INSURANCE STATUS AND ACCESS TO HEALTH-SERVICES AMONG POOR PERSONS

Objective. We examine the relationship between health insurance status and access to care among low-income persons 65 years of age and under , taking into account their social demographic characteristics and hea lth care needs. Data Sources and Study Setting. Study groups consist o f the subsamples of persons with incomes between 100 and 150 percent o f the federal poverty level and those below the federal poverty level interviewed in the 1983, 1984, and 1986 Health Interview Surveys (HIS) of the National Center for Health Statistics. Sample sizes range from about 6,000 to 11,000 depending on the proportion of each study group administered the insurance supplement. Study Design. Annual visits an d whether hospitalized during a year are used as measures of access to medical care. The analysis consists of identifying predictors of use of services (i.e., health status and social characteristics) and, taki ng them into account, examining the relationship of insurance status t o access to care. This was first undertaken on the 1983 survey; the mo dels obtained then are replicated on the other two years of data. Data Collection/Extraction Methods. The HIS utilizes in-person interviews to gather health and medical history information from a stratified ran dom sample of the U.S. population. Data were obtained through public u se tapes distributed by the National Center for Health Statistics. Pri ncipal Findings. Results am consistent for all three years among perso ns in poverty. Being covered by Medicaid, in contrast to having privat e insurance or being without health insurance, is related to use of bo th ambulatory care and hospital care. The access differences for perso ns in poverty, regardless of their vulnerability or ''risk'' of requir ing medical care, are marked and generally statistically significant. Among the near-poor the same findings occur, although the differences are less sharp and less often statistically significant. Conclusions. The most obvious explanation is that the poor, and to a considerable e xtent the near-poor, have limited access because of copayments and ded uctibles that are typically part of private insurance coverage. The fi ndings raise policy questions regarding the utility of either ''play o r pay'' employer-provided insurance or income tax deductions to increa se access.