Analysis of Children's Health Insurance Patterns: Findings from the SIPP. 2. Duration of New Spells of Uninsurance

05/12/1999

We have demonstrated that there are very pronounced demographic and socioeconomic differentials in the likelihood that a child is uninsured at a point in time or over the course of a year. Do these differences extend to the features of children's spells of uninsurance? In particular, are there important differences in the duration of spells of uninsurance by demographic or socioeconomic characteristics? We examined differentials in the distribution of completed spells of uninsurance among spells that started in FY93. Our findings with respect to demographic characteristics are presented in Tables 14 and 15. Socioeconomic differentials are reported in Tables 16 and 17.

As we explained in Appendix B, the durations of completed spells of uninsurance as measured in the SIPP incorporate a significant type of measurement error that greatly overstates the reported frequency of spells lasting exact multiples of four months. Consequently, the distributions reported in the tables that follow should not be interpreted literally. In particular, the 54 percent of all new spells that are reported as having been completed in 1 to 4 months is probably overstated, as some of the many spells identified as being completed in exactly 4 months undoubtedly lasted 5, 6, or even 7 months. Similarly, the percentage of spells lasting 13 months or more is probably understated, given the likely overreporting of spell durations of exactly 12 months. Intermediate spells are understated at the low end and overstated at the high end, with an uncertain effect on their overall frequency.9

TABLE 14: COMPLETED DURATION OF NEW SPELLS OF UNINSURANCE IN FY93, BY DEMOGRAPHIC CHARACTERISTICS AT START OF SPELL
Demographic Characteristic Completed Duration in Months Total
1 to 4 5 to 8 9 to 12 13+
All Children 54 16.9 9 20.1 100
Age of Child          
    Infant (0) 58.9 15.5 8.2 17.4 100
    1 to 5 56.7 14.2 9.3 19.8 100
    6 to 8 50.2 18.7 7.8 23.3 100
    9 to 10 53.2 19 8.3 19.4 100
    11 to 15 55.1 16.3 10.4 18.2 100
    16 to 18 49.8 20.2 8.1 21.8 100
Race/Ethnicity of Child          
    White Non-Hispanic 57 15.3 7.9 19.7 100
    Black Non-Hispanic 52 21.5 11.6 14.9 100
    Hispanic 50.1 16 8.8 25.2 100
    Other 50.6 18.9 10.2 20.3 100
Family Composition          
    Both Parents Present 49.7 18.2 8.9 23.2 100
    Mother Only Present 62.2 15 9 13.8 100
    Father Only Present 49.3 14.7 17.3 18.8 100
    No Parent Present 60.3 15.6 2.6 21.5 100
Metropolitan Residence          
    Metro 54.5 16.9 8.7 19.9 100
    Non-Metro 54.7 16.4 8.8 20.1 100
    Not Applicable 22.5 23.8 25.6 28.1 100
Region          
    New England 74.1 4.1 5.2 16.7 100
    Middle Atlantic 53.2 18.5 8.5 19.9 100
    East North Central 64.9 11.4 6.5 17.3 100
    West North Central 55.4 18.1 11.2 15.3 100
    South Atlantic 51.4 23.1 10.4 15 100
    East South Central 43.9 15.7 9.2 31.3 100
    West South Central 58.8 13.6 6.8 20.8 100
    Mountain 61.8 16.7 13.2 8.4 100
    Pacific 45.2 19.1 10.1 25.5 100
SOURCE: Survey of Income and Program Participation, 1992 Panel.

 

TABLE 15: DISTRIBUTION OF DEMOGRAPHIC CHARACTERISTICS BY COMPLETED DURATION OF NEW SPELLS OF UNINSURANCE, FY93
Demographic Characteristic Completed Duration in Months
1 to 4 5 to 8 9 to 12 13+
Age of Child 100 100 100 100
Infant (0) 6.9 5.8 5.8 5.5
    1 to 5 29.8 23.7 29.4 28.1
    6 to 8 13.5 16.1 12.7 16.8
    9 to 10 9.6 11 9 9.4
    11 to 15 24.9 23.5 28.1 22.1
    16 to 18 15.4 19.9 15 18.1
Race/Ethnicity of Child 100 100 100 100
    White Non-Hispanic 53.3 45.7 44.5 49.7
    Black Non-Hispanic 20.4 26.9 27.3 15.8
    Hispanic 22.9 23.4 24.2 31
    Other 3.3 4 4 3.6
Family Composition 100 100 100 100
    Both Parents Present 55.1 64.4 59.4 69.3
    Mother Only Present 34.8 26.8 30.3 20.8
    Father Only Present 4.2 4 8.8 4.3
    No Parent Present 5.9 4.9 1.5 5.6
Metropolitan Residence 100 100 100 100
    Metro 75.1 74.4 71.9 73.7
    Non-Metro 24.3 23.3 23.5 24
    Not Applicable 0.7 2.3 4.6 2.3
Region 100 100 100 100
    New England 4 0.7 1.7 2.4
    Middle Atlantic 11 12.2 10.5 11
    East North Central 17.4 9.7 10.4 12.4
    West North Central 6.4 6.7 7.8 4.8
    South Atlantic 15.6 22.4 19.1 12.2
    East South Central 6.6 7.5 8.3 12.6
    West South Central 15.5 11.4 10.8 14.8
    Mountain 5.2 4.5 6.7 1.9
    Pacific 18.4 24.8 24.7 27.8
SOURCE: Survey of Income and Program Participation, 1992 Panel.

 

TABLE 16: COMPLETED DURATION OF NEW SPELLS OF UNINSURANCE IN FY93, BY SOCIOECONOMIC CHARACTERISTICS AT START OF SPELL
Socioeconomic Characteristic Completed Duration in Months  
1 to 4 5 to 8 9 to 12 13+ Total
Poverty Level          
    Less than 50% FPL 62.8 15.5 8.1 13.7 100
    50% to < 100% FPL 55.3 17 8.6 19.1 100
    100% to < 200% FPL 50.8 17.8 8.6 22.8 100
    200% to < 300% FPL 51.2 13.6 11.4 23.8 100
    300% FPL or Greater 53 19.7 9.5 17.8 100
Parents' Employment          
    1 or More Full Time 53.5 17.2 8.5 20.8 100
    Part Time Only 49.8 20.2 13.1 16.8 100
    No Working Parent 56.3 14.5 10.5 18.7 100
    No Parent Present 60.3 15.6 2.6 21.5 100
Parents' Education          
    No Parent Present 60.3 15.6 2.6 21.5 100
    6 Years or Less 46 13.9 7 33.1 100
    7 to 11 Years 54.9 11.1 11.6 22.4 100
    12 Years 50.5 20.2 8.3 21 100
    Attended College 56.2 16 10.8 17 100
    4-Year College Degree 63.9 13.1 8.8 14.2 100
    Graduate Work 54.9 26 6.6 12.5 100
SOURCE: Survey of Income and Program Participation, 1992 Panel.

 

TABLE 17: DISTRIBUTION OF SOCIOECONOMIC CHARACTERISTICS BY COMPLETED DURATION OF NEW SPELLS OF UNINSURANCE, FY93
Socioeconomic Characteristic Completed Duration in Months
1 to 4 5 to 8 9 to 12 13+
Poverty Level 100 100 100 100
    Less than 50% FPL 17.8 14 13.8 10.4
    50% to < 100% FPL 24.5 24 22.8 22.7
    100% to < 200% FPL 34.3 38.3 34.9 41.4
    200% to < 300% FPL 12.2 10.3 16.3 15.3
    300% FPL or Greater 11.3 13.4 12.2 10.2
Parents' Employment 100 100 100 100
    1 or More Full Time 65.8 67.6 62.5 68.9
    Part Time Only 9.1 11.8 14.5 8.3
    No Working Parent 19.2 15.8 21.5 17.1
    No Parent Present 5.9 4.9 1.5 5.6
Parents' Education 100 100 100 100
    No Parent Present 5.9 4.9 1.5 5.6
    6 Years or Less 5 4.8 4.6 9.7
    7 to 11 Years 18 11.6 22.8 19.7
    12 Years 33.8 43 33.4 37.7
    Attended College 22.6 20.5 26.1 18.3
    4-Year College Degree 8.4 5.5 6.9 5
    Graduate Work 6.4 9.7 4.7 3.9
SOURCE: Survey of Income and Program Participation, 1992 Panel.

Despite this measurement error in the reported durations of spells, differentials in the relative frequency of spells of different length may carry important information about differences in the experience of uninsurance among children across demographic and socioeconomic subgroups. We recognize, though, that measurement error in the reporting of durations may vary by these same characteristics and either weaken or distort the observed relationships.

The results reported in Table 14 suggest that, generally, demographic differentials in the reported duration of children's spells of uninsurance are weak at best. There are no meaningful differences by age. With respect to race and ethnicity we find that Hispanic children have the fewest spells of 1 to 8 months in length and the most spells of 13 months or longer, but the differences between Hispanic children and other children are modest. Turning to family composition, we find that children in mother-only and no parent families have the highest incidence of spells reported to have lasted 4 months or fewer while children in mother-only families also have the lowest incidence of spells exceeding 12 months. There are no differences by metropolitan residence but there are differences by region. Spells tend to be shortest in New England and longest in the East South Central and Pacific regions. The size of the Hispanic populations in these latter areas may contribute to the longer duration of spells, given that Hispanic children appear to have the highest frequency of long spells. Finally, the East North Central and mountain regions join New England in having relatively short durations, but beyond this the regional differences are inconsistent.

With relatively weak differentials in the duration of uninsurance spells by demographic characteristics, we would not expect the distribution of demographic subgroups of uninsured children to vary much by spell duration. Table 15 shows the distribution of demographic subgroups of uninsured children within each grouping of spells by duration. Age composition shows no meaningful variation by spell duration. Race and ethnic composition show very limited variation. Non-Hispanic white children represent a somewhat larger share of 1 to 4 month spells than they do of longer durations while Hispanic children represent a larger share of spells exceeding 12 months than they do of shorter spells. Non-Hispanic black children appear with relatively greater frequency among spells of 5 to 12 months than they do among shorter or longer spells. Children in mother-only families represent 35 percent of 1 to 4 month spells compared to only 21 percent of 13 month or longer spells. Children in two-parent families show the opposite tendency. They represent 69 percent of the longest spells but only 55 percent of the shortest spells. Metropolitan residence continues to show no consistent variation while there are small regional differences. Children from New England and the East North Central states appear with greater frequency among 1 to 4 month spells than among longer spells while children from the Pacific states account for only 18 percent of the 1 to 4 month spells but 28 percent of the 13 month and longer spells.

Like demographic characteristics, socioeconomic characteristics display a much weaker association with spell duration than with the incidence of uninsurance. In Table 16 we see that poverty has a weak, inverse relationship with spell duration. Children from the poorest families tend to experience a higher frequency of very short spells and a lower frequency of long spells than children from less poor or higher income families. We speculate that this may reflect the impact of Medicaid as a source of coverage that is more available to children in very poor families than it is to children in less poor families. The highest incidence of spells lasting 13 months or more occurs

among children between 100 and 300 percent of poverty. Long spells decline in frequency in the top income class. Spell length shows a very inconsistent relationship with parents' employment, with no category being associated unambiguously with long spells or short spells. For example, children with no parent present are most likely to have spells of 1 to 4 months and spells of 13 months or longer. To some extent this inconsistency may be due to the fact that parents' employment is itself a dynamic characteristic. Differentials in the duration of uninsurance may depend on when we measure parents' employment (before, during, or after a spell of uninsurance). In Table 16, as the title indicates, we measure characteristics at the start (that is, in the first month) of a spell, which gives us a uniform measure across spells and increases the likelihood that the characteristics we observe are associated with why the child is uninsured. If we measure socioeconomic characteristics at only one point in time, clearly this is he preferred point to do so. But this is not to say that there is nothing to be learned by examining differentials in duration by income and parents' education measured at another point in time.

The educational attainment of children's parents has a moderately strong, inverse relationship to the duration of spells of uninsurance. This is most evident in the proportion of children with durations of 13 months or longer, which declines monotonically from 33 percent to 12 percent as parents' education rises (excluding the children with no parent present). It shows up as well in the proportion of children with spell durations of 8 months or less, which rises--also monotonically--from 60 percent to 81 percent as parents' education increases.

Socioeconomic differentials are even less evident in the shares of children completing spells of different durations (Table 17). Children in families below 50 percent of poverty represent an increasingly smaller share of spells as duration rises, but there are no other consistent patterns by poverty level. This lack of consistency is true of differences in shares of spells represented by children classified by their parents' employment and parents' education. The fact that we see such weak differences in spell shares by parents' education despite the fairly strong differences in the distribution of spell length by parents' education appears to be due to the small numbers of uninsured children whose parents fall into the lowest and highest levels of education. Children whose parents completed less than 7 years of schooling account for twice as many of the longest spells as they do all shorter spells, but this represents only a five percentage point difference. Similarly, children whose parents completed some graduate school represent only half as many of the longest spells as they do spells of 8 months or less, but this is only a 4 percentage point difference.

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