Monitoring Outcomes for Former Welfare Recipients: A Review of 11 Survey Instruments. Access to Health Care and Health Status

08/11/1999

Grantees did not ask as many questions about access to health care and health care status as they did about food security.  Four grantees did not include any questions, four asked only question, and three asked three to five questions, as shown in Table V.

Table V:  Access to Health Care and Health Status

Questions
Was anyone in your home sick or hurt or in need of doctor, but could not afford to get medical care? X
X
C
  X
X
X
 
X
 
X
 
X
 
        6
Satisfaction with quality of health care   X C                   1
Health status X
C
X
C
X                 3
Total 5 4 3 1 1 1 1 0 0 0 0 0

X = Question asked of adult;  C = Question asked about children in household.

Notes:
Florida asks this type of question three times:

  1. If could not afford care since left TANF;
  2. If need medical care and unable to obtain it at the present time; and
  3. If children in need of medical care at present time.

 

The Cuyahoga/L.A. survey asks two questions, first whether unable to go see doctor or hospital because of lack of money or medical insurance, and second, whether unable to see dentist.

The most common question related to whether or not there was somebody in the home who was ever sick or hurt but unable to afford to get medical care.  Six grantees asked a version of this question, which is asked in the National Health Interview Survey (NHIS), the Survey of Income and Program Participation (SIPP), and other national surveys.  Five asked whether this had occurred “since leaving TANF.”  In some cases this time interval may be four months, in other cases, nine to twelve months, depending on the timing of the survey interview relative to TANF exit in the various studies.  The sixth grantee, the Cuyahoga/L.A. survey explicitly asks whether the adult or her children or spouse/partner have been unable to see a doctor or go to the hospital in the past twelve months.  This has the advantage of being similar phrasing as in the NHIS and the SIPP, and so can be more easily compared.  As in the SIPP, the Cuyahoga/L.A. survey repeats the question with regard to seeing a dentist.  Two grantees (South Carolina and Wisconsin) ask about lack of access to needed health care during the time period the former recipient was on welfare, as well as since exit from welfare.

In Florida, the general question about not being to afford medical care when sick or hurt is supplemented by two later questions:  whether the respondent needs medical care and cannot obtain it at the present time, and whether children are unable to obtain needed medical care at the present time.  It will be interesting to learn how these “current time” questions fare.

Three grantees ask about health care status.  Florida and Cuyahoga/L.A. use the same wording as in National Health Interview Survey and the Survey on Income and Program Participation, that is, “would you say that in general your health is excellent, very good, fair or poor?”  Illinois asks how satisfied or dissatisfied the respondent is with her personal health and physical condition, and that of her children.  Illinois also asks about satisfaction with the quality of the health care that the family can afford, and further, whether the respondent thinks, in terms of medical care for her children, she is better off, worse off, or about the same as when she left welfare.  Finally, although not included in this analysis, a number of surveys include questions about personal or child health disability or sickness that may pose barriers to employment.