those who did not answer the initial question affirmatively 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").
The comparability of HIPRIVATE is limited somewhat by universe changes and the changes in question wording that are documented in the variable description.
Users should be aware that, to maximize comparability across multiple decades, the responses in HIPRIVATE were not edited for accuracy. HIPRIVATE is thus not comparable with the variable HIPRIVATEE,which was back-edited by NCHS staff for accuracy in the classification of coverage.
During the course of data editing, the NCHS discovered many errors in the responses to questions about insurance coverage. 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 categories on a flashcard. Beginning in 1997, plan names were used to back-edit responses to verify the accuracy of insurance type. (See the variable description for HINOTCOVE for a description of this back-editing process.)
HIPRIVATE, which reflects respondents' original replies without back-editing, is more suitable for studying private coverage both before and after 1997. Users should be aware, however, that some responses in HIPRIVATE were misreported. Analysis done by IHIS staff suggests that, between 2004 and 2009, approximately 1.0 percent of the sample responded incorrectly by reporting they had private insurance when they did not; another 0.7 percent of the sample thought they did not have private insurance when they actually did.
From 1990 to 1992, HIPRIVATE is part of the Family Resources supplement. All missing data in this supplement were imputed by the NHIS. Please refer to HIPRIVATEFL to identify persons with imputed data.
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.
- 1976: Persons with a health insurance plan that pays for any part of hospital, doctor or surgeon's bill (excluding Medicare and Medicaid or plans that pay only for accidents).
- 1978: Persons with a health insurance plan that pays for any part of a hospital bill (excluding Medicare or plans that pay only for accidents).
- 1980; 1982; 1984; 1986: All persons.
- 1983; 1993: Persons in quarters 3 or 4.
- 1989-1992: All persons.
- 1994-1996: All persons.
- 1997-2003: Persons covered by some type of health care plan.
- 2004-2018: All persons.
- 2019-2020: Sample adults age 18+ and sample children age 0-17.
- 1976, 1978, 1980, 1982-1984, 1986, 1989-2020