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HIPRIVATE
Has any private health insurance

Codes and Frequencies



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Description

For 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 forward, respondents were asked what kind of health insurance they had and shown a flashcard that 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:

If a respondent indicates that he/she is covered by COBRA (the Consolidated Omnibus Budget Reconciliation Act of 1985) or by TCC (Temporary Consolidation of Coverage), this should be coded as a Private Health Insurance Plan from employer or workplace. COBRA provides a bridge between health plans for qualified workers, their spouses and their dependent children when their health insurance might otherwise be cut off. Under this act, if a person voluntarily resigns from a job or is terminated for any reason other than 'gross misconduct,' they are guaranteed the right to continue in their former employer's group health insurance plan as an individual or family health care coverage for up to 18 months at one's own expense. In some cases, a spouse and dependent children are also eligible for COBRA coverage for as long as three years.

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.

Survey Questions

The survey questions collecting information about private insurance coverage changed over time.

 

1976, 1980

  • 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?
1980, 1982-1984,1986,1989
  • (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?
1986, 1989: or dentist bills, dental bills
1989: Do NOT include plans that pay for ONLY ONE type of service such as nursing home care or accidents.
1990-1991
  • 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)?
1992
  • (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.
1993-1996
  • (Not counting the government health programs we just mentioned,) In (month) was anyone in the family covered by a private health insurance plan?
1997 forward
Interviewers first asked, "Are you covered by health insurance or some other kind of health care plan?" Individuals who had an affirmative response were asked, "What kind of health insurance or health care coverage do you have?" Respondents were handed a flashcard that listed various insurance types and told to mark all that applied; response categories for private insurance 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)

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").

Comparability

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.)

The NCHS strongly advises analysts to use the back-edited insurance variables as a more reliable source of information about the types of insurance coverage than is provided by respondents' unedited answers about their insurance type. Most researchers studying the period for 1997 forward should use HIPRIVATEE to identify persons with private insurance coverage.

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.

Universe

  • 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.

Availability

  • 1976, 1978, 1980, 1982-1984, 1986, 1989-2018

Weights