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HIPTYPER
Has HMO or non-HMO plan

Codes and Frequencies



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Description

HIPTYPER is a recoded variable created by the IPUMS NHIS staff, which indicates, for all persons who had a general purpose private health insurance health plan, whether the plan was an HMO/IPA (Health Maintenance Organization or Individual Practice Association) or non-HMO/IPA.

For 1997 forward, private insurance characteristics reported by the family respondent, including HMO and IPA status, were edited by the NCHS staff, based on the plan name. See the comparability section for more details.

Definition of HMO and IPA 

For 1986 to 1996, the NHIS Field Representative's Manuals generally defined an HMO as a "health care plan that delivers comprehensive, coordinated medical services to enrolled members on a prepaid basis." (Prior to 1986, the Manuals did not define an HMO.) The Manuals further described listed three types of HMOs.

1) a Group/Staff HMO, which 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;

2) an IPA, which makes contractual arrangements with doctors in the community, who treat HMO members out of their own offices;
3) a Network HMO, which contracts with two or more group practices to provide health services.

The Manuals noted that "an HMO differs from other health insurance because it directly provides its members with most or all of their health care, while traditional health insurers simply process the claims. An HMO assumes responsibility for providing the treatment as well as paying the bills."

For 1997 forward, the Manuals defined HMOs as "health delivery systems that offer comprehensive health coverage for hospital and physician services for a prepaid, fixed fee."

Definition of Private Insurance

The definition of private insurance changed over time. Users are encouraged to review the User Note on "Changes in the Definition of Private Insurance." The description below is an abbreviated version of the information provided in that User Note.

 

For 1976 to 1992, private health insurance excluded single service plans that paid for only one type of service (such as nursing home care, accidents, or dental care). For 1976 to 1989, plans that paid extra cash while hospitalized counted as private insurance; such "extra cash plans" are not mentioned in the Manuals for 1992 and 1996.

For 1993 to 1996, single service plans were considered to be health insurance; however, only respondents who indicated their plan was a general purpose plan were asked the question for HIPTYPER. For 1997 and 1998, the definition of private insurance excluded single service plans. For 1999 forward, a separate category indicating single service plans was added to the survey, to better distinguish single service plans from comprehensive private health insurance.

For 1976 to 1989, the general definition of private insurance in the Field Representative's Manuals referred to plans "specifically designed to pay all or part of the hospital, doctor, surgeon, or other medical expenses of the insured individual" (including dentist expenses for 1989 and 1986). The Manuals further stated, "The plan, in order to be considered as insurance, must be a formal one with defined membership and benefits. Include Health Maintenance Organizations (HMOs) and Individual Practice Associations (IPAs), such as Kaiser, Group Health, etc."

For 1990 forward, the 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, CHIP (the Children's Health Insurance Plan, beginning in 1999), and health insurance from other government programs.

Survey Text

The questions used to collect information on HMO/IPA status of private insurance plans changed over time.

 

1997 forward Read 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.

  • Is {plan name} an HMO (Health Maintenance Organization), an IPA (Individual Practice Association), or is it some other kind of plan?
1993-1996Read if necessary: Health Maintenance Organizations, or HMO's and Individual Practice Associations, or IPA's, are plans whose members are required to use only those health care providers who work for or in association with the HMO or IPA. Sometimes there is an option to permit use of providers not associated with the Plan, but usually at greater cost to the enrollee. Generally, members do not have to submit claims for costs of medical care services.
  • Is (plan name) an HMO (Health Maintenance Organization) or IPA (Individual Practice Association), or is it some other kind of plan?
1986,1989, 1992 Read if necessary: Health Maintenance Organizations, or HMO's, sometimes called Individual Practice Associations or IPA's, are plans whose members are required to use only those health care providers who work for the HMO or IPA. Also, members do not have to submit claims costs of medical care services
  • Is this (name) plan a Health Maintenance Organization or HMO?

Number of Plans Included

Information was collected on up to five private insurance plans per family between 1980 and 1989 and on up to four plans for 1992 forward. However, only data for plans one and two are publicly available for 2004 and later years. Changes in the number of insurance plans considered should have little effect on the results for HIPTYPER.

 

Persons with three or more plans have a "yes" response to HIPRIVGT2 (available for 2004 forward). Analysis by IHIS staff indicates that a very small number of persons (less than 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.

Comparability

HIPTYPER is largely comparable over time, particularly for 1980-1996 and for 1997 forward. The reduction in the number of plans for which data are publicly available should have little effect, given the rarity of people with more than two private insurance plans. Although there were changes in the question wording and definition of private insurance (outlined in the variable description), those wording changes were slight, and consistently only people with comprehensive insurance were asked whether their plan was an HMO/IPA.

The most serious challenge to comparability is the implementation of back-editing of insurance data to correct respondents' misreporting of insurance type. Beginning in 1997, NCHS staff evaluated mismatches between verbatim insurance plan names and the type of coverage reported by respondents, and reclassified misreported cases into the proper category (e.g., from private insurance into Medicaid, or vice versa). (See HIPRIVATEE for more information on the back-editing process.) Analysis by IHIS staff indicates that each year from 2004 to 2009, around 1.6 percent of respondents who reported having private insurance did not have private insurance.

Therefore, for 1997 forward, details on private plan coverage, such as HIPTYPER, reflect responses for which the coverage type was back-edited. For earlier years, respondents may have misreported what type of insurance they had, and these errors were not corrected. Users should thus exercise caution in comparing results for HIPTYPER from before and after 1997.

Universe

  • 1980; 1982; 1984; 1986; 1989; 1990; 1991; 1992: Persons who are covered by a general health insurance plan (excludes single service plans)
  • 1983; 1993: Persons in quarters 3 and 4 covered by a general health insurance plan (excludes single service plans)
  • 1994-2017: Persons who are covered by a general health insurance plan (excludes single service plans)

Availability

  • 1980, 1982-1984, 1986, 1989, 1992-2017

Weights