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

1. 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

2. 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

4. What to do? Tailor a Healthy People program that addresses the health needs on the Border Healthy Border 2010 Program

5. Healthy Border 2010 common topic areas

7. 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

8. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. Table: Significant logistic regression results: odds ratio estimates for the Border population < 64 Years of age: Uninsured status

21. 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

22. Limitations • Survey mode • Sample • Convenience sample

23. Comparison of CLHIC between NHIS and BRFSS by ethnicity

24. 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

25. 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 United States-Mexico Border Health Commission Activities http://www.borderhealth.org/

27. “An approximate answer to the right problem is worth a good deal more than an exact answer to an approximate problem”--J.W. Tukey

28. References Desai J. State-based diabetes surveillance among minority populations Prev Chronic Dis [serial online] 2004 Apr . Available from : URL: http://www.cdc.gov/pcd/issues/2004/apr/03_0030.htm Land G. Measuring 2010 national objectives and leading indicators at the state and local level. J Public Health Manag Prac 2002;8 (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.