An Assessment of Health Insurance Concerns

Quality of life issues, particularly the cost of health care for individuals, are beginning to emerge as key areas of public concern. The United States currently spends about $1.5 billion a day on health care, or nearly 12% of the gross national product, and that proportion is expected to reach 15% by the year 2000 (United Way Strategic Planning Institute, 1989). The quality of and access to the U.S. health care system is currently in question.

Family and Consumer Science Extension agents in five eastern Ohio counties wanted to see what concerns people had about health insurance. Where could Extension help? National and State Initiatives of the Extension Service encourage involvement in public policy education and improving family well being both physically and economically. A survey was designed and distributed to Extension audiences in February 1994 to identify concerns about health insurance.

This self-administered survey included four sections. In the first section, participants rated their concern ("no concern," "some," or "much concern") on 12 health care issues such as various costs, time spent in doctors offices and availability of health insurance. The second section of the survey asked what type of insurance coverage people had. Section three assessed people's current knowledge of health insurance. The final section measured attitudes about health insurance rights.

The survey was distributed in five rural, Appalachian counties. In these counties, average family income was $12,820 and unemployment ranged from 8.3% to 13.7%. County populations ranged from 11,336 to 71,074 and the largest town was Marietta, with a population of 15,000.

Surveys were distributed, completed, and collected during group meetings conducted by Extension personnel. Respondents were divided into three groups: Extension clientele included Family and Community Education Associations, 4-H advisors, and agricultural clientele groups; professional groups consisted of Kiwanis, Lions, and Chamber of Commerce members; and non-Extension groups included members of Mothers' Clubs, church groups, and community action groups. Three hundred seventy-seven usable questionnaires were obtained.

Of the respondents, 31% were under 45 years of age, 37% were 45 to 64, and 27% were over 65. Twenty percent lived on farms, 32% were rural non-farm, and 36% lived in towns. Thirteen percent of the respondents had an income of less than $10,000 per year. Forty percent earned between $10,000 and $30,000. Eleven percent made over $50,000 and 23% earned between $30,000 and $50,000.

People surveyed were more concerned about cost issues than availability. Only 2% of those surveyed had no insurance. Ninety-seven percent expressed "some" to "much concern" about rising hospital bills and 94% were concerned about rising doctor bills. Ninety-three percent expressed concern about the cost of health insurance. Seventy-seven percent were concerned about the availability of health insurance and 79% were concerned about the risk of losing all or part of their coverage.

Seventy-four percent of the respondents were concerned about understanding their current coverage and 79% were confused about Medicare. Of the 12 issues, selecting MedSup plans was of the least concern to most people. This may reflect the age of respondents since only 27% were 65 or older. Seventy-five percent had only "some" or "no concern" about "Time spent in the doctor's office" and "time with the doctor."

Looking at the three respondent groups, professionals were less concerned than other groups in all areas of the survey. Their major area of concern was "the cost of insurance" with 70% expressing "much concern." Sixty-two percent expressed "much concern" over rising hospital bills. The professionals were younger and had higher incomes than the other groups. This group expressed less concern about losing all or part of their coverage. Twenty-five percent expressed "no concern," 37% "some concern" and 36% "much concern." In the other groups, 54% expressed "much concern."

The second part of the survey asked what types of insurance coverage were carried. "Major medical" and "hospital expense" were the two most commonly carried types of insurance for all groups with "surgical coverage" close behind. Two percent of the respondents had no insurance and 3% admitted they did not know what types of coverage they carried. Thirteen percent of the total group were enrolled in cancer or special illness plans, while 21% of the professional group carried this type of insurance. One-third knew they had dental coverage and 25% had vision coverage. Based on the responses, there was some question about whether respondents really knew what types of coverage were included in their plans. But when asked how well they understood their coverage, 10% thought they "understood very well," 32% "well enough to get by," 43% thought their "understanding could be better," and 8% felt "totally confused."

Fifty-two percent of all the respondents felt "confident" about their ability to "select the best plans for them," 14% felt "very confident," and 28% were "not very confident."

Survey participants were asked to match terms and definitions. Sixty-three percent could correctly identify the definition of "lifetime maximum" and 57% chose the correct definition for "deductible." Only one-third selected the correct definitions for "co-payment" and "out-of-pocket limit." The participants in the professional group had the highest percentage of correct answers; 62% compared to 42% for Extension audiences and 41% for the non-Extension groups.

Participants were asked to identify the types of insurance about which they wanted to know more. The five most frequently listed topics were: dental, hospital expense, major medical, long term care, and drug and pharmacy.

The survey also included three additional questions regarding participants' attitudes about health insurance policy issues. When asked "Would you support health care cost discounts for healthy life style practices?" 61% said yes, 12% no, and 19% were undecided. When asked "Do you think all Americans are entitled to the same health care whether they work or not?" 34% said yes, 41% no, and 23% were undecided. Of the higher income respondents, nearly half said no. Among the lower income respondents, 42% said yes, 36% no, and 22% were undecided.

In response to the question "Is it okay for some employers to provide more or better health care coverage than others?" about half of the total respondents said yes, 28% no, and 19% were undecided. Of those with lower incomes, 50% said no and 31% said yes.

This study suggests that over 51% of respondents felt they needed to be able to better understand their health insurance. With any change or reform, it will be necessary to thoroughly inform the public about the features of the health care policy and coverage details.

It is evident that most consumers in the study did not understand basic insurance terms. Extension involvement could include the development of written fact sheets distributed to clientele and businesses, public forums about types of insurance and costs, or worksite programs.

The results of this study will be shared with an existing regional health care committee. This committee is contributing to the legislative process that will impact health care change in Ohio. The summary of findings could be given to human resource department directors to encourage better health care coverage explanations to their employees. Survey results could also be shared with the public through newsletters or media articles.

The survey can easily be duplicated to assess local or regional trends. Do these attitudes also prevail in urban areas? Is this study influenced by Midwest attitudes/values or do similar attitudes exist across the country?

The project may be easily adapted to the interdisciplinary or multi-disciplinary system for issues programming. Community development and home economics agents may assist human resource personnel in local businesses to address employee concerns in benefits training sessions. Agriculture agents may help rural farm families understand health insurance needs and practices. 4-H Youth Development staff may begin to help families and older youth involved in financial planning programs to understand health insurance issues.

Extension can play a vital role in educating consumers about impending health insurance reform.

United Way Strategic Planning Institute. (1990, July/August). Nine forces reshaping America. The Futurist, XXIV(4), pp. 9-16.