U.S. Department of Health and Human Services
Disability, Health Insurance Coverage, and Utilization of Acute Health Services in the United States
Executive Summary
Mitchell P. LaPlante
Institute for Health and Aging, University of California, San Francisco
October 1993
This report was prepared under contract #G0087C2014 with the University of California, San Francisco. Funding was provided by the U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and the Department of Education, National Institute for Disability and Rehabilitation Research. For additional information about the study, you may visit the DALTCP home page at http://aspe.hhs.gov/daltcp/home.htm or contact the office at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, SW, Washington, DC 20201. The e-mail address is: webmaster.DALTCP@hhs.gov. The DALTCP Project Officer was Michele Adler.
Health insurance facilitates access to health services and provides some protection against large and unforeseen health care expenses (Office of Health Policy and U.S. Department of Health and Human Services, 1987). However, at least 33 million Americans under age 65 lack health insurance coverage (Short, 1992; Short, Monheit, and Beauregard, 1989; U.S. Bureau of the Census, 1991a) and the rate of uninsurance appears to be rising (Himmelstein, Woolhandler, and Wolfe, 1992; U.S. Bureau of the Census, 1991a; U.S. Bureau of the Census, 1991b; U.S. Bureau of the Census, 1992) especially since 1989. The rate of uninsurance is high among racial and ethnic minorities and people with low incomes. These populations have elevated rates of illness and elevated need for health services (Bunker, Gomby, and Kehrer, 1989), raising the issue of how well the American health care system provides coverage to populations with elevated health needs.
People with disabilities as a group rank highest among populations with elevated need for short- and long-term health services. People with disabilities have significantly higher rates of physician contacts and hospitalization compared to those without disabilities and 3.6 times higher per capita costs of care in 1980 (Rice and LaPlante, 1992). Like other nonelderly Americans, children and adults with disabilities are at risk of being uninsured for health care (Mathematica Policy Research, 1989) and as a result may receive less care than the insured (Davis and Rowland, 1983).
Disability occurs when health impairments (caused by congenital or developmental conditions, chronic illness, or injury) limit human action or activities. the severity of disability can be defined from minor to major by the importance of the actions and activities that are limited and the degree to which they are limited (Verbrugge, 1990). Since disability causes people to withdraw from work, and employment is the gateway to private insurance coverage, many people unable to work depend on public insurance coverage. But public insurance coverage is provided to people with the most "severe" disabilities and people who are poor in certain "needy" categories, such as single parents with children. People with less "severe" disabilities and marginal financial means are at greater risk of being uninsured (Mathematica Policy Research, 1989).
This report uses data from the 1989 National Health Interview Survey--the largest and most recent sample of the U.S. population with detailed disability and health insurance information--to estimate health insurance coverage of children and nonelderly adults with disabilities and their utilization of physician and hospital care as a function of health insurance status. The results are divided in three sections: in part 1, national statistics on disability and insurance status are provided for several different measures and categories of disability. Estimates of the percent of the population with various types of insurance coverage (private, Medicare, Medicaid, military, and other insurance) or with no insurance coverage are provided by sociodemographic and disability status. In part 2, the relationship of insurance to the utilization of health care of people with simultaneously control for other sociodemographic factors are developed to measure the impact of insurance on utilization of health services. Finally, in Part 3, the relationships of poverty, employment, and disability with private insurance--and whether employment-based or not--public insurance, and uninsurance are examined to help frame certain policy options.
REFERENCES
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Davis, K., & Rowland, D. (1983). Uninsured and underserved: Inequities in health care in the United States. Milbank Memorial Fund Quarterly: Health and Society, 61(2), 149-176.
Himmelstein, D.U., Woolhandler, S., & Wolfe, S.M. (1992). The vanishing health care safety net: new data on uninsured Americans. International Journal of Health Services, 22(3), 381-96.
Mathematica Policy Research (1989). Population Profile of Disability. Washington, DC: Assistant Secretary for Planning and Evaluation, Department of Health and Human Services.
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Rice, D.P., & LaPlante, M.P. (1992). Medical expenditures for disability and disabling comorbidity. American Journal of Public Health, 82(5), 739-41.
Short, K. (1992, May). Health Insurance Coverage: 1987-1990 (Selected data from the Survey of Income and Program Participation). Current Population Reports, Series P-70 (29). Washington, D.C.: U.S. Bureau of the Census.
Short, P.F., Monheit, A.C., & Beauregard, K. (1989). A Profile of Uninsured Americans. National Medical Expenditure Survey Research Findings 1 (DHHS Pub.No. PHS 89-3443). Rockville, Maryland: Public Health Service, Agency for Health Care Policy and Research.
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Verbrugge, L.M. (1990). The Iceberg of Disability. In S.M. Stahl (Eds.), The Legacy of Longevity (pp.55-75). Newbury Park, Pennsylvania: Sage Publications.