Health services utilization in the U.S. population by health insurance coverage.

Abstract

The goal of the National Medical Care Utilization and Expenditure Survey (NMCUES) is to improve the understanding of the ways in which Americans use and pay for health care. This report is one in a series of descriptive reports based on NMCUES data. Data concerning several aspects of insurance coverage were collected from household respondents in NMCUES. These data included the kind of insurance in effect for each person (Medicare, Medicaid, private, or other) and the use of inpatient and ambulatory health services. The purpose of this report is to provide descriptive information about the distribution of insurance coverage among the U.S. population and the use of inpatient and ambulatory services by people with different kinds of insurance. The results presented are based on data collected about the civilian noninstitutionalized persons in the NMCUES national household sample. In this report, "person-year" estimates for health insurance coverage are used; that is, individuals are assigned to different categories of insurance coverage according to the proportion of the year that they were covered by each kind of insurance. Although estimates are calculated as person-years of coverage, they are expressed as persons covered for convenience. Two important subpopulations--persons under 65 years of age and persons 65 years of age or over--are addressed separately because they have different patterns of insurance coverage and because utilization is so heavily influenced by age. Persons 65 years of age or over used significantly more inpatient and ambulatory services than persons under 65 years of age did. Only those in the younger group with Medicare, who were disabled, had utilization rates very similar to those of the aged. Persons under 65 years of age are classified by six mutually exclusive insurance categories: All Medicare. Medicaid, no private health insurance. Private health insurance, no Medicaid. Medicaid and private health insurance. Other coverage only. No insurance. Persons 65 years of age or over are classified by four mutually exclusive categories: Medicare only. Medicare and Medicaid. Medicare and private or other coverage. No Medicare. These categories of insurance coverage describe the kind of organization or program that supplies the coverage. With the exception of Medicare, which is a national program, these classifications provide little information about the scope of benefits and level of payment available to people who are covered. Considerable variation exists by State within the Medicaid category and by plan or program within the private insurance and other coverage categories.(ABSTRACT TRUNCATED AT 400 WORDS)