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Medical Care Research and Review, Vol. 63, No. 6, 663-700 (2006)
DOI: 10.1177/1077558706293634

Reviews

How Much Health Insurance Is Enough? Revisiting the Concept of Underinsurance

Lynn A. Blewett

University of Minnesota

Andrew Ward

University of Minnesota

Timothy J. Beebe

Mayo Clinic College of Medicine

There is little consensus on what constitutes adequate health insurance coverage. The concept of a lack of adequate coverage, or underinsurance, is a matter of ongoing debate. A measure of adequate coverage is of critical importance as the nature of health insurance products evolves. Changes to health coverage include more direct out-of-pocket spending by consumers and a reduction of covered benefits. This article updates and extends an earlier review of underinsurance measurement published in 1993. We present a conceptual approach to measuring underinsurance and provide a review of the empirical findings obtained from the application of these approaches. A discussion of the limitations in the selection of a measurement approach includes a review of the extant data sources used. We recommend a national effort to develop a consistent approach to monitor changes in the economic and structural dimensions of health insurance coverage with a concerted effort to define and measure underinsurance.

Key Words: health insurance coverage • underinsurance • health surveys

References

  • Academy for Health Services Research and Health Policy. 2002. State of the states. The Robert Wood Johnson Foundation’s State Coverage Initiatives Program, January 2002.
  • American Psychological Association (APA). 2005. PsycEXTRAfrequently asked questions. Retrieved August 20, 2005, from http://www.apa.org/psycextra/faq.html%23gray.
  • Bartlett, D. III. 2000. The growth of the uninsured and the underinsured. Journal of Financial Service Professionals 54(5): 62-66.
  • Bashshur, R., D. Smith, and R. Stiles. 1993. Defining underinsurance: A conceptual framework for policy and empirical analysis. Medical Care Review 50(2): 199-218.[Medline] [Order article via Infotrieve]
  • Bennefield, R. L. 1998. Dynamics of economic well-being: Health insurance, 1993 to 1995. Who loses coverage and for how long? Washington, DC: U.S. Census Bureau.
  • Berk, M., and C. Schur. 1997. A review of the national access-to-care surveys. In To improve health and health care, 1997. The Robert Wood Johnson Foundation Anthology, edited by S. Isaacs and J. Knickman. San Francisco: Jossey-Bass.
  • Berk, M., C. Schur, and J. C. Cantor. 1995. Ability to obtain health care: Recent estimates from the Robert Wood Johnson Foundation National Access to Care Survey. Health Affairs 14(3): 139-146.[Abstract]
  • Bilheimer, L. T. 1997. CBO testimony on proposals to expand health coverage for children. Washington, DC: U.S. House of Representatives, Committee on Ways and Means, Subcommittee on Health.
  • Blendon, R., K. Donelan, C. A. Hill, W. Carter, D. Beatrice, and D. Altman. 1994. Paying medical bills in the United States: Why health insurance isn’t enough. The Journal of the American Medical Association 271(12): 949-951.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Blumberg, S. J. 2003. Comparing states using survey data on health care services for children with special health care needs (CSHCN). Ninth Annual Maternal and Child Health Epidemiology Conference, December 12, 2003, Tempe, AZ.
  • Burgess, J. Jr., and T. Stefos. 1991. Federal provision of health care: Creating access for the underinsured. Journal of Health Care for the Poor and Underserved 1(4): 364-387.[Medline] [Order article via Infotrieve]
  • Centers for Disease Control and Prevention (CDC). 1998. State-specific prevalence estimates of uninsured and underinsured persons—Behavioral Risk Factor Surveillance System, 1995. Morbidity and Mortality Weekly Report 47(3): 51-55.
  • Christianson, J. B, S. T. Parente, and R. Taylor. 2002. Defined-contribution health insurance products: Development and prospects. Health Affairs 21(1): 49-64.[Abstract/Free Full Text]
  • Collins, S. R., C. Schoen, M. M. Doty, A. L. Holmgren, and S. K. How. 2005. Paying more for less: Older adults in the individual insurance market. The Commonwealth Fund, Task Force on the Future of Health Insurance. Issue Brief publication #841, June 2005.
  • Committee on the Consequences of Uninsurance. 2001. Coverage matters: Insurance and health care. Washington, DC: National Academy Press. Available at http://books.nap.edu/html/coverage_matters/notice.html.
  • Congressional Budget Office. 2003. How many people lack health insurance and for how long? Washington, DC: Congressional Budget Office. May 2003. Available at http://www.cbo.gov/ftpdocs/42xx/doc4210/05-12-Uninsured.pdf.
  • Czajka, J. 1999. Analysis of children’s health insurance patterns: Findings from SIPP. Washington, DC: Mathematica Policy Research, Inc., May. Document No. PR99-64.
  • Czajka, J., and K. Lewis. 1999. Using national survey data to analyze children’s health insurance coverage: An assessment of issues. Mathematica Policy Research, Inc., May 1999. Available at http://aspe.hhs.gov/health/reports/Survey%2520Data.htm%23x.
  • Daniels, N. 2000. Normal functioning and the treatment-enhancement distinction. Cambridge Quarterly of Healthcare Ethics 9: 309-322.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Davis, J. 2000. Conceptualizing the lack of health insurance. Health Care Analysis 8(1): 55-64.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Donelan, K., C. M. DesRoches, and C. Schoen. 2000. Inadequate health insurance: Costs and consequences. Medscape General Medicine 2(3): E37-E37.
  • Economic Research Institute on the Uninsured (ERIU). 2002. A revolving door: How individuals move in and out of health insurance coverage. ERIU Research Highlight Number 1. Ann Arbor: University of Michigan, May.
  • Edwards, J., M. Doty, and C. Schoen. 2002. The erosion of employer-based health coverage and the threat to workers’ health care: Findings from the Commonwealth Fund 2002 Workplace Health Insurance Survey. The Commonwealth Fund, August.
  • Evans, W., and W. K. Viscusi. 1993. Income effects and the value of health. The Journal of Human Resources 28 (3): 497-518.[CrossRef]
  • Farley, P. 1985. Who are the underinsured? Milbank Memorial Fund Quarterly—Health and Society 63 (3): 476-503.[CrossRef]
  • Fox, H., M. McManus, R. Almeida, and R. Graham. 1997. Eligibility options under the State Children’s Health Insurance Program: The Children’s Health Insurance Project. Maternal and Child Health Policy Research Center: Issue Brief 1.
  • Freedman, S. A., B. R. Klepper, R. P. Duncan, and S. P. Bell III. 1988. Coverage of the uninsured and underinsured: A proposal for school enrollment-based family health insurance. The New England Journal of Medicine 318(13): 843-847.[ISI][Medline] [Order article via Infotrieve]
  • Gabel, J. 2002. Erosion of private health insurance coverage for retirees: Findings from the 2000 and 2001 Retiree Health and Prescription Drug Coverage Survey. The Commonwealth Fund, April.
  • Gabel, J., G. Claxton, E. Holve, J. Pickreign, H. Whitmore, K. Dhont, S. Hawkins, and D. Rowland. 2003. Health benefits in 2003: Premiums reach thirteen-year high as employers adopt new forms of cost sharing. Health Affairs 22(5): 117-126.[Abstract/Free Full Text]
  • Gabel, J., L. Levitt, E. Holve, J. Pickreign, H. Whitmore, K. Dhont, S. Hawkins, and D. Rowland 2002. Job-based health benefits in 2002: Some important trends. Health Affairs 21(5): 143-151.[Abstract/Free Full Text]
  • Gerst, A., L. Rogson, and R. Hetherington. 1969. Patterns of satisfaction with health plan coverage: A conceptual approach. Inquiry 6(3): 37-51.
  • Hayward, R. A., M. F. Shapiro, H. E. Freemen, and C. R. Corey. 1988. Inequalities in health services among insured Americans: Do working-age adults have less access to medical care than the elderly? The New England Journal of Medicine 318(23): 1507-1512.[Abstract]
  • Institute of Medicine. 2001. Coverage matters: Insurance and health care. Institute of Medicine, Board on Health Care Services, Committee on the Consequences of Uninsurance. Washington, DC: National Academy Press.
  • Kaiser Commission on Medicaid and the Uninsured. 2002. Underinsured in America: Is health coverage adequate? The Henry J. Kaiser Family Foundation, publication number 4060, July.
  • Kaiser Family Foundation. 2004. 2003 Health insurance survey—Summary and chartpack. Publication number 7203, October.
  • Kaiser Family Foundation and Health Research and Educational Trust (HRET). 2003. Employer health benefits 2003 annual survey chartpack.
  • Kentucky Cabinet for Health and Family Services. 2001. Kids now: 10,000 underinsured children immunized.
  • Kogan, M. D., P. W. Newacheck, L. Honberg, and B. Strickland. 2005. Association between underinsurance and access to care among children with special health care needs in the United States. Pediatrics 116: 1162-1169.[Abstract/Free Full Text]
  • Kuttner, R. 1999. The American health care system: Health insurance coverage. The New England Journal of Medicine 340(2): 163-168.[Free Full Text]
  • Lundy, J., B. Finder, and G. Claxton. 2004. Trends and indicators in the changing health care marketplace, 2004 update. The Henry J. Kaiser Family Foundation.
  • Merlis, M. 2002. Family out-of-pocket spending for health services: A continuing source of financial insecurity. The Commonwealth Fund, publication number 509.
  • Monheit, A. 1994. Underinsured Americans: A review. Annual Review of Public Health 15: 61-85.
  • Monheit, A., and C. L. Schur. 1988. The dynamics of health insurance: A tale of two cohorts. Inquiry 25 (3): 315-327.[ISI][Medline] [Order article via Infotrieve]
  • National Survey of Children with Special Health Care Needs (NS-CSHCN). 2004. The National Survey of Children with Special Health Care Needs chartbook 2001. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. Rockville, MD: U.S. Department of Health and Human Services. Available at http://mchb.hrsa.gov/chscn/index.htm.
  • New York State Association of County Health Officials. 1996. Serving the uninsured and underinsured in New York State. Albany, NY: New York State Association of County Health Officials, July. Available at http://www.nysacho.org/Policies/Serving_the_Under___Uninsured_/body_serving_the_under___uninsured_.html.
  • Newhouse, J. P. 2004. Consumer-directed health plans and the Rand Health Insurance Experiment. Health Affairs 23 (6): 107-113.[Abstract/Free Full Text]
  • Reis, J., S. Sherman, J. Macon, and B. Friedman. 1990. Care for the underinsured: Who should pay? Journal of Nursing Administration 20(3): 16-20.[ISI][Medline] [Order article via Infotrieve]
  • Rice, D. P. 1991. Ethics and equity in U.S. health care: The data. International Journal of Health Services 21(4): 637-651.[ISI][Medline] [Order article via Infotrieve]
  • Richmond, J. B., and R. Fein. 1995. The health care mess. A bit of history. The Journal of the American Medical Association 273(1): 69-71.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Rowland, D., and R. Garfield. 2002. Health insurance for unemployed workers. Medscape General Medicine 4(1): 5-5.
  • Schoen, C., and C. DesRoches. 2000. Uninsured and unstably insured: The importance of continuous insurance coverage. Health Services Research 35 (1 pt. II): 187-206.[ISI][Medline] [Order article via Infotrieve]
  • Schoen, C., M. M. Doty, S. R. Collins, and A. L. Holmgren. 2005. Insured but not protected: How many adults are underinsured? Health Affairs W5-289-W5-302, June 14.
  • Schur, C. L., M. M. Doty, and M. L. Berk. 2004. Lack of prescription coverage among the under 65: A symptom of underinsurance. The Commonwealth Fund, Task Force on the Future of Health Insurance. Issue Brief publication #716, February.
  • Shearer, G. 2000. The health care divide: Unfair financial burdens. Consumers Union. Available at http://www.consumersunion.org/health/divide/divide.htm.
  • Short, P., and J. Banthin. 1995. New estimates of the underinsured younger than 65 years. The Journal of the American Medical Association 274(16): 1302-1306.[Abstract]
  • Short, P., and D. Graefe. 2003. Battery-powered health insurance? Stability in coverage of the uninsured. Health Affairs 22(6): 244-255.[Abstract/Free Full Text]
  • Stroupe, K. T., E. D. Kinney, and T. J. J. Kniesner. 2000. Does chronic illness affect the adequacy of health insurance coverage? Journal of Health Politics, Policy and Law 25(2): 309-341.[Abstract]
  • Strunk, B. C., and J. D. Reschovsky. 2004. Trends in U.S. health insurance coverage, 2001-2003. Center for Studying Health System Change, Tracking Report No. 9.
  • Swartz, K., J. Marcotte, and T. D. McBride. 1993. Personal characteristics and spells without health insurance. Inquiry 30(1): 64-76.[ISI][Medline] [Order article via Infotrieve]
  • U.S. Census Bureau. 2006. Income, poverty, and health insurance coverage in the United States: 2005. Current Population Reports, P60-231, p. 20-20. Washington, DC: U.S. Government Printing Office, August. Available at http://www.census.gov/hhes/www/hlthins/hlthin05.html.
  • U.S. Congress, Office of Technology Assessment. 1988. Medical testing and health insurance. OTA-H-384. Washington, DC: U.S. Government Printing Office, August.
  • University of Minnesota Center for Bioethics. 1997. Distributing limited health care resources. Available at http://www.bioethics.umn.edu/publications/Limited_Resources.pdf.
  • Walden D. C., D. R. Wilensky, and J. A. Kasper. 1985. Changes in health insurance status: Full-year and part-year coverage. National Center for Health Services Research and Health Care Technology Assessment. Data Preview 21, National Health Care Expenditure Study. DHHS Pub. No. (PHS) 85-337.
  • Woodward, A. 1987. Private health insurance and the underinsured. HealthSpan 4(8): 3-13.[Medline] [Order article via Infotrieve]
  • Wu, L. T., and W. E. Schlenger. 2004. Private health insurance coverage for substance abuse and mental health services, 1995 to 1998. Psychiatric Services 55(2): 180-482.[Abstract/Free Full Text]

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C. Schoen, S. R. Collins, J. L. Kriss, and M. M. Doty
How Many Are Underinsured? Trends Among U.S. Adults, 2003 And 2007
Health Aff., July 1, 2008; 27(4): w298 - w309.
[Abstract] [Full Text] [PDF]

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