Health Insurance Coverage Among North Dakotans

May 10, 2004

Alana Knudson, PhDKyle Muus, PhDMike Cogan, MA

North Dakota Phone Survey

Partners Development Geographic Groups Descriptive Statistics

North Dakota Phone Survey

Collaborative Endeavor North Dakota Department of Health University of North Dakota Center for

Rural Health UND Social Science Research Institute Mathematica Policy Research, Inc.

Survey Development

Review of national literature Review of CPS and CDC survey results Review of existing state surveys Review of previous state results Customize survey to address North

Dakota concerns Survey instrument developed by SSRI

Respondents

Three population groups Urban (greater than 16,718)

Bismarck, Fargo, Grand Forks & Minot Large Rural (5,000 to 16,717)

Devils Lake, Dickinson, Jamestown, Minot AFB, Valley City, Wahpeton, & Williston

Small Rural (under 5,000) Remainder of the state

Overview of Survey Findings

Gender

Male49.6%Female

50.4%

Age

9.9%

14.8% 14.8%15.6%

14.0%

8.8%

22.1%

0%

5%

10%

15%

20%

25%

0-17 18-24 25-34 35-44 45-54 55-64 65 orover

Age Groups

% o

f re

spo

nd

ents

Health Insurance Coverage

17.4

1.04.9 6.3

1.2 0.7

36.530.8

9.4

0.8 0.30

10

20

30

40

50

60

70

80

90

100

Medic

are

Railroad R

etire

Champus

or VA

Medic

aid

Health

y Ste

ps

CHAND

Work

or U

nion

Other

Purchase

d-Tar

get

COBRA

Studen

t Heal

th

%

Number of Health Insurance Policy Types Per Person

87.2

11.7

1.1

0 20 40 60 80 100

1

2

3+

# o

f P

oli

cies

per

per

son

%

Is there a particular doctor you see?

Yes75.4%

No24.6%

How many miles do you travel to receive health care services?

11.5%

2.0%

12.6%9.2%

58.3%

6.4%

0%

10%

20%

30%

40%

50%

60%

70%

5 or less 6 to 10 11 to 20 21 to 50 51 to 100 100 or more

Miles

% o

f p

op

ula

tio

n

When was the last time you received a routine check up?

11.2%

1.4%

42.5%

8.1%

3.6%

33.2%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

1 to 6 7 to 12 13 to 24 25 to 36 37 to 48 More than 48

Months

Are you confident that you can get health care when you need it?

Strongly Agree52.6%

Neutral5.4%

Agree35.6%

Strongly Disagree

1.8%Disagree

4.6%

How many times have you visited the doctor in the past 6 months?

34.7%

6.6%4.7% 5.9%

10.2%

23.3%

14.6%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

1 2 3 4 5 6 7 or more

# of Visits

How would you describe your health?

Good23.6%

Very Good32.6%

Excellent34.5%

Poor1.9%

Fair7.4%

What is your marital status?

18.4%

4.0%0.3%

6.0%

67.6%

3.7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Single Married Partner Divorced Separated Widowed

% o

f p

op

ula

tio

n

What is your level of education?

High School Graduate

25.9%

Less than High School

Diploma9.9%College

Graduate33.1%

Some College31.1%

What is your employment status?

12.3%

3.7%

17.5%

5.0% 4.3%0.1%

57.1%

0%

10%

20%

30%

40%

50%

60%

Self Employed Employed bysomeone

Homemaker Volunteer Retired Full-timeStudent

Unemployed

Do you have more than one paying job?

Yes13.3%

No86.7%

Is this job permanent, temporary or seasonal?

Seasonal4.2%

Permanent91.9%

Temporary3.9%

Prior Active Duty in the Military?Yes

13.7%

No86.3%

North Dakota’sUnderinsured

UNDERINSURANCE

Situations where: a) too few services are covered or the coverage is

inadequate; b) the amount of out-of-pocket expenses, regardless of family

income, is excessive; c) some combination of the above

..cost-sharing places such an economic hardship on the insured that its presumed benefits are lost

Based on economic, experiential & attitudinal factors

Typical Characteristics of the Underinsured

Self-employed, PT employees, and FT employees of small companies

Aged 19-24 and 55-64 Fair/poor health status Ethnic minorities Below 200% of poverty level

Economic Conditions

Out-of-pocket expenses, with or without regard to family income, are excessive

Out-of-pocket expenses >10% of income Inadequate insurance against large bills The financial impact of serious illness Unable to obtain needed health care due to

economic reasons <200% of poverty level & their employer

makes no contribution

Experiential Measures Too few services are covered Ineligible for or cannot afford certain plan

benefits of interest Pre-existing condition prevents person from

obtaining coverage Coverage prevents them from reaching their

health potential Waiting periods before a condition is covered Difficulty in obtaining referrals Basic health needs (prenatal, immunizations,

etc.) are not covered

Attitudinal Factors

Insurance is perceived to be inadequate

Quality of care is considered inadequate

Desired services are not included in the plan

Needed to see a doctor but could not because of the cost (past 12 months)

7.1

0

2

4

6

8

10

12

14

16

18

IA NE MA HI NJ ND IL RI SD WI CT MN DE KS P A VT NY WA MD MI NH TN MO VA OK CO IN OH DC MT UT ME AZ GA NC WY AL AK SC FL NM LA OR CA R KY ID NE TX MS WV

State

% w

ho a

nsw

ered

yes

ND

Source: BRFSS, 2000

Estimated Annual Out-of-Pocket Medical Expenses for the Past Year

0

10

20

30

40

50

60

70

80

90

100

<500 500-999 1000s 2000s 3000s 4000s 5000-9999

10000+

($)

%

Range=$2-100,000; Mean=$1496; Median=$400

Health Underinsurance* in ND

Insured, 275709, 92%

Under-Insured, 25479, 8%

*Annual out-of-pocket >10% of median annual household income

Insured, 272131, 83%

Under-Insured, 55417, 17%

Target Target’s Household

Health Underinsurance* of Target, by Age Group

96.189 94.3 93.6 90.7 87.8 82.7

3.911 5.7 6.4 9.3 12.2 17.3

0%

100%

0-17 18-24 25-34 35-44 45-54 55-64 65+

Age Group

Insured Underinsured

*Annual out-of-pocket >10% of median annual household income

Health Underinsurance* by Gender

Insured, 148460, 91%

Under-Insured, 15435, 9%

*Annual out-of-pocket >10% of median annual household income

Insured, 127248, 93%

Under-Insured, 10045, 7%

Females Males

Health Underinsurance*by Race/Ethnicity

9281 85.3

819 14.7

0%

100%

Caucasian Native American Other

Insured Underinsured

*Annual out-of-pocket >10% of median annual household income

Underinsurance* by geographic group

7.36.910.2

05

101520253035404550

Small Rural Large Rural Urban

% o

f pop

ulat

ion

*Annual out-of-pocket >10% of median annual household income

Where do the underinsured reside?

Small Rural , 13,086,

51%

Large Rural,

4,251, 17%

Urban, 8,142, 32%

Health Underinsurance* of Target, by Income Level

46

72.3

88.6 86.897 95.6 97.4

54

27.7

11.4 13.23 4.4 2.6

0%

100%

<10K 10-20K 20-25K 25-35K 35-45K 45-60K 60-80K

Annual Household Income

Insured Under-Insured

*Annual out-of-pocket >10% of median annual household income

Health Underinsurance* of Target’s Household, by Income

49.9 54.6

71.5 76.984.3 87.8

94.6

50.1 45.4

28.5 23.115.7 12.2

5.4

0%

100%

<10K 10-20K 20-25K 25-35K 35-45K 45-60K 60-80K

Annual Household Income

Insured Underinsured

*Annual out-of-pocket >10% of median annual household income

Health Underinsurance* of Target, by Policy Type

71.9 78.6 79.2 82.5 83.3 86.5 90.5 93.5 94.5 97

28.1 21.4 20.8 17.5 16.7 13.5 9.5 6.5 5.5 3

0%

100%

Insured Under-Insured

*Annual out-of-pocket >10% of median annual household income

Underinsurance* by Employment Status

93.7%87.5%

79.3%69.6%

6.3%11.5% 12.5% 16.2% 20.7%

30.4%

83.8%88.5%

0%

100%

Employed bysomeone

Self Employed Full-timeStudent

Retired Homemaker Unemployed

*Annual out-of-pocket >10% of median annual household income

Self-Perceived Health Status, Insured versus Underinsured*

Excellent36%

Very Good33%

Good24%

Fair6%

Poor1%

*Annual out-of-pocket >10% of median annual household income

Insured Underinsured

Excellent11%

Very Good28%

Good28%

Fair21%

Poor12%

North Dakota’s Uninsured

What is percentage and number of the uninsured in North Dakota?

8.2% of North Dakotans are uninsured 51,920 people

Similar to the population of Bismarck

How does North Dakota’s uninsured percentage compare with the U.S.?

15.28.2

05

101520253035404550

NorthDakota

U.S.

% o

f p

op

ula

tio

n u

nin

su

red

Who are the uninsured by gender?

Females42%

Males58%

Health Uninsurance*by Race/Ethnicity

93.1

68.3

93.3

6.9

31.7

6.7

0%

100%

Caucasian Native American Other

Insured Uninsured

What is the percentage of uninsured in each geographic group?

7.77.49.1

05

101520253035404550

Small Rural Large Rural Urban

% o

f p

op

ula

tio

n

Where do the uninsured reside?

Small Rural , 23120, 44%

Large Rural, 10303, 20%

Urban, 18498, 36%

Under 1822%

18 - 2419%

25 - 3417%

35 - 4415%

45 - 5417%

55 - 648%

65 and over2%

Who are the uninsured by age?

Among the uninsured, have you ever been insured?

No28.8%

Yes71.2%

Marital Status

0102030405060708090

100

Single Married Partner Divorced Separated Widowed

% o

f p

op

ula

tio

n

Uninsured Insured

0

5

10

15

20

25

30

35

40

45

50

<$10,000 $10,001-$20,000

$20,001-$25,000

$25,001-$35,000

$35,001-$45,000

$45,001-$60,000

$60,001-$100,000

>$100,000

% o

f popula

tion

Uninsured Insured

Household Income by Insurance Status

Educational Level

0

10

20

30

40

50

Grade School Some HighSchool

High SchoolGrad

SomeCollege/Voc

College Grad Postgrad

% o

f p

op

ula

tio

n

Uninsured Insured

Employment Status

0

20

40

60

80

100

Self Employed Employed bySomeone

Homemaker Full-timeStudent

Retired Unemployed

% o

f p

op

ula

tio

n

Uninsured Insured

Types of Employment

0 20 40 60 80 100

Permanent

Temporary

Seasonal

% of population

UninsuredInsured

Firm Size

0

10

20

30

40

50

1 2 to 10 11 to 50 51 to 100 101 to 500 500+

Number of Employees

% o

f p

op

ula

tio

n

UninsuredInsured

Are you offered health insurance through employer or union?

Yes15%

No52%

Don't Know4%

Not Applicable

29%

Do you have access to health insurance through your spouse?

Yes10%

No46%

Spouse not employed

4%

No spouse40%

Why not buy insurance on your own?

Do not need5%

Could not afford76%

Rarely sick2%

Other17%

Would you enroll in Medicaid if eligible?

Yes69%

No 14%

Don't Know17%

Describe your health…

0

10

20

30

40

50

Excellent Very Good Good Fair Poor

% o

f p

op

ula

tio

n

Uninsured Insured

North Dakotans Indicating A Regular Place for Health Care

93.6

74.8

0102030405060708090

100

Uninsured Insured

% o

f p

op

ula

tio

n

Where do people seek health care?

0102030405060708090

100

ER/UrgentCare

Clinic Doctor'sOffice

Other

% o

f p

op

ula

tio

n

Uninsured Insured

Are you confident that you can get health care when you need it?

Uninsured

Strongly Agree29%

Agree42%

Neutral9%

Disagree11%

Strongly Disagree

9%

I nsured

Strongly Agree55%

Agree35%

Neutral5%

Disagree4%

Strongly Disagree

1%

Percent of Population With Dental Care Insurance

52.1

17.6

0102030405060708090

100

Uninsured Insured

% o

f p

op

ula

tio

n

For more information contact:

Center for Rural HealthUND School of Medicine and Health SciencesGrand Forks, ND 58202-9037

701-777-3848

http://medicine.nodak.edu/crh