THE UNINSURED: Study Examines Attitudes Toward Health Coverage
Lacking health coverage is "not solely an issue for the poor," in California according to a study in the current issue of Health Affairs. Conducted in 1998, the Field Research Corporation interviewed 1,009 of California's nonpoor --those with family incomes at least 200% of the federal poverty level -- who lacked health insurance to determine "attitudes, utilization and charges, perception of the cost of health insurance premiums, and willingness to pay." The majority of respondents (81%) were employed, but of those people, researchers found that only 20% worked for an employer who offered health coverage, and half those were eligible for benefits. Of those respondents who turned down employee-offered health insurance, most cited cost as the main reason. Although 60% of respondents said they worried a lot about obtaining sufficient medical care and the cost of care, 57% disagreed with the statement, "Health insurance ranks very high on my list of priorities for where to spend my money." Researchers noted that health coverage may be a low priority for some people because of its perceived value; 43% agreed with the statement, "Health insurance is not a very good value for the money." The study also found that those with higher incomes and those in better health were less concerned about obtaining medical care for themselves and their families.
Is Cost the Issue?
Many respondents believed that health insurance costs were twice as much they were willing to pay. Comparing the perceived costs of health plan premiums to the actual cost of those premiums, researchers found that "perceptions of cost often exceeded the actual cost, especially for the lower-premium plans." Respondents also preferred high-copayment plans to high-deductible plans, as "premiums paid for the high-deductible coverage appear to be wasted when ... the deductible is not reached." Researchers suggested that the misperceptions about health insurance costs may play a significant role in nonpoor families' decisions to forego health insurance. The report notes health plans that actively educate consumers about health plan options and prices could persuade them to buy health insurance.
The study indicates that there are two distinct groups of nonpoor Californians which elect not to buy health insurance: the minority that is concerned about lacking coverage, but is bordering on 200% of poverty; and the majority that have higher incomes but are less worried about health insurance. Researchers suggest that the minority group is likely to respond to individually-based tax incentives that would lower insurance costs, but the majority group is "unlikely to enter the market voluntarily." Researchers conclude that "any system that relies on individuals to purchase insurance voluntarily will fall far short of universal coverage." California families with incomes of at least 200% of the federal poverty level account for nearly 40% of the state's uninsured population, and families with incomes of at least 300% of poverty represent 25% of the uninsured (Yegian et al., July/August 2000 issue).