Codes and Frequencies
For sample adults and sample children (and, prior to 2019, persons) with military health care coverage (HIMILITE), HITRICARE reports whether the person has TRICARE military health care. TRICARE is a regionally managed health care program for active duty and retired members of the uniformed services, their families, and survivors. TRICARE offers eligible beneficiaries four choices for their health care: TRICARE Prime, TRICARE Extra, TRICARE Standard and TRICARE for life. TRICARE (not an acronym) Standard became the name for traditional CHAMPUS (Comprehensive Health and Medical Plan for the Uniformed Services).
Interviewers handed respondents a flashcard that listed various types of insurance, including Military health care (TRICARE/VA/CHAMP-VA). Respondents who selected military health care were then asked to indicate whether they had TRICARE, VA, CHAMP-VA or other military coverage, and could select all that applied.
HITRICARE has not been edited by the National Center for Health Statistics (NCHS) to correct for errors in the type of insurance the person had. See the variable description for HIMILITE for more information.
Data Editing and Recoding
During the course of data editing, the 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 the card.
Accordingly, the NCHS created a series of recoded insurance variables. For these recoded insurance variables, such as HIMILITE, the data are back-edited, taking into account the verbatim names of insurance plans. The NCHS strongly advises analysts to use these recoded insurance variables as a more reliable source of information about the types of insurance coverage than is provided by respondents' original and unedited answers about their insurance type.
In the course of investigating this variable for integration, IPUMS NHIS staff observed inconsistencies in the universe for HITRICARE, HICHAMPVA, and HIMILITOTH in 2018. The 2018 person file layout documentation notes that all individuals who indicate they have military health care coverage in HIMILITE are in universe for HITRICARE, HICHAMPVA, and HIMILITOTH. However, there are a number of people who have a "yes" on HIMILITE who are out of universe for these three variables. The start of the inconsistencies coincides with the introduction of a new question in 2018 intended to address the undercount of individuals with VA coverage. There were no inconsistencies in the universes for these variables in earlier years.
HIMILITE is a constructed variable that was recoded on the basis of several questions. First, individuals were asked a question about what kind of health insurance or health care coverage they have. Those who selected "Military health care (TRICARE/VA/CHAMP-VA)" were coded to "yes" on HIMILITE. The respondents were subsequently asked questions about the name of their health insurance plans. If an individual named a military health care plan in one of these verbatim fields, but did not initially select that they had military health care coverage in the first question, their response to HIMILITE was recoded to "yes." Then, those who indicated military health care coverage were asked a question ascertaining the specific type of coverage with the following options: TRICARE, VA, CHAMP-VA, or other military coverage (specify). The individual's answer to this question provided the information for HITRICARE, HIVA, HICHAMPVA, and HIMILITOTH, respectively.
Beginning in 2018, NCHS added a question intended to address the undercount of individuals with VA coverage in NHIS. After ascertaining the specific type of military coverage from people who indicated they are covered by military health care, this question asked persons aged 18 and older who have ever served in the U.S. Armed Forces if they have ever enrolled in or used VA health care. In 2019, an additional question was added which asked if they received any care at a Veteran's Health Administration facility or received any other health care paid for by the VA during the past 12 months. Those who indicated "yes" to this new question had their value for HIMILITE recoded to "yes" and their value for HIVA recoded to "mentioned." However, because this recode of HIMILITE occurred after the question about the specific type of military health care and HITRICARE, HICHAMPVA, and HIMILITOTH were not edited for persons who indicated "yes" to the new question, there are individuals who were originally coded as out of universe for HITRICARE despite having a recoded value of "yes" on HIMILITE. For their analyses, users may wish to recode these individuals who are "yes" on HIIMLITE and "NIU" on HITRICARE as "no" to increase comparability with previous years. In 2018, there are 789 people who are "yes" on HIMILITE and are out of universe for HITRICARE. Of these 789 people, 788 of them are out of universe for HICHAMPVA and HIMILITOTH.
Other than inconsistencies in the universe, HITRICARE is comparable for years prior to 2019. Questionnaire changes introduced in 2019 may affect comparability with earlier years.
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.