Health Insurance Coverage Along the US-Mexico Border: An Overview

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Health Insurance Coverage Along the US-Mexico
Border An Overview

• Juan R. Albertorio-Díaz, MA
• Jill Marsteller, Ph.D.
• National Center for Health Statistics
• Center for Disease Control and Prevention

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Objectives

• Upon completion of this presentation
• Quantify the lack of health insurance along the
  US-MX Border by ethnicity
• Evaluate access to health care by ethnicity and
  insurance status

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What to do?

• Tailor a Healthy People program that addresses
  the health needs on the Border
• Healthy Border 2010 Program

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Healthy Border 2010 common topic areas
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Timeline US questionnaire and survey design,
Behavioral Risk Factor Surveillance Survey
(BRFSS)

• Border Health Behavioral Risk Factor Survey
  (BHBRFS)
• Feb. 2004 First meeting in El Paso
• Feb. 2004 First draft of questionnaire, based
  on BRFS
• March 2004 Draft funding agreement and draft 2
  of questionnaire
• April-June 2004 Multiple drafts of
  questionnaire
• July-Sept 2004 Texas border survey
• April 2005 Questionnaire revision based on
  pilot survey results
• Began with literal translation of US
  questionnaire
• Questionnaire modified using cognitive
  interviewing techniques
• Cognitive interviewing workshop held in El Paso,
  July 2005
• Participants from US and Mexico
• Cognitive techniques applied to sample of
  respondents in Juarez
• Led to many changes/improvements in
  Spanish-language questionnaire
• Spanish questionnaire will be used in US as well

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Methodology

• Merged 4 years of the Inhouse National Health
  Interview Survey (2000-2003)
• Analysis limited to adult (18)
• Ethnicity (Hispanic vs. Non Hispanic)
• Uninsured Status
• Did not have any private health insurance,
  Medicare, Medicaid, SCHIP, State sponsored or
  other government sponsored health plan, or
  military plan at the time of the interview.
• Had only Indian Health Service coverage or had
  only a private plan that paid for one type of
  service such as accident or dental care.
• Border Vs. Non Border counties, 4 Border states
  combined and the U.S.
• Use SPSS 13.0 Complex sample module

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Border adult population are more likely to not
have health insurance at the time of the
interview 2000-2003
Stat significance at 95
Source Inhouse National Health Interview Survey,
2000-2003
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Hispanics at the Border are more likely to not
have health insurance coverage than Hispanics
nationally 2000-2003
Source Inhouse National Health Interview Survey,
2000-2003
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Hispanics at the Border are more likely to not
have health insurance coverage than Hispanics in
all region examined 2000-2003
Source Inhouse National Health Interview Survey,
2000-2003
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Hispanics are more likely to not have a usual
place to receive health care when they are sick
or need advice about their own health 2000-2003
Verbatim Is there any place that you USUALLY
go when you are sick or need advice about your
health? No response. Source Inhouse National
Health Interview Survey, 2000-2003
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Hispanics are less likely to have seen/talked to
a doctor in the past year 2000-2003
Verbatim DURING THE PAST 12 MONTHS, have you
seen or talked to any of the following health
care providers about your own health? A general
doctor who treats a variety of illness ( a doctor
in general practice, Family medicine, or internal
medicine). Source Inhouse National Health
Interview Survey, 2000-2003
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Hispanic are more likely to have not seen/talked
to a dentist in more than a year 2000-2003
Verbatim About how long last it been since you
last saw a dentist? One year benchmark. Include
all type of dentist, such as orthodontists, oral
surgeons, and all other dental specialist, as
well as dental hygienists. Source Inhouse
National Health Interview Survey, 2000-2003
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Hispanics are less likely to have seen/talked to
a mental health professional in the past 12
months 2000-2003
Verbatim DURING THE PAST 12 MONTHS, have you
seen or talked to any of the following health
care providers about your own health? A mental
health professional such as psychiatrist,
psychologist, psychiatric Nurse, or clinical
social worker? Source Inhouse National Health
Interview Survey, 2000-2003
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Hispanics are more likely to self-report unmet
medical need due to cost 2000-2003
Verbatim During the last 12 months, was there
any time when you need it medical care but you
did not get it because you could not afford
it? Source Inhouse National Health Interview
Survey, 2000-2003
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Uninsured adult population is more likely to not
be able to afford dental care for the past 12
months 2000-2003
Verbatim DURING THE PAST 12 MONTHS was there
any time when you needed any of the following
(dental care including check-ups), but did not
get it because you could not afford it? Source
Inhouse National Health Interview Survey,
2000-2003
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Hispanics at the Border are less likely to have
received mental care/counsel services due to the
cost even when they needed it 2000-2003
Verbatim DURING THE PAST 12 MONTHS was there
any time when you needed mental health
counseling, but did not get it because you could
not afford it? Source Inhouse National Health
Interview Survey, 2000-2003
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Table Significant logistic regression results
odds ratio estimates for the Border population lt
64 Years of age Uninsured status
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Remarks

• Preliminary data shows
• Within US-Mexico Border counties, 22.9 of people
  were uninsured and 86.9 of these had lacked
  coverage for a year or more.
• At all geographic levels, uninsurance was
  considerably higher for Hispanics. The difference
  between Hispanics and Non-Hispanics was larger in
  the Border counties than nationally.
• Lack of health insurance at the Border showed
  similar patterns as nationally.
• Ethnicity and health insurance status has a
  direct effect on the accessibility of health care
  services
• NHIS is a effective tool for measure AHC along
  the Border
• Future research direction
• Perform further analysis of the concept of AHC
  using NHIS
• Study the construct of AHC as a function of
  demographic variables
• Study economic burden of AHC at the Border.
• Psychological distress co-occurring with limited
  AHC
• Explore other areas of research asthma,
  diabetes, cancer incidence
• Ethnographic studies

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Limitations

• Survey mode
• Sample
• Convenience sample

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Comparison of CLHIC between NHIS and BRFSS by
ethnicity
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Thanks

• Sam Notzon, Ph.D.
• National Health Interview Survey Staff
• Robin Cohen, Ph.D.
• Viona Brown
• Eve Powell-Griner, Ph.D.
• Susan Jack
• US-Mexico Border Health Commission

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United States-Mexico Border Health Commission
Activities

• Healthy Border 2010
• Early Warning Infectious Diseases Surveillance
  Project
• Border Models of Excellence
• Binational Tuberculosis Case Management Pilot
  Project
• Border Health Information Network
• Promotoras, among others new initiatives

http//www.borderhealth.org/
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An approximate answer to the right problem is
worth a good deal more than an exact answer to an
approximate problem--J.W. Tukey
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References

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• Land G. Measuring 2010 national objectives and
  leading indicators at the state and local level.
  J Public Health Manag Prac 20028 (4)9-13.
• Smedley BD, Stith AY, Nelson AR, editors. Unequal
  treatment confronting racial and ethnic
  disparities in healthcare. Washington (DC)
  National Academies Press 2003. 764 p.