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Research Findings #17: Women in the Health Care System: Health Status, Insurance, and Access to Care

Barbara M. Altman, Ph.D., Centers for Disease Control and Prevention, National Center for Health Statistics,1 and Amy K. Taylor, Ph.D., Agency for Healthcare Research and Quality
1
Formerly with the Agency for Healthcare Research and Quality.

 

Abstract

The estimates in this report are based on the most recent data available at the time the report was written. However, selected elements of MEPS data may be revised on the basis of additional analyses, which could result in slightly different estimates from those shown here. Please check the MEPS Web site for the most current file releases.

This report from the Agency for Healthcare Research and Quality (AHRQ) focuses on adult noninstitutionalized women in the United States in 1996. In terms of health status, the report shows perceived health, mental health, and the presence of a number of different limitations. Health insurance status is examined in terms of whether women are publicly insured, privately insured, or uninsured, and whether insured women are policyholders or dependents. Data on women’s usual source of health care, use of ambulatory care services, and use of selected preventive services are used to examine access to care. The report does not compare women’s health to men’s health but instead looks at the health status of women by various demographic and health characteristics that may be associated with disparities in access to care or other disadvantages in the health care system, including a measure that combines marital status, presence of children in the household, and age of children. The estimates shown come from the Household Component of AHRQ’s Medical Expenditure Panel Survey (MEPS).

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Introduction

Women make up more than half of the U.S. population, but it is only lately that their political, economic, and health situations have been closely examined and brought to the attention of policymakers. With this increased concern about women’s health, it is important to monitor their health status, as well as their access to health insurance, health care services, and prevention services. Earlier chartbooks and compilations of survey data have given valuable information about women’s health in the late 1980s and early 1990s, including health-related behaviors (Brown, Wyn, Cumberland, et al., 1995), reproductive health issues and incidence and risk factors for chronic disease (Jacobs Institute of Women’s Health, 1993; Leiman, Meyer, Rothschild, et al., 1997), factors affecting the health of minority women (Leigh and Lindquist, 1998), and health issues for aging women (Guralnik, Fried, Simonsick, et al., 1995). A recent publication by the Commonwealth Fund (Collins, Schoen, Joseph, et al., 1999) reports on women’s use of hormone replacement therapy, experience with violence and abuse, risk for depressive symptoms, and insurance status.

This report focuses on adult noninstitutionalized women and describes their health status, access to health care, and insurance status during calendar year 1996. The report does not compare women’s health to men’s health. Instead, it looks at the health status of different groups of women who may, because of their circumstances, experience disparities in access to care or other disadvantages in the health care system. Perceived physical and mental health status and disability, health insurance status, and health care access and the source of that access are examined. Specific comparisons are made by age, race/ethnicity, income, employment status, education, and the combined effect of marital status and presence of children in the home.

This report provides a basis for comparison with future data to describe trends in women’s health status, insurance status, and access to care and preventive services in the United States.

The estimates of health status, insurance status, and access to care reported here are derived from data collected from respondents in the Household Component (HC) of the Medical Expenditure Panel Survey (MEPS). The estimates represent the civilian noninstitutionalized population of women age 18 and over in the United States during calendar year 1996. A technical appendix at the end of this report provides definitions of the variables used in this report. It also gives a detailed description of the MEPS HC, including data collection methods, sample size, variable construction, and statistical procedures for deriving estimates. Table A in the technical appendix provides comparison information on men’s health status, also derived from the 1996 MEPS. Tables B-F give the standard errors associated with Tables 1-5, discussed in the text of this report. Only differences between estimates that are statistically significant at the 0.05 level are discussed in the text unless otherwise specified.

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Health and Disability Status

An examination of women’s physical and mental health as perceived by the MEPS household respondent (Table 1) shows that approximately 60 percent were in excellent or very good general health and about 70 percent had excellent or very good mental health. Table 2 shows that only 14.3 percent of all women had a functional limitation, 10.4 percent had activity limitations, and 6.8 percent needed help with an activity of daily living (ADL) or an instrumental activity of daily living (IADL). An examination of different sociodemographic characteristics shows that some groups of women experience higher levels of poor health and disability than others.

Age

As women age, their general health and mental health status show signs of deterioration. Table 1 shows that women ages 18-29 were the most likely to have excellent or very good perceived general health (67.1 percent). By ages 45-64, only 56.6 percent had excellent or very good general health—a significant drop. The percent of women in fair or poor general health increased with age up to age 85. Less than one-quarter of women ages 65-74 had fair or poor general health, but by age 75 the proportion in fair or poor health had leveled off at nearly 30 percent.

Over three-quarters (77.1 percent) of women ages 18-29 had excellent or very good mental health. This 

proportion dropped to 67.8 percent by ages 45-64. The deterioration in mental health continues as women age, with women age 75 and over having higher proportions with fair or poor mental health—13.5 percent of women 75-84 and 19.3 percent of those age 85 and over.

Only 5.4 percent of women ages 18-29 had any type of limitation or impairment, but the proportion with limitations increased with age, so that by ages 65-74 almost one-third of women had a limitation of some kind, more than half of women 75-84 (53.7 percent) had a limitation, and more than three-quarters of women age 85 and over had some limitation (Table 2). Although only about 30 percent of women 75 and over had fair or poor health, about 43 percent of women 75-84 and 67 percent of those 85 and over had a functional limitation.

Nearly one-quarter of women ages 75-84 and more that half of women 85 and over required assistance with an ADL or IADL.

Race/Ethnicity

The racial and ethnic differences in women’s self-reported health that have been noted elsewhere (Weigers and Drilea, 1999) are also seen in these data on general health status and mental health status. 

In this analysis, we have used a measure of race/ethnicity that specifically identifies whites, blacks, and Hispanics but groups all other races, including Asians and Pacific Islanders, Native Americans, and other small groups, into one category identified as "other." White women were more likely to have excellent or very good health (62.7 percent) than either black women (50.7 percent) or Hispanic women (48.6 percent), although they did not differ significantly from the "other" racial and ethnic group. Following the same pattern, Hispanics and blacks were more likely to have fair or poor health than either white women or women of other races. White women were also more likely to have excellent or very good perceived mental health (71.8 percent) than black women (61.6 percent) or Hispanic women (64.1 percent). They were less likely to have fair or poor perceived mental health than black women (6.0 percent vs. 10.2 percent), but there were no significant differences in fair/poor mental health status among white women, Hispanic women, and women in the other racial/ethnic group Despite the differences between white and black women in perceived health and mental health status, there were no significant differences in the proportions of black and white women with functional limitations, activity limitations, or need for assistance with ADLs and IADLs. Women in the other race/ethnicity category were the least likely to have any limitations (12.5 percent, compared to 20.9 percent for whites, 18.9 percent for blacks, and 16.2 percent for Hispanics) and also the least likely to need assistance with ADLs and IADLs.

Marital Status and Children

The results of this analysis show that a woman’s marital status, combined with the ages of children, if she has any at home, is associated with her perceived health status. Among women with children age 5 and under, married women were significantly more likely than single women to report excellent or very good general health (69.7 percent vs. 53.0 percent) and less likely to report fair or poor health (7.5 percent vs. 12.5 percent). However, there were no differences in reports of general health between married and single women with children ages 6-18. For women without children at home, there were no differences between the proportion of married and single women with excellent or very good health, but single women were more likely than married women to be in fair or poor health (18.8 percent compared to 15.8 percent).

Among women with children age 5 and under, married women were less likely than single women to have fair or poor perceived mental health (3.5 percent compared to 7.1 percent) and more likely to have excellent or very good reported mental health (77.1 percent compared to 61.4 percent). Women with children ages 6-18 were more likely to have excellent or very good perceived mental health if they were married than if they were single (71.6 percent compared to 62.4 percent), but there was no difference between them in the report of fair or poor mental health. Married women without children were more likely than single women without children to have excellent or very good perceived mental health (71.7 percent compared to 67.4 percent).

There are no differences in the proportions of married women with children and single women with children who had activity limitations, had functional limitations, or needed assistance with ADLs or IADLs, regardless of the age of the children. However, single women without children were more likely than married women without children to have activity limitations, functional limitations, and need for assistance with ADLs and IADLs.

Income and Insurance Status

Over one-quarter of women living at or near poverty level were reported to be in fair or poor health (26.4 percent). That is twice the level for women in families with middle-level incomes (12.3 percent) and three times the proportion for women with high family incomes (8.4 percent). The pattern is repeated with perceived mental health. Thirteen percent of women in families with poor or near-poor levels of income had fair or poor perceived mental health. This is more than four times the proportion among women in families with high incomes (3.1 percent). Women in poor or near-poor as well as low-income families also were more likely than women with higher incomes to have functional limitations, activity limitations, and need for assistance with ADLs or IADLs. Women in families with incomes at or near the poverty level were more than twice as likely as women in high-income families to have some form of physical limitation (30.7 percent compared to 13.4 percent) and more than three times as likely to need assistance with ADLs or IADLs (13.0 percent compared to 3.4 percent).

Among women under age 65, those covered only by public insurance were the least likely to have excellent or very good perceived physical health (only 36.3 percent). Over a third of them were reported to be in fair or poor health (34.8 percent)—almost twice the proportion for uninsured women under 65 (18.6 percent) and four times the proportion for those with private insurance (8.1 percent). Approximately 13 percent of women under age 65 were uninsured. Among those who were uninsured, 18.6 percent were in fair or poor health. As with self-reported physical health, women under age 65 who had only public insurance were more likely to have fair or poor perceived mental health (18.6 percent) than women who had private insurance (3.7 percent) or who were uninsured (6.9 percent).

Among women 65 and over, about half of those with Medicare only or Medicare plus private insurance were in excellent or very good general health. Among women 65 and over, 45.6 percent of those with Medicare along with Medicaid or other public insurance had fair or poor general health, a higher proportion than for women with Medicare alone or Medicare and private insurance. Similarly, reports of excellent or very good mental health were more common for women over 65 with Medicare only (63.4 percent) or Medicare and private insurance (63.9 percent), while those with Medicare and Medicaid or other public insurance had much higher proportions with fair or poor mental health (21.7 percent).

Among women under age 65, those with only public health insurance were the most likely to have any physical limitation: over one-third had a limitation, almost 16 percent required assistance with an ADL or IADL, and close to one-quarter had activity limitations and/or functional limitations. The highest proportion of elderly women with limitations was for those with Medicare and other public insurance: more than 40 percent of these women needed assistance with ADLs or IADLs and more than 60 percent had some type of limitation.

Employment

The examination of employment and health status is limited to women ages 18-64. Women who were employed all year were the most likely to be in excellent or very good health (67.1 percent) and mental health (75.9 percent). Women who were not employed at all during the year had the highest levels of fair or poor general health (27.8 percent) and fair or poor mental health (13.1 percent), and they also were the most likely to have some type of limitation (30.2 percent).

Education

Women with less that 12 years of education were much more likely to have fair or poor perceived health (32.0 percent) than those with a high school education (13.0 percent) or those with education beyond high school (8.6 percent). The same is true for perceived mental health status. Women with less than 12 years of education were more likely to have fair or poor mental health (14.9 percent) than women with 12 years of education (5.6 percent) or more than 12 years of education (3.8 percent).

Area of Residence

Women living in metropolitan areas were more likely than women living outside of metropolitan areas to be in excellent or very good health (61.1 percent vs. 54.2 percent). The reverse relationship also held, with a higher proportion of women in nonmetropolitan areas having fair or poor health (17.4 percent). The proportion of women with excellent or very good reported mental health was higher in metropolitan areas (71.1 percent), but there was no metropolitan-nonmetropolitan difference in the proportion with fair or poor mental health. Consistent with higher levels of fair or poor health, women in nonmetropolitan areas were also more likely to have limitations, including ADLs or IADLs, activity limitations, and functional limitations.

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Insurance Status and Source of Care

In Table 3, the insurance status of women in the United States is described. The data on private insurance not only show the percent of women with and without insurance but also indicate the proportions of women who were policyholders of their insurance or dependents on someone else’s policy. Policyholders can have access to insurance through their employment, including self-employment, or through union programs, or they could purchase the insurance independently of those employment mechanisms. About 75 million, or 75 percent of all women, were covered by private insurance in 1996. Over half of these women (about 62 percent, calculated from Table 3) were covered by policies that they held themselves. The remainder were covered by private insurance as a dependent. Another 14.8 percent of women were covered by public health insurance only, leaving 10.7 percent without any coverage to facilitate their access to medical care. This section discusses the factors associated with whether a woman is insured and the type of insurance she holds, as well as characteristics associated with her usual source of medical care (Tables 3 and 4).

Age

Young women ages 18-29 were the most likely to be uninsured (18.1 percent); among women under age 65, they were also the most likely to have only public insurance (13.6 percent). Once women reach age 65, however, very few are uninsured and the levels of public insurance increase with age. Interestingly, 56.4 percent of women 85 and over, 63.9 percent of women 75-84, and 66.8 percent of women 65-74 had private insurance in addition to Medicare. Women in all age groups were more likely to hold their own policies than to be dependents on another policy.

Younger women were the most likely to lack a usual source of health care (26.4 percent), followed by women ages 30-44 (17.2 percent). Older women were the least likely to lack a usual source of care. About 10 percent of women 65-74 had no usual source of care, and by age 85, that proportion was less than 4 percent. Most women with a usual source of care saw an office-based physician for that care. However, for all ages up to age 85, between 9 and 12 percent of women who had a usual source of care got their care in a hospital outpatient department.

Race/Ethnicity

White women were the most likely to have private insurance; about 80 percent had private insurance as either their main form of insurance or as a supplement to Medicare. Hispanic women were the least likely to have private insurance (only 52.9 percent). Only a little more than 58 percent of black women were covered by private insurance. Like white women, black women were significantly more likely to hold their own policies than to be a dependent on someone else’s policy. Black and Hispanic women were the most likely to receive public insurance (26.6 percent and 25.0 percent, respectively). However, public insurance did not compensate for low rates of private insurance among Hispanic women, so they were the most likely to be uninsured (22.1 percent).

Hispanic women (26.3 percent) also were more likely than white women (14.5 percent) or black women (17.1 percent) to lack a regular source of medical care. Among women who had a source of care, white women were the most likely to visit an office-based physician, while blacks, Hispanics, and women of other races were more likely than white women to use hospital outpatient services.

Health and Disability Status

Women in fair or poor general health were much less likely to have private health insurance than women in better health (53.7 percent compared to 81.3 percent for women in excellent or very good health and 71.5 percent for women in good health), and they were much less likely than women in better health to hold their own private policies (33.1 percent). Women in excellent or very good health were less likely to be uninsured (9.3 percent) than women in good health (12.4 percent) or fair to poor health (13.4 percent). Similarly, women reported to be in fair or poor mental health were much less likely to have private insurance than women in better mental health (50.3 percent compared to 79.8 percent for women in excellent or very good health and 66.7 percent for women in good health) and much more likely to be covered by public insurance only (38.5 percent).

Women in fair or poor general health were the most likely to have an office-based physician as a usual source of care. They were the least likely to lack a regular source of care (9.7 percent for women in fair or poor health compared to 18.0 percent for women in excellent or very good health and 15.8 percent for women in good health). These patterns did not necessarily hold for women in fair or poor mental health.

As with women in fair or poor health, women with a limitation were less likely to have private insurance (60.7 percent) than women without a limitation (77.9 percent). Women with limitations were significantly more likely than those without limitations to have public insurance and less likely to be uninsured.

Women with limitations were significantly less likely to lack a usual source of care (9.0 percent compared to 18.0 percent for women without limitations), and their usual source of care was more likely to be a physician’s office (79.3 percent compared to 72.4 percent). There was no difference in the use of hospital outpatient facilities or the emergency room as the usual source of care between women with and without limitations.

Marital Status and Children

There is a marked difference in insurance status between married women with children age 5 and under and single women with children age 5 and under.

Among mothers of children age 5 and under:

  • Over three-quarters (81.6 percent) of married women but only approximately 39 percent of single women had private insurance.
  • Only 7.9 percent of married women had public insurance only, and 10.5 percent were uninsured.
  • Over 40 percent of single women (more than eight times the proportion of married women) had public insurance only, and approximately 17 percent were uninsured.

A similar pattern holds for women with older children. Among mothers of children ages 6-18:

  • Married women were much more likely to have private insurance (83.7 percent compared to 59.7 percent for single women).
  • Single women were more likely than married women to have public insurance only or to be uninsured. More than one-fifth of single women had public insurance and 16 percent were uninsured.
  • When they did have private insurance, single women were much more likely (56.4 percent) than married women (38.0 percent) to hold the private insurance coverage themselves.

Among women without children in the household, married women were again more likely than single women to have private insurance (83.8 percent compared to 67.6 percent), while single women were almost twice as likely to be uninsured and twice as likely to be covered by public insurance only.

Of all the groups discussed here, single women with children age 5 and under were the most likely to lack a usual source of care (25.0 percent). They are also the least likely to have an office-based physician as their regular source of care (58.8 percent). Single women with children ages 6-18 were more likely to see an office-based physician (69.5 percent) than single women with children age 5 and under, but they were less likely to do so than married women with children ages 6-18. Among women without children in the household, single women were more likely than married women to lack a usual source of care.

Income

Women with family incomes at or near the poverty level were the least likely to have private health insurance (37.7 percent). They had the highest proportions of public insurance (41.4 percent), and an additional 21.0 percent of them were uninsured. Only 66.1 percent of low-income women had private insurance, compared to 83.9 percent of middle-income women and 91.3 percent of  high-income women. 

Regardless of income, women with private insurance were more likely to hold the private insurance policies themselves than to be dependents on someone else’s policy.

Poor and low-income women were the most likely to lack a regular source of care (21.1 percent and 20.6 percent, respectively, compared to 15.9 percent for middle-income women and 11.9 percent for high-income women). When poor and low-income women had a usual source of care, they were less likely than middle- and high-income women to have an office-based physician as that source of care.

Employment Status

Employment status is an important factor associated with the health insurance coverage of women ages 18-64. Private insurance coverage was significantly more common among women who were employed all year (86.6 percent) than among women who worked only part of the year (63.5 percent) or did not work during the year (54.8 percent). Women who worked all year were also significantly more likely to be policyholders of their insurance (61.7 percent compared to 23.9 percent for women who worked part of the year and 12.0 percent for women who were not employed during the year). Women who were not employed during the year were the most likely to be covered by public insurance only (26.9 percent), while women who worked for part of the year were the most likely to be uninsured (19.6 percent).

Women who were not employed during the year were about as likely as women who were employed to lack a source of care (17-18 percent). Women who worked for only part of the year were the most likely to lack a regular source of care. Employment is associated with where women get their care. Women employed all year were more likely than other women to have an office-based practitioner as the usual source of care (74.0 percent). The usual source of care was more likely to be hospital based for women employed for part of the year (11.6 percent) and women who were not employed (11.1 percent) than for women employed all year (8.6 percent).

Education

The highest proportion with private insurance (86.6 percent) was for women with more than 12 years of education. In addition, women with the most education were more likely to be the holders of their private insurance policies, less likely to have public insurance (5.7 percent), and less likely to be uninsured (7.8 percent).

Area of Residence

Women living in metropolitan areas were more likely to have private insurance (75.4 percent) than women living outside metropolitan areas. Women in nonmetropolitan areas were about as likely as women in metropolitan areas to have public insurance but were more likely to be uninsured.

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Use of Preventive Services

About 81 percent of American women used some form of ambulatory health service in 1996 (Table 5). Approximately 71 percent of women received a Pap smear in the last 2 years, 64 percent of those ages 40 and over received a mammogram in the last 2 years, and about 67 percent of women had a complete physical within the last 2 years. Preventive care has been found to be associated with individual characteristics and with available resources. The discussion below examines the impact of characteristics and resources on use of preventive services.

Age and Race/Ethnicity

The youngest women (18-29 years) were the least likely to have had an ambulatory health care visit (73.3 percent), and the oldest women (age 85 and over) were the most likely to have had such a visit (93.0 percent). Although older women were more likely to have had a medical care visit, as age increased after age 64, they were less likely to have received a Pap smear (60.9 percent for ages 65-74, 42.4 percent for ages 75-84, and 26.3 percent for age 85 and over).

Looking only at women age 40 and over, women age 40 and over, the data show that after age 65, a similar pattern appears with mammograms; with each increasing 10 years of age, the probability of having received a mammogram within the past 2 years was significantly reduced. There are fewer differences between age groups on receiving a complete physical.

White women were more likely than women of other racial and ethnic groups to have had an ambulatory health visit in 1996 (84 percent). This racial/ethnic difference does not hold, however, when looking at use of preventive care. White women and Hispanic women were equally likely to have received Pap smears within the past 2 years, but black women were the most likely to have had a Pap smear (76.5 percent for black omen compared to 70.6 percent for whites, 69.0 percent for Hispanics, and 58.2 percent for women of other races). Black, white, and Hispanic women age 40 and over were equally likely to have received a mammogram in the past 2 years (63-65 percent), but a smaller percentage of women of other races (50.4 percent) received a mammogram. In addition to receiving Pap smears more often, black women were significantly more likely than women of any other racial or ethnic group to have had a complete physical within the last 2 years.

Health and Disability Status

As one would expect, women in fair or poor health or fair or poor mental health were more likely than other women to have had an ambulatory visit during 1996. However, fair or poor health or mental health appears to be associated with lower probabilities of receiving preventive gynecological screenings, both Pap smears (62.7 percent for women in fair or poor general health and 60.1 percent for women in fair or poor mental health) and mammograms for women 40 and over (58.3 percent for women in fair or poor general health and 50.6 percent for women in fair or poor mental health). On the other hand, women in fair or poor general health were more likely to receive a complete physical (73.6 percent) than women with better health status (64.6 percent for women in excellent or very good health and 68.5 percent for women in good health).

Like women in fair or poor health, women with some form of limitation were significantly more likely to have had an ambulatory health care visit during the year (93.4 percent). However, this increased use of health care does not translate into increased use of gynecological preventive care for women with limitations. They were significantly less likely than women without limitations to have received either a recent Pap smear (58.9 percent compared to 73.5 percent) or a recent mammogram (56.4 percent compared to 67.1 percent). Nonetheless, women with limitations were more likely to have received a physical within the last 2 years (70.2 percent compared to 65.7 percent for women without limitations).

Marital Status and Children

Married women with children, regardless of the ages of the children, were more likely to have an ambulatory health care visit than single women with children (81.6 percent for married women with children 5 and under and 77.5 percent for married women with children 6-18, compared to 72.0 percent for single women with children in either age group). Among women with children age 5 and under, married women were more likely than single women to have had a Pap smear (87.8 percent compared to 81.2 percent), but there was no significant difference in the percent receiving mammograms or complete physicals in the last 2 years.

Among women with children ages 6-18, there were no differences by marital status in gynecological screenings, but single women were more likely to have had a complete physical (70.4 percent compared to 64.0 percent).

Among women without children at home, married women were more likely than single women to have had a Pap smear and, for those age 40 and over, a mammogram in the past 2 years. There was no difference in the proportion that received a physical exam for these two groups.

Income and Insurance Status

Women with high family incomes were more likely than those with lower incomes to have had an ambulatory health care visit in 1996: 84.7 percent of high-income women compared to 76.4 percent of poor or near-poor women, 78.7 percent of low-income women, and 81.7 percent of middle-income women. In addition, income was associated with the receipt of Pap smears and mammograms. While there are no differences between women with poverty-level incomes and those with low incomes, middle-income women were more likely to have had a Pap smear (72.4 percent) than poor or near-poor women (61.7 percent) and low-income women (64.4 percent). Middle-income women were also more likely to have received a mammogram (64.1 percent compared to 51.3 percent for poor and near-poor women and 56.3 percent for low-income women). As with ambulatory visits, high-income women were more likely than any of the other income groups to have had a Pap smear or a mammogram. However, there was little difference among the income groups on receipt of a complete physical.

Among women under age 65, having some form of insurance is associated with having an ambulatory health visit. In 1996, the proportion with an ambulatory visit was higher for women with private insurance (82.2 percent) or public insurance (84.0 percent) than for uninsured women (57.4 percent). The same pattern holds for receipt of the three types of preventive care examined here. A higher proportion of women covered by either private or public insurance than uninsured women had Pap smears, mammograms, and physical examinations. Women under age 65 who had private insurance were more likely than those with public coverage to have received a Pap smear (79.6 percent compared to 72.1 percent) or a mammogram (71.1 percent compared to 58.8 percent) but were less likely to  have had a complete physical (67.1 percent compared to 72.1 percent).

Older women with Medicare benefits and private insurance are at an advantage over women with Medicare only and women with Medicare and other public insurance. In 1996, elderly women who had private insurance in addition to Medicare were more likely to have ambulatory visits and all three types of preventive care services than women who had Medicare coverage only or Medicare and other public insurance. There were no differences in use between women with Medicare only and those with Medicare and other public insurance.

Employment

Ambulatory visits were more likely for women ages 18-64 who were employed all year (79.9 percent) or not employed during the year (79.1 percent) than for women who were employed for part of the year (74.9 percent). The proportion receiving a Pap smear was larger for women who were employed throughout the year (78.1 percent) than for women employed part of the year (71.2 percent) or women not employed during the year (69.6 percent). Similarly, the proportion of women getting a mammogram was greater for women employed all year (68.6 percent) than for women employed part of the year (59.9 percent) or not employed (64.2 percent). Women who were either employed all year or not employed at all were more likely to have had a physical exam within the last 2 years than women who had a job at some point in the year.

Education

While women with education levels greater than high school graduation were more likely than women with less education to have an ambulatory visit, women of all levels of education were equally likely to have received a physical examination within the last 2 years. However, that equality did not extend to receipt of gynecological preventive services. Women with more than a high school education were more likely to have received a Pap smear (78.0 percent, compared to 56.4 percent for women with less than 12 years of education and 69.3 percent for high school graduates) and a mammogram (70.9 percent compared to 52.4 percent for women with less than 12 years of education and 64.3 percent for high school graduates) within the past 2 years.

Area of Residence

Where a woman lives also was associated with access to certain services. Although women who lived in metropolitan and nonmetropolitan areas were equally likely to have had an ambulatory health care visit during the year, the women in nonmetropolitan areas were less likely to have had any of the preventive services examined here within the past 2 years (Pap smear, 63.3 percent as opposed to 72.4 percent for women in metropolitan areas; mammogram, 56.8 percent as opposed to 66.0 percent for women in metropolitan areas; or physical exam, 60.8 percent as opposed to 68.0 percent for women in metropolitan areas).

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Conclusions

These data give a clear indication that, as the population of women ages, their health status deteriorates slowly until about age 75, when approximately 30 percent are reported to be in fair or poor health. While this is not unexpected, it also should be noted that among older women, limitations in functioning and limitations in activities are more widespread than fair or poor health and should be of equal concern. Although there are still indications of racial/ethnic differences in the proportion of women in fair or poor general health, white and black women, at least, have similar levels of activity limitation, functional limitation, and need for assistance with ADLs and IADLs. Hispanic women and women of other races have lower levels of these limitations than whites and blacks.

Marital status and the presence of children in the family also are associated with women’s health. Single women with children age 5 and under have poorer general health status and mental health status than their married counterparts. Moreover, there is a marked difference in the types of insurance coverage between the two groups. Single women with children age 5 and under are much less likely than married women with small children to have private insurance, are much more dependent on public insurance, are much more likely to be uninsured, are much more likely to lack a usual source of medical care, and are less likely to have had an ambulatory health care visit. However, despite the access problems faced by single women with children age 5 and under, they are receiving some preventive care services at the same level as other women (mammograms and physical exams).

Two other important characteristics that influence women’s health and their access to medical care are family income and health insurance status. When compared to women with higher income levels, poor women have much higher levels of perceived fair or poor health and fair or poor mental health. In addition, they have the highest levels of activity limitations and need for help with ADLs or IADLS; along with low-income women, they also have the highest levels of functional limitations. Both women at or near poverty and those with low incomes are significantly more likely than higher income women to lack a usual source of care; when they do have a source of care, it is less likely to be an office-based physician. Poverty is strongly related to women’s insurance status, with poor and near-poor women being the income group least likely to have private insurance and most likely to have public coverage or be uninsured. This combination of poverty and insurance status has a significant effect on poor and near-poor women, and they are less likely than middle-income and high-income women to have an ambulatory visit or to have gynecological screening in the form of a Pap smear or mammogram (for women 40 and over). Access to ambulatory visits or preventive care services is significantly restricted for those poor and near-poor women who are uninsured. Employment for women ages 18-64 significantly improves their access to private health insurance. A high number of women who are not working or who worked only part of the year are uninsured.

Finally, there are some subtle differences in health status and access to health care between women who live in metropolitan areas and those who live in nonmetropolitan areas. Women in nonmetropolitan areas are more likely to need help with ADLs or IADLS and to have activity limitations or functional limitations. At the same time, they are less likely than women in metropolitan areas to have private health insurance, are more likely to be uninsured, and are less likely to receive preventive services.

^top


Tables

Tables showing information on women by sociodemographic
characteristics:
1. Physical and mental health status
2. Functional and activity limitations
3. Health insurance status
4. Usual source of care
5. Use of ambulatory and preventive care services

Table 1.Physical and mental health status of civilian noninstitutionalized women by sociodemographic characteristics: United States,1996

Population characteristic

Total population of women in thousands

 Perceived healtha


Perceived mental healthb


  

  

Excellent/very  good

 Good 

 Fair/poor 

Excellent/very  good

 Good 

 Fair/poor

  

Total in thousands

101,000

59,906

25,585 

14,828

70,043

23,622 

6,641

 

  

  Percent


   

Percent of all women

59.7

25.5

14.8

69.8

23.6

6.6

   

Age in years 

18-29

21,071

67.1

25.8

7.1

77.1

18.6

4.3

30-44

32,755

65.2

24.1

10.7

71.9

22.2

5.9

45-64

27,953

56.6

25.9

17.5

67.8

25.9

6.3

65-74

10,142

49.5

27.0

23.5

65.5

27.0

7.5

75-84

6,850

43.5

26.7

29.9

56.6

29.9

13.5

85 and over

2,225

42.1

28.6

29.2

54.6

26.1

19.3

   

Race/ethnicity 

White

75,247

62.7

23.9

13.4

71.8

22.2

6.0

Black

12,229

50.7

28.8

20.5

61.6

28.2

10.2

Hispanic

9,273

48.6

31.7

19.6

64.1

28.2

7.7

Other

4,247

57.4

29.9

12.7

70.7

23.4

5.9

   

Education 

Less than 12 years

19,830

37.1

30.9

32.0

49.8

35.2

14.9

12 years

35,645

58.2

28.8

13.0

68.7

25.7

5.6

More than 12 years

45,402

70.8

20.6

8.6

79.4

16.8

3.8

   

Marital status and childrenc

Married without children

29,973

58.5

25.7

15.8

71.7

23.4

4.9

Married with children 5 and under

11,722

69.7

22.8

7.5

77.1

19.4

3.5

Married with children 6-18

13,844

62.6

26.9

10.5

71.6

23.1

5.3

Single without children

35,320

57.5

23.7

18.8

67.4

23.0

9.6

Single with children 5 and under

4,480

53.0

34.5

12.5

61.4

31.5

7.1

Single with children 6-18

5,657

57.6

30.6

11.9

62.4

31.1

6.5

   

Income 

Poor/near-poor

20,591

41.8

31.9

26.4

54.5

32.5

13.1

Low income

14,431

52.0

28.5

19.5

63.5

27.6

9.0

Middle income

30,390

63.7

24.0

12.3

72.2

22.5

5.3

High income

35,584

69.7

21.9

8.4

79.2

17.7

3.1

   

Insurance statusd 

Under age 65:

 
 
 
 
 
 
 

Private

62,852

68.0

23.9

8.1

76.6

19.7

3.7

Public only

8,149

36.3

28.9

34.8

46.2

35.1

18.6

Uninsured

10,778

51.9

29.5

18.6

63.3

29.8

6.9

Age 65 and over:e 

Medicare only

4,187

49.3

27.9

22.7

63.4

24.2

12.3

Medicare and private

12,347

49.2

27.0

23.8

63.9

27.9

8.2

Medicare and other public

2,593

28.4

25.9

45.6

43.9

34.3

21.7

   

Employmentf

Employed full year

54,066

67.1

25.2

7.7

75.9

20.7

3.3

Employed part year

9,710

55.8

29.2

15.0

67.3

27.1

5.5

Not employed

17,970

43.8

28.3

27.8

56.8

30.2

13.1

   

Metropolitan statistical area (MSA) 

MSA

81,138

61.1

24.8

14.1

71.1

22.4

6.5

Non-MSA

19,858

54.2

28.4

17.4

64.5

28.4

7.1

   

a Perceived health status was collected during Round 1 and refers to health status during the first half of 1996. The estimated population excludes less than 0.7 percent missing data resulting from item nonresponse.

b Perceived mental health status was collected during Round 1 and refers to mental health status during the first half of 1996. The estimated population excludes less than 0.7 percent missing data resulting from item nonresponse.

c Marital status and number of parents in the home were collected during Round 1 and refer to the first half of 1996.

d Health insurance status was collected during Round 1 and refers to health insurance status during the first half of 1996. Public and private insurance categories refer to individuals with public or private insurance at any time during this period; individuals under age 65 with both public and private insurance are considered privately insured.

e Health insurance for persons age 65 and over excludes less than 1.0 percent missing data resulting from item nonresponse.

f Employment reflects the employment status over Rounds 1 and 2 and indicates if the person worked throughout those two periods, worked for only a portion of those two periods, or did not work at all during those two periods. Employment is measured only for women ages 18-64. The estimated population of women ages 18-64 is 81,745,971.

Note: Percents may not add to 100 because of rounding.

Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1996.

Table 2. Functional and activity limitation status of civilian noninstitutionalized women by sociodemographic characteristics: United States,1996

Population characteristic

Total population in thousands

ADLs or IADLsa

Activity limitations

Physical activity limitations

 Any limitationsb

 

Total in thousands

101,000

6,802

10,510

14,455

20,044

 

  

  Percent


 

Percent of all women

6.8

10.4

14.3

19.8

 

Age in years 

18-29

21,071

1.5

2.6

2.1

5.4

30-44

32,755

2.8

6.4

7.9

13.2

45-64

27,953

5.5

12.1

15.6

21.3

65-74

10,142

10.9

15.9

25.7

32.2

75-84

6,850

24.9

26.8

43.1

53.7

85 and over

2,225

55.3

48.3

67.1

76.6

 

Race/ethnicity 

White

75,247

7.0

11.1

15.2

20.9

Black

12,229

7.8

10.7

14.4

18.9

Hispanic

9,273

5.4

7.1

10.0

16.2

Other

4,247

2.0

4.8

8.4

12.5

 

Perceived healthc 

Excellent/very good

59,906

1.8

3.0

5.3

8.4

Good

25,585

5.6

10.0

15.9

23.0

Fair/poor

14,828

27.1

39.8

46.8

59.3

 

Perceived mental healthd 

Excellent/very good

70,043

3.2

5.7

9.3

13.0

Good

23,622

9.1

15.1

20.0

27.9

Fair/poor

6,641

32.8

40.8

44.1

60.8

 

Education 

Less than 12 years

19,830

14.6

20.3

26.3

35.3

12 years

35,645

6.4

9.9

14.1

19.1

More than 12 years

45,402

3.6

6.5

9.3

13.6

 

Marital status and childrene 

Married without children

29,973

5.1

10.3

15.1

20.4

Married with children 5 and under

11,722

*0.9

3.1

2.4

6.1

Married with children 6-18

13,844

2.2

5.7

8.2

11.5

Single without children

35,320

13.4

16.4

22.1

29.8

Single with children 5 and under

4,488

*1.5

4.5

4.5

8.3

Single with children 6-18

5,657

*1.6

5.5

8.8

13.1

 

Income 

Poor/near-poor

20,591

13.0

18.5

22.3

30.7

Low income

14,431

9.4

14.5

18.9

26.1

Middle income

30,390

5.2

7.8

12.6

17.0

High income

35,584

3.4

6.3

9.3

13.4

  

Insurance statusf 

Under age 65: 

Private

62,852

2.0

5.0

7.1

11.0

Public only

8,149

15.9

26.1

23.9

36.7

Uninsured

10,778

2.3

6.9

9.0

13.8

Age 65 and over:g 

Medicare only

4,187

24.2

21.3

31.3

41.9

Medicare and private

12,347

15.8

21.0

35.9

42.4

Medicare and other public

2,593

41.8

40.0

50.4

63.3

 

Employmenth 

Employed full year

54,066

1.0

2.7

5.4

8.7

Employed part year

9,710

2.7

6.5

7.3

13.2

Not employed

17,970

11.3

22.0

20.9

30.2

 

Metropolitan statistical area (MSA)

MSA

81,138

6.4

9.7

13.5

19.0

Non-MSA

19,858

8.2

13.3

17.6

23.3

 

a Activities of daily living (ADLs) include activities such as bathing and dressing. Instrumental activities of daily living (IADLs) include activities such as shopping and paying bills.

b The measure of any limitations combines indicators of any activity limitations, functional limitations, and problems with ADLs or IADLs. In addition, it includes social role limitations and cognitive limitations not reported here. Measures of limitations were collected in Round 1.

c Perceived health status was collected during Round 1 and refers to health status during the first half of 1996. The estimated population excludes less than 0.7 percent missing data resulting from item nonresponse.

d Perceived mental health status was collected during Round 1 and refers to mental health status during the first half of 1996. The estimated population excludes less than 0.7 percent missing data resulting from item nonresponse.

e Marital status and number of parents in the home were collected during Round 1 and refer to the first half of 1996.

f Health insurance status was collected during Round 1 and refers to health insurance status during the first half of 1996. Public and private insurance categories refer to individuals with public or private insurance at any time during this period; individuals under age 65 with both public and private insurance are considered privately insured.

g Health insurance for persons age 65 and over excludes less than 1.0 percent missing data resulting from item nonresponse.

h Employment reflects the employment status over Rounds 1 and 2 and indicates if the person worked throughout those two periods, worked for only a portion of those two periods, or did not work at all during those two periods. Employment is measured only for women ages 18-64. The estimated population of women ages 18-64 is 81,745,971.

*Relative standard error greater than 30 percent.

Note: Percents may not add to 100 because of rounding.

Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1996.

Table 3. Health insurance status of civilian noninstitutionalized women by sociodemographic characteristics: United States,1996

Population characteristic

Total population in thousands

 Private insurancea


 
 

 

 

Total     

Policyholder 

Dependent 

Public only

Uninsured

  

Total in thousand

101,000

75,198 

46,610

28,588

14,928 

10,778

 

 

  Percent


  

Percent of all women

74.5

46.2 28.3

14.8

10.7

 
  

Age in years 

18-29

21,071

68.3

38.3

30.0

13.6

18.1

30-44

32,755

78.7

49.4

29.3

9.4

11.9

45-64

27,953

81.2

48.5

32.7

7.9

11.9

65-74

10,142

66.8

43.8

23.1

33.2

0.0

75-84

6,850

63.9

47.4

16.5

36.1

0.0

85 and over

2,225

56.4

51.8

4.6

43.6

0.0

  

Race/ethnicity 

White

75,247

80.4

48.5

31.9

11.4

8.2

Black

12,229

58.2

44.5

13.8

26.6

15.2

Hispanic

9,273

52.9

33.4

19.5

25.0

22.1

Other

4,247

64.2

38.0

26.2

18.2

17.6

  

Perceived healthb 

Excellent/very good

59,906

81.3

49.7

31.5

9.4

9.3

Good

25,585

71.5

45.7

25.9

16.1

12.4

Fair/poor

14,828

53.7

33.1

20.6

32.9

13.4

  

Perceived mental healthc

Excellent/very good

70,043

79.8

49.5

30.3

10.6

9.7

Good

23,622

66.7

41.4

25.3

19.8

13.5

Fair/poor

6,641

50.3

29.6

20.8

38.5

11.2

  

Any limitationd 

No

80,982

77.9

47.7

30.2

10.6

11.5

Yes

20,044

60.7

40.0

20.8

31.9

7.4

  

Education 

Less than 12 years

19,830

47.6

29.1

18.5

36.0

16.4

12 years

35,645

74.3

43.6

30.7

14.5

11.1

More than 12 years

45,402

86.6

55.7

30.8

5.7

7.8

  

Marital status and childrene

Married without children

29,973

83.8

44.3

39.4

9.5

6.7

Married with children 5 and under

11,722

81.6

36.5

45.1

7.9

10.5

Married with children 6-18

13,844

83.7

38.0

45.7

4.9

11.3

Single without children

35,320

67.6

54.4

13.2

20.3

12.2

Single with children 5 and under

4,480

39.0

31.8

7.2

43.6

17.4

Single with children 6-18

5,657

59.7

56.4

3.3

24.2

16.1

  

Income

Poor/near-poor

20,591

37.7

24.4

13.3

41.4

21.0

Low income

14,431

66.1

43.0

23.2

17.5

16.4

Middle income

30,390

83.9

52.2

31.7

7.2

8.9

High income

38,584

91.3

55.0

36.2

4.8

4.0

  

Employmentf 

Employed full year

54,066

86.6

61.7

25.0

3.1

10.2

Employed part year

9,710

63.5

23.9

39.6

16.9

19.6

Not employed

17,970

54.8

12.0

42.8

26.9

18.4

  

Metropolitan statistical area (MSA)

MSA

81,138

75.4

46.7

28.7

14.7

9.9

Non-MSA

19,858

70.8

44.0

26.8

15.1

14.1

 

a Health insurance status was collected during Round 1 and refers to health insurance status during the first half of 1996. Public and private insurance categories refer to individuals with public or private insurance at any time during this period; individuals under age 65 with both public and private insurance are considered privately insured.

b Perceived health status was collected during Round 1 and refers to health status during the first half of 1996. The estimated population excludes less than 0.7 percent missing data resulting from item nonresponse.

c Perceived mental health status was collected during Round 1 and refer to mental health status during the first half of 1996. The estimated population excludes less than 0.7 percent missing data resulting from item nonresponse.

d The measure of any limitations combines indicators of any activity limitations, functional limitations, and problems with activities of daily living and instrumental activities of daily living. In addition, it includes social role limitations and cognitive limitations not reported here. Measures of limitations were collected in Round 1.

e Marital status and number of parents in the home were collected during Round 1 and refer to the first half of 1996.

f Employment reflects the employment status over Rounds 1 and 2 and indicates if the person worked throughout those two periods, worked for only a portion of those two periods, or did not work at all during those two periods. Employment is measured only for women ages 18-64. The estimated population of women ages 18-64 is 81,745,971.

Note: Percents may not add to 100 because of rounding.

Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1996.

Table 4. Usual source of care for civilian noninstitutionalized women by sociodemographic characteristics: United States,1996

   
     
   

 Usual source of health care


Population characteristic 

Total population in thousands

No usual source of health care

Office based

Hospital outpatient

Emergency room

 

Total in thousands

101,000

16,186

73,560  

9,516

530

  

  

  Percent


 

Percent of all women

16.2

73.7

9.5

0.5

 

Age in years 

18-29

21,071

26.4

62.9

9.6

*1.0

30-44

32,755

17.2

72.9

9.6

*0.3

45-64

27,953

12.3

77.7

9.3

0.6

65-74

10,142

9.7

80.4

9.5

*0.3

75-84

6,850

8.8

78.6

11.8

*0.9

85 and over

2,225

3.9

93.6

2.4

*0.0

 

Race/ethnicity

White

75,247

14.5

77.5

7.6

0.4

Black

12,229

17.1

65.5

16.1

*1.3

Hispanic

9,273

26.3

59.7

13.3

*0.6

Other

4,247

21.8

61.4

16.8

0.0

 

Perceived healtha

Excellent/very good

59,906

18.0

72.9

8.7

*0.4

Good

25,585

15.8

73.7

10.1

0.5

Fair/poor

14,828

9.7

77.4

11.9

*1.1

 

Perceived mental healthb

Excellent/very good

70,043

17.1

73.2

9.2

0.4

Good

23,622

14.3

75.0

9.8

0.9

Fair/poor

6,641

13.0

74.3

12.0

*0.6

 

Any limitationc 

No

80,952

18.0

72.4

9.3

0.4

Yes

20,044

9.0

79.3

10.7

1.0

 

Education

Less than 12 years

19,830

19.1

68.3

11.5

1.1

12 years

35,645

15.6

74.6

9.2

0.6

More than 12 years

45,402

15.4

75.4

8.9

*0.3

 

Marital status and childrend 

Married without children

29,973

12.7

78.2

8.8

*0.3

Married with children 5 and under

11,722

19.3

71.7

8.5

*0.5

Married with children 6-18

13,844

13.0

77.3

9.3

*0.4

Single without children

35,320

17.8

71.7

9.9

*0.6

Single with children 5 and under

4,480

25.0

58.8

14.9

*1.2

Single with children 6-18

5,657

19.6

69.5

9.8

*1.0

 

Income

 
 
 
 
 

Poor/near-poor

20,591

21.1

64.5

12.9

1.5

Low income

14,431

20.6

68.4

10.3

*0.7

Middle income

30,390

15.9

75.2

8.5

*0.4

High income

38,584

11.9

79.9

8.2

*0.1

 

Insurance statuse 

Under age 65: 

Any private

62,852

15.1

76.2

8.5

0.2

Public only

8,149

15.6

65.5

17.0

*2.0

Uninsured

10,778

36.6

52.0

10.1

*1.2

Age 65 and over f 

Medicare only

4,187

13.6

73.8

12.6

*0.0

Medicare and private

12,347

6.6

84.6

8.1

*0.7

Medicare and other public

2,593

9.1

78.1

12.3

*0.6

 

Employmentg

Employed full year

54,066

17.0

74.0

8.6

0.4

Employed part year

9,710

24.0

64.0

11.6

*0.4

Not employed

17,970

17.5

70.3

11.1

1.1

 

Metropolitan statistical area (MSA)

 
 
 
 

MSA

81,138

16.9

73.0

9.7

0.5

Non-MSA

19,858

13.6

76.5

9.0

*0.9

 
a Perceived health status was collected during Round 1 and refers to health status during the first half of 1996. The estimated population excludes less than 0.7 percent missing data resulting from item nonresponse.

b Perceived mental health status was collected during Round 1 and refers to mental health status during the first half of 1996. The estimated population excludes less than 0.7 percent missing data resulting from item nonresponse.

c The measure of any limitations combines indicators of any activity limitations, functional limitations, and problems with activities of daily living and instrumental activities of daily living. In addition, it includes social role limitations and cognitive limitations not reported here. Measures of limitations were collected in Round 1.

d Marital status and number of parents in the home were collected during Round 1 and refer to the first half of 1996.

e Health insurance status was collected during Round 1 and refers to health insurance status during the first half of 1996. Public and private insurance categories refer to individuals with public or private insurance at any time during this period; individuals under age 65 with both public and private insurance are considered privately insured.

f Health insurance for persons age 65 and over excludes less than 1.0 percent missing data resulting from item nonresponse.

g Employment reflects the employment status over Rounds 1 and 2 and indicates if the person worked throughout those two periods, worked for only a portion of those two periods, or did not work at all during those two periods. Employment is measured only for women ages 18-64. The estimated population of women ages 18-64 is 81,745,971.

*Relative standard error is greater than 30 percent.

Note: Percents may not add to 100 because of rounding.

Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1996.

Table 5. Use of ambulatory and preventive care services by civilian noninstitutionalized women by sociodemographic characteristics: United States,1996

Population characteristic

Total population in thousands  

Any use of ambulatory services

Pap smear in past 2 years

Mammograma in past 2 years     

Complete physical in past 2 years

 

Total in thousands

101,000

82,050

71,316

37,317

67,229

 

  

  Percent


 

Percent of all women

81.2

70.6

a64.1

66.6

 

Age in years

18-29

21,071

73.3

73.6

62.2

30-44

32,755

78.8

79.5

57.1

64.4

45-64

27,953

83.8

71.8

70.7

68.4

65-74

10,142

90.1

60.9

68.9

74.8

75-84

6,850

90.0

42.4

52.0

71.6

85 and over

2,225

93.0

26.3

31.5

63.8

 

Race/ethnicity

White

75,247

84.2

70.6

64.9

65.4

Black

12,229

72.1

76.5

63.3

78.5

Hispanic

9,273

73.6

69.0

63.8

65.1

Other

4,247

71.9

58.2

50.4

55.9

 

Perceived healthb

Excellent/very good

59,906

78.2

73.5

67.0

64.6

Good

25,585

82.7

70.1

64.5

68.5

Fair/poor

14,828

91.8

62.7

58.3

73.6

 

Perceived mental healthc

Excellent/very good

70,043

80.3

73.5

67.8

66.8

Good

23,622

83.1

66.8

61.2

67.8

Fair/poor

6,641

87.3

60.1

50.6

67.1

 

Any limitationd 

No

80,952

78.2

73.5

67.1

65.7

Yes

20,044

93.4

58.9

56.4

70.2

 

Education

Less than 12 years

19,830

79.3

56.4

52.4

65.1

12 years

35,645

79.6

69.3

64.3

66.5

More than 12 years

45,402

83.5

78.0

70.9

67.4

 

Marital status and childrene

Married without children

29,973

85.9

71.1

70.2

68.5

Married with children 5 and under

11,722

81.6

87.8

59.4

64.9

Married with children 6-18

13,844

77.5

75.9

63.6

64.0

Single without children

35,320

81.3

60.4

57.6

65.8

Single with children 5 and under

4,480

72.0

81.2

55.0

67.5

Single with children 6-18

5,657

72.0

74.6

61.0

70.4

 

Income 

Poor/near-poor

20,591

76.4

61.7

51.3

63.3

Low income

14,431

78.7

64.4

56.3

65.4

Middle income

30,390

81.7

72.4

64.1

66.6

High income

35,584

84.7

76.7

72.6

68.9

 

Insurance statusf

Under age 65:

Private

62,852

82.2

79.6

71.1

67.1

Public only

8,149

84.0

72.1

58.8

72.1

Uninsured

10,778

57.4

60.3

40.4

48.9

Age 65 and over:g

Medicare only

4,187

86.1

40.8

49.3

66.8

Medicare and private

12,347

92.3

54.7

63.7

75.2

Medicare and other public

2,593

90.8

45.4

50.2

67.7

 

Employmenth 

Employed full year

54,066

79.9

78.1

68.6

65.5

Employed part year

9,710

74.9

71.2

59.9

61.5

Not employed

17,970

79.1

69.6

64.2

66.4

 

Metropolitan statistical area (MSA) 

MSA

81,139

81.3

72.4

66.0

68.0

Non-MSA

19,857

80.8

63.3

56.8

60.8

 

a Data on mammograms were limited to women age 40 and over. The population total reflects the number of women this age. Approximately 37,317,000, or 64.1 percent, of women age 40 and over (37 percent of all women age 18 and over) received a mammogram in the past 2 years.

b Perceived health status was collected during Round 1 and refers to health status during the first half of 1996. The estimated population excludes less than 0.7 percent missing data resulting from item nonresponse.

c Perceived mental health status was collected during Round 1 and refers to mental health status during the first half of 1996. The estimated population excludes less than 0.7 percent missing data resulting from item nonresponse.

d The measure of any limitations combines indicators of any activity limitations, functional limitations, and problems with activities of daily living and instrumental activities of daily living. In addition, it includes social role limitations and cognitive limitations not reported here. Measures of limitations were collected in Round 1.

e Marital status and number of parents in the home were collected during Round 1 and refer to the first half of 1996.

f Health insurance status was collected during Round 1 and refers to health insurance status during the first half of 1996. Public and private insurance categories refer to individuals with public or private insurance at any time during this period; individuals under age 65 with both public and private insurance are considered privately insured.

g Health insurance for persons age 65 and over excludes less than 1.0 percent missing data resulting from item nonresponse.

h Employment reflects the employment status over Rounds 1 and 2 and indicates if the person worked throughout those two periods, worked for only a portion of those two periods, or did not work at all during those two periods. Employment is measured only for women ages 18-64. The estimated population of women ages 18-64 is 81,745,971.

Note: Percents may not add to 100 because of rounding.

Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1996.

 

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References

Brown ER, Wyn R, Cumberland WG, et al. Women’s health-related behaviors and use of clinical services. A report to The Commonwealth Fund, Commission on Women’s Health. Los Angeles: UCLA Center for Health Policy Research; 1995.

Cohen J. Design and methods of the Medical Expenditure Panel Survey Household Component., Rockville (MD): Agency for Health Care Policy and Research; 1997. MEPS Methodology Report No. 1. AHCPR Pub. No. 97-0026.

Cohen JW, Monheit AC, Beauregard KM, et al. The Medical Expenditure Panel Survey: a national health information resource. Inquiry 1996;33:373-89.

Cohen S. Sample design of the 1996 Medical Expenditure Panel Survey Household Component. Rockville (MD): Agency for Health Care Policy and Research; 1997. MEPS Methodology Report No. 2. AHCPR Pub No. 97-0027.

Collins KS, Schoen C, Joseph S, et al. Health concerns across a woman’s lifespan: The Commonwealth Fund survey of women’s health. New York: The Commonwealth Fund; 1999.

Guralnik JM, Fried LP, Simonsick EM, et al., editors. 1995. The Women’s Health and Aging Study: health and social characteristics of older women with disability. Bethesda (MD): National Institute on Aging; 1995. NIH Pub. No. 95-4009.

Jacobs Institute of Women’s Health. The women’s health data book; 1993.

Leigh WA, Lindquist MA. Women of color health data book. Bethesda (MD): Office of Research on Women’s Health, Office of the Director, National Institutes of Health; 1998. NIH Pub. No. 98-4247.

Leiman JM, Meyer JE, Rothschild N, Simon LJ. Selected facts on U.S. women’s health: a chart book. New York: The Commonwealth Fund, Commission on Women’s Health; 1997.

Vistnes JP, Monheit AC. Health insurance status of the U.S. civilian noninstitutionalized population: 1996. Rockville (MD): Agency for Health Care Policy and Research; 1997. MEPS Research Findings No. 1. AHCPR Pub. No. 97-0030.

Weigers ME, Drilea SK. Health status and limitations: a comparison of Hispanics, blacks, and whites, 1996. Rockville (MD): Agency for Health Care Policy and Research; 1999. MEPS Research Findings No. 10. AHCPR Pub. No. 00-0001.

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Technical Appendix
Survey Design   Table on Men's Health Status
Health Status Standard Error Table B
Population Characteristics Standard Error Table C
Use of Ambulatory and Preventive Services Standard Error Table D
Sample Design and Accuracy of Estimates Standard Error Table E
Rounding Standard Error Table F
Comparisons with Other Data Sources  

The data in this report were obtained in the Round 1, 2, and 3 interviews for the Household Component (HC) of the 1996 Medical Expenditure Panel Survey (MEPS). MEPS is cosponsored by the Agency for Healthcare Research and Quality (AHRQ) and the National Center for Health Statistics (NCHS). The MEPS HC is a nationally representative survey of the U.S. civilian noninstitutionalized population that collects medical expenditure data at both the person and household levels. The focus of the MEPS HC is to collect detailed data on demographic characteristics, health conditions, health status, use of medical care services, charges and payments, access to care, satisfaction with care, health insurance coverage, income, and employment. In other components of MEPS, data are collected on residents of licensed or certified nursing homes and from the supply side of the health insurance market.

Survey Design

The sample for the 1996 MEPS HC was selected from respondents to the 1995 National Health Interview Survey (NHIS), which was conducted by NCHS. NHIS provides a nationally representative sample of the U.S. civilian noninstitutionalized population and reflects an oversampling of Hispanics and blacks. The MEPS HC collects data through an overlapping panel design. In this design, data are collected through a precontact interview that is followed by a series of five rounds of interviews over 2-years. Interviews are conducted with one member of each family, who reports on the health care experiences of the entire family. Two calendar years of medical expenditure and utilization data are collected from each household and captured using computer-assisted personal interviewing (CAPI). This series of data collection rounds is launched again each subsequent year on a new sample of households to provide overlapping panels of survey data which that will provide continuous and current estimates of health care expenditures.

The reference period for Round 1 of the MEPS HC was from January 1, 1996, to the date of the first interview, which occurred during the period from March through July 1996. The reference period for Round 2 of the MEPS HC was from the date of the first interview (March-July 1996) to the date of the second interview, which took place during the period from August through November 1996. The reference period for Round 3 was from December 1996 through July 1997. However, the only Round 3 data included in this Research Findings represent information collected from the end of Round 2 through December 31, 1996.

Health Status

A questionnaire module on health status was administered in Rounds 1 and 2 of the MEPS HC. The data reported in Tables 1-4 on perceived health, perceived mental health, and functional, ADL (activities of daily living), IADL (instrumental activities of daily living), and activity limitations were collected during Round 1. 

Only women ages 18 and over who were assigned a positive person-level weight were included in this analysis. Positive person-level weights were assigned to eligible members of the U.S. civilian noninstitutionalized population for whom data were collected as a means to apply sampling adjustments and reapportion population subgroups that were originally oversampled to their representation in the full population. Of the 24,676 persons surveyed in the first round, 23,612 were assigned a positive person-level weight. Of the 23,767 individuals surveyed in the second round, 22,149 were assigned a positive person-level weight. The estimated population total for the U.S. civilian noninstitutionalized population as of the first half of 1996 was 263,515,813.

Although this report is on women’s health, Table A shows data for men for comparison purposes.

Perceived Health and Mental Health Status

The respondent was asked to rate the health and mental health of each person in the family at the time of the Round 1 interview according to the following categories: excellent, very good, good, fair, or poor.

Minimal editing was done to the perceived health status variables reported in Tables 1-5. For this report, the response categories "excellent" and "very good" were collapsed, as were "fair" and "poor." Women with missing data on perceived health or mental health status were excluded from the estimates. Data for perceived health status were missing for 57 persons in the sample (.70 percent). This left an unweighted sample population of 8,011 women on which the estimates in Table 1 were based. Data for perceived mental health status were missing for 59 persons in the sample (.73 percent), which left an unweighted sample population of 8,009 women on which the estimates in Table 1 were based.

Functional Limitations

Three indicators of functional limitation were used for this analysis: the need for help with IADLs or ADLs; physical activity limitations (such as difficulties walking, bending, or stooping); and work/housework/school limitations. A combined measure of any of those limitations was also used. Questions about functional limitation were asked first at the family level to ascertain if anyone in the household had a particular problem or limitation. These were followed by questions at the person level to determine which household member had each problem or limitation. Logical editing at the person level was performed to insure that family-level and person-level responses were consistent. Particular attention was given to cases where missing values were reported at the family level to ensure that appropriate information was carried to the person level. For variables that pertained only to persons of certain age groups, editing was performed to appropriately code other ages as "inapplicable."

Physical activity limitations are reported in Table 2 only for women ages 18 and over. In this analysis, women whose physical activity limitation status was unknown were considered to have no physical activity limitations. Data for ADL or IADL limitations were missing for 13 persons in the sample (.16 percent). This left an unweighted sample of 8,055 women on which estimates in Table 2 were based. Data for the activities limitation measure were missing for 19 persons in the sample (.23 percent). This left an unweighted sample population of 8,049 women on which estimates in Table 2 were based. There were no missing data for physical functional limitations.

IADLs and ADLs

Limitations in the ability to perform instrumental activities of daily living were assessed by first asking the respondent whether anyone in the family received help or supervision using the telephone, paying bills, taking medications, preparing light meals, doing laundry, or going shopping. If the respondent indicated that someone in the household received help with any of these activities, a followup question was asked to determine which household member received help.

Limitations in the ability to perform activities of daily living were assessed by asking whether anyone in the family received help or supervision with personal care such as bathing, dressing, or getting around the house.

A combined indicator was constructed for this analysis to report whether individuals received help with either IADLs or ADLs.

Physical Activity Limitations

Limitations in physical activities were measured by asking whether anyone in the family had difficulty walking, climbing stairs, grasping objects, reaching overhead, lifting, bending or stooping, or standing for long periods of time. A followup question identified each family member over age 12 who experienced any type of physical limitation.

Activity Limitations

These limitations include both paid work and unpaid housework, as well as limitations in the ability to attend school. The work/housework/school limitation was measured by asking the respondent whether anyone in the family was limited in any way in the ability to work at a job, do housework, or go to school because of an impairment or a physical or mental health problem. For all individuals identified as having a work/housework/school limitation, a followup question was asked to clarify if the limitation applied to working at a job, doing housework, going to school, or some combination of the three.

Any Limitation

The measure "any limitations," reported first in Table 2, is simply a combined measure that indicates whether an individual had one or more of the limitations previously described: IADLs/ADLs, physical activity limitations, or activity limitations. It also included other limitations in social role behavior and cognitive limitations, measures which were not included in the tables.

Population Characteristics Age

The respondent was asked to report the age of each family member as of the date of the Round 1 interview. The age at Round 1 was used for the analysis of both Round 1 and Round 2 data.

Race/Ethnicity

Classification by race and ethnicity was based on information reported for each household member. Respondents were asked if the race of the sample person was best described as American Indian, Alaska Native, Asian or Pacific Islander, black, white, or other. Respondents were also asked if the sample person’s main national origin or ancestry was Puerto Rican; Cuban; Mexican, Mexicano, Mexican American, or Chicano; other Latin American; or other Spanish. All persons who claimed main national origin or ancestry in one of these Hispanic groups, regardless of racial background, were classified as Hispanic. Since the Hispanic grouping can include black Hispanic, white Hispanic, and other Hispanic, the race categories of black, white, and other do not include Hispanic.

Place of Residence

Individuals were identified as residing either inside or outside a metropolitan statistical area (MSA) as designated by the U.S. Office of Management and Budget, which applied 1990 standards using population counts from the 1990 U.S. census. An MSA is a large population nucleus combined with adjacent communities that have a high degree of economic and social integration within the nucleus. Each MSA has one or more central counties containing the area’s main population concentration. In New England, metropolitan areas consist of cities and towns rather than whole counties.

Health Insurance

The household respondent was asked if, between January 1, 1996, and the time of the Round 1 interview, anyone in the family was covered by any of the sources of public and private health insurance coverage discussed in the following paragraphs. For this report, Medicare and CHAMPUS/CHAMPVA coverage represent coverage as of the date of the Round 1 interview. (CHAMPUS and CHAMPVA are the Civilian Health and Medical Programs for the Uniformed Services and Veterans Affairs.) All other sources of insurance represent coverage at any time during the Round 1 reference period. Persons counted as uninsured were uninsured throughout the Round 1 reference period. For additional details on health insurance status measures in MEPS, see Vistnes and Monheit (1997). 

Public Coverage

For this report, individuals were considered to have public coverage only if they met both of the following criteria:

  • They were not covered by private insurance.
  • They were covered by one of the following public programs: Medicare, Medicaid, or other public hospital/physician coverage.

Private Health Insurance

Private health insurance was defined for this report as insurance that provides coverage for hospital and physician care. Insurance that provided coverage for a single service only, such as dental or vision coverage, is not counted. Coverage by CHAMPUS/CHAMPVA was included as private health insurance.

Uninsured

The uninsured were defined as persons not covered by Medicare, CHAMPUS/CHAMPVA, Medicaid, other public hospital/physician programs, or private hospital/physician insurance throughout the entire Round 1 reference period. Individuals covered only by noncomprehensive State-specific programs (e.g., Maryland Kidney Disease Program, Colorado Child Health Plan) or private single-service plans (e.g., coverage for dental or vision care only, coverage for accidents or specific diseases) were not considered to be insured.

Marital Status and Presence of Children

Family composition was a constructed indicator of living arrangements based on the relationship of each person to each of the other people in the household at the time of the Round 1 interview. Separate categories were coded for adults living alone; adults living with a spouse or partner, either with or without children age 18 and under; adults without a spouse or partner living with a child or other nonrelated adults. In addition, the ages of the children were reported in such a way that the presence of any children age 5 or under in the household was noted. Otherwise, the children living in the household were considered to be ages 6-18. Women who had at least one child age 5 or under were included in that category even if they had older children as well. Women categorized as having children 6-18 had no children in the household under age 6. This age break was chosen on the assumption that children ages 6 and over were in school full time, while children younger than that probably required some type of daycare arrangements.

Employment

For this report, employment status was determined at any time during Round 1 and Round 2 by asking whether each adult in the household was currently employed for pay. Only employment status for women ages 18-64 is used in this analysis. Women employed for pay throughout Round 1 and Round 2 were considered to be employed. Women employed for pay for some part of the Round 1 or Round 2 reference period and women who were temporarily unemployed throughout the Round 1 or Round 2 reference period but had a paying job to return to were considered employed during the year. Women not employed during Rounds 1 or 2 and without a job to return to were considered not employed.

Poverty Status of Family

Each sample woman was classified according to the total 1996 income of her family. Within a household, all individuals related by blood, marriage, or adoption were considered to be a family. Personal income from all family members was summed to create family income. Possible sources of income included annual earnings from wages, salaries, bonuses, tips, and commissions; business and farm gains and losses; unemployment and Worker’s Compensation; interest and dividends, alimony, child support, and other private cash transfers; private pensions, individual retirement account (IRA) withdrawals, Social Security, and Department of Veterans Affairs payments; Supplemental Security Income and cash welfare payments from public assistance, Aid to Families with Dependent Children and Aid to Dependent Children; gains or losses from estates, trusts, partnerships, S corporations, rent, and royalties; and a small amount of "other" income. 

Poverty status is the ratio of family income to the 1996 Federal poverty thresholds, which control for family size and the age of the head of the family. The results are grouped into five categories. Poor indicates family income less than 100 percent of the poverty line; near-poor indicates family income from 100 to less than 125 percent of poverty; low income indicates family income from 125 to less than 200 percent of poverty; middle income indicates family income from 200 to less than 400 percent of poverty; and high income indicates family income 400 percent of poverty or more.

Education

Respondents were asked to report the highest grade or year of schooling ever completed by each family member 18 years of age and over as of the date of the Round 1 interview. There was a small amount of item nonresponse for education (1.40 percent among Hispanics, 1.17 percent among blacks, and .76 percent among whites). Within each racial/ethnic group, a correction was applied to adjust for item nonresponse so that the distribution of educational levels for each group adds to 100.0 percent.

Use of Ambulatory and Preventive Services Any Use of Ambulatory Services

Office-based ambulatory events include visits to physician and nonphysician providers as well as office-based providers of unknown type. Telephone contacts with office-based providers, regardless of provider type, are not included in the estimates. Examples of nonphysician providers include chiropractors, physical and occupational therapists, nurses and nurse practitioners, podiatrists, technicians and receptionists, clerks or secretaries.

Hospital-based ambulatory events include visits to physician and nonphysician providers as well as providers of unknown type in hospital outpatient departments and emergency rooms. Same-day hospital discharges (hospital events classified as inpatient that did not result in an overnight stay) also are treated as ambulatory hospital-based events in these estimates. Telephone contact with hospital-based providers is not included in these estimates.

Preventive Care Use

Data on preventive care are based on a series of questions asked in Round 3 about preventive health care use and when it occurred: within the past year, the past 2 years, the past 5 years, or never. The set of indicators included receipt of a Pap smear, mammogram, breast exam, physical exam, blood pressure reading, and flu shot. Pap smears, mammograms, and physical exams were included in this analysis. Since many preventive services are considered most effective if received within a 1-year to 2-year period, women were identified as having received such services if they had received them within that time period.

Usual Source of Care

For each family member, the MEPS interviewer ascertained whether there was a particular doctor’s office, clinic, health center, or other place that the individual usually went when sick or in need of health advice. For those family members who did not have a usual source of health care, the interviewer ascertained the reasons why, but that information is not used in this analysis.

Sample Design and Accuracy of Estimates

The sample selected for the 1996 MEPS, a subsample of the 1995 NHIS, was designed to produce national estimates that are representative of the civilian noninstitutionalized population of the United States. Round 1 data were obtained for approximately 9,400 households in MEPS, resulting in a survey response rate of 78 percent. This figure reflects participation in both NHIS and MEPS. For Round 2, the response rate was 95 percent, resulting in a response rate of 74 percent overall from the NHIS interview through Round 2 of MEPS.

The statistics presented in this report are affected by both sampling error and sources of nonsampling error, which include nonresponse bias, respondent reporting errors, and interviewer effects. For a detailed description of the MEPS survey design, the adopted sample design, and methods used to minimize sources of nonsampling error, see J. Cohen (1997), S. Cohen (1997) and Cohen, Monheit, Beauregard, et al. (1996).

The MEPS person-level estimation weights include nonresponse adjustments and poststratification adjustments to population estimates derived from the March 1996 Current Population Survey based on cross-classifications by region, age, race/ethnicity, and sex.

Tests of statistical significance were used to determine whether the differences between populations exist at specified levels of confidence or whether they occurred by chance. Differences were tested using Z-scores having asymptotic normal properties at the 0.05 level of significance. Unless otherwise noted, only statistically significant differences between estimates are discussed in the text.

Rounding

Estimates presented in Tables 1-5 were rounded to the nearest 0.1 percent. Standard errors, presented in Tables B-F, were rounded to the nearest 0.01. Some of the estimates for population totals of subgroups presented in the tables will not add exactly to the overall estimated population total as a consequence of rounding.

Comparisons with Other Data Sources

Because of methodological differences, caution should be used when comparing these data with data from other sources. Particularly with questions about limitations in activities, a range of results is frequently found among surveys based on question wording, the sequencing of questions, the placement of questions, and whether or not the respondent was a proxy for the person with the limitation. Benchmarking activities indicate that the proportions with ADLs and IADLs are very similar to those reported in the National Health Interview Survey. However, the estimates of limitations in work, school, or housework activities are more conservative than those found in NHIS.

Standard Error Tables

Table A. Physical and mental health status of civilian noninstitutionalized men by sociodemographic characteristics: United States,1996

  

 

 Perceived healtha

Perceived mental healthb


Population characteristic  

Total population of men in thousands  

Excellent/very   good

  Good  

Fair/poor  

Excellent/very   good

  Good  

Fair/poor

 

  Percent


All men

91,720

63.2

25.3

11.5

72.2

21.5

6.3

 

Age in years 

18-29

20,000

75.6

20.9

4.5

77.5

17.8

4.7

30-44

31,840

68.8

23.5

7.7

76.1

18.8

5.1

45-64

26,270

57.7

28.1

14.2

69.8

23.8

6.4

65-74

8,185

47.0

29.4

23.6

62.6

28.5

8.9

75-84

4,672

38.5

33.0

28.5

57.7

29.4

12.9

85 and over

753

45.3

24.3

30.4

43.4

33.0

23.7

 

Race/ethnicity

 
 
 
 
 
 
 

White

68,690

64.8

24.6

10.6

73.3

20.7

6.1

Black

9,598

58.5

24.3

17.3

65.8

25.7

8.5

Hispanic

9,416

59.1

28.8

12.2

70.5

23.4

6.1

Other

4,015

56.5

31.7

11.9

73.5

22.0

4.5

 

Education 

Less than 12 years

17,690

42.2

32.0

25.8

50.8

34.2

15.0

12 years

29,770

61.6

28.0

10.4

71.4

23.3

5.3

More than 12 years

44,190

72.7

20.7

6.6

81.4

15.3

3.4

 

Income 

Poor/near-poor

13,859

46.7

30.3

23.0

57.1

29.3

13.6

Low income

11,550

51.3

31.3

17.4

61.4

27.7

10.9

Middle income

29,310

65.4

25.0

9.6

73.7

21.6

4.7

High income

37,000

71.3

21.7

6.9

80.1

16.7

3.3

 

Insurance statusc 

Under age 65: 

Private

55,790

70.6

22.9

6.5

79.2

17.9

2.9

Public

5,184

33.6

30.0

36.4

39.6

34.0

26.4

Uninsured

17,740

62.2

27.7

10.1

68.3

24.7

7.1

Age 65 and over: 

Medicare only

3,205

43.6

32.1

24.3

52.5

36.3

11.2

Medicare and private

8,566

45.9

29.6

24.5

64.0

25.5

10.5

Medicare and other public

933

31.0

27.8

41.2

58.4

19.7

21.9

 

a Perceived health status was collected during Round 1 and refers to health status during the first half of 1996. The estimated population excludes less than 0.7 percent missing data resulting from item nonresponse.

b Perceived mental health status was collected during Round 1 and refers to mental health status during the first half of 1996. The estimated population excludes less than 0.7 percent missing data resulting from item nonresponse.

c Health insurance status was collected during Round 1 and refers to health insurance status during the first half of 1996. Public and private insurance categories refer to individuals with public or private insurance at any time during this period; individuals under age 65 with both public and private insurance are considered privately insured.

Note: Percents may not add to 100 because of rounding.

Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1996.

Table B. Standard errors for physical and mental health status of civilian noninstitutionalized women by sociodemographic characteristics: United States,1996

Corresponds to Table 1

  
 Perceived healtha

Perceived mental healthb


Population  characteristic

Excellent/very   good

 Good

Fair/poor  

Excellent/very   good

Good  

 Fair/poor

 

  Standard error


Total

0.77

0.63

0.47

0.67

0.54

0.35

 

Age in years

18-29

1.36

1.33

0.71

1.22

1.19

0.60

30-44

1.16

0.96

0.65

1.10

0.94

0.54

45-64

1.20

1.07

0.85

1.15

1.04

0.60

65-74

2.00

1.77

1.67

1.73

1.65

0.99

75-84

2.53

1.91

2.27

2.53

2.14

1.57

85 and over

4.24

3.88

4.22

4.28

3.92

3.23

 

Race/ethnicity 

White

0.94

0.72

0.52

0.78

0.62

0.37

Black

1.69

1.75

1.62

1.59

1.62

1.29

Hispanic

1.71

1.48

1.25

1.62

1.48

0.85

Other

3.57

3.10

2.10

3.09

2.59

1.70

 

Education 

Less than 12 years

1.32

1.21

1.26

1.29

1.11

0.99

12 years

1.18

1.01

0.77

1.15

0.99

0.53

More than 12 years

0.94

0.86

0.54

0.77

0.69

0.34

 

Marital status and childrenc

Married without children

1.21

1.09

0.78

0.99

0.93

0.50

Married with children 5 and under

1.66

1.48

0.85

1.43

1.36

0.76

Married with children 6-18

1.69

1.48

1.01

1.45

1.34

0.66

Single without children

1.22

0.93

1.01

1.13

0.90

0.73

Single with children 5 and under

2.73

2.83

1.69

2.84

2.74

1.4

Single with children 6-18

2.23

2.25

1.36

2.40

2.16

1.26

 

Income 

Poor/near-poor

1.37

1.38

1.33

1.56

1.33

1.51

Low income

1.75

1.40

1.36

1.64

1.52

1.01

Middle income

1.17

1.03

0.78

1.06

0.95

0.50

High income

1.13

0.96

0.65

0.87

0.80

0.40

 

Insurance statusd

Under age 65:

Private

0.83

0.75

0.43

0.73

0.67

0.31

Public only

2.0

2.06

2.10

2.27

1.93

1.76

Uninsured

1.95

1.84

1.47

1.82

1.77

1.04

 

Age 65 and overe

Medicare only

3.18

2.74

2.44

2.67

2.30

1.68

Medicare and private

1.95

1.69

1.72

1.78

1.59

1.04

Medicare and other public

3.47

3.21

3.99

3.67

3.37

2.74

 

Employmentf

Employed full year

0.90

0.83

0.41

0.79

0.74

0.31

Employed part year

2.20

1.84

1.30

1.96

1.87

0.97

Not employed

1.56

1.33

1.33

1.43

1.26

1.02

 

Metropolitan statistical area (MSA) 

MSA

0.87

0.70

0.52

0.75

0.59

0.37

Non-MSA

1.55

1.41

1.24

1.40

1.36

0.93

 

a Perceived health status was collected during Round 1 and refers to health status during the first half of 1996. The estimated population excludes less than 0.7 percent missing data resulting from item nonresponse.

b Perceived mental health status was collected during Round 1 and refers to mental health status during the first half of 1996. The estimated population excludes less than 0.7 percent missing data resulting from item nonresponse.

c Marital status and number of parents in the home were collected during Round 1 and refer to the first half of 1996.

d Health insurance status was collected during Round 1 and refers to health insurance status during the first half of 1996. Public and private insurance categories refer to individuals with public or private insurance at any time during this period; individuals under age 65 with both public and private insurance are considered privately insured.

e Health insurance for persons age 65 and over excludes less than 1.0 percent missing data resulting from item nonresponse.

f Employment reflects the employment status over Rounds 1 and 2 and indicates if the person worked throughout those two periods, worked for only a portion of those two periods, or did not work at all during those two periods. Employment is measured only for women ages 18-64. The estimated population of women ages 18-64 is 81,745,971.

Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1996.

Table C. Standard errors for functional and activity limitation status of civilian noninstitutionalized women by sociodemographic characteristics: United States,1996

Corresponds to Table 2

Population characteristic

ADLs or IADLsa

Activity limitations

Physical activity limitations

 Any limitationsb

 

 Standard error


Total

0.31

0.41

0.48

0.53

 

Age in years 

18-29

0.34

0.42

0.41

0.64

30-44

0.39

0.60

0.66

0.81

45-64

0.48

0.72

0.78

0.93

65-74

1.09

1.45

1.69

1.77

75-84

1.92

2.06

2.33

2.22

85 and over

4.60

4.69

3.95

3.67

 

Race/ethnicity 

White

0.39

0.51

0.59

0.65

Black

0.97

1.12

1.29

1.39

Hispanic

0.79

0.79

0.83

1.29

Other

0.78

1.32

1.82

2.08

 

Perceived healthc

Excellent/very good

0.22

0.29

0.36

0.48

Good

0.55

0.69

0.94

1.06

Fair/poor

1.34

1.56

1.57

1.56

 

Perceived mental healthd 

Excellent/very good

0.24

0.35

0.42

0.50

Good

0.65

0.90

1.04

1.20

Fair/poor

2.26

2.16

2.24

2.26

 

Education

 
 
 
 

Less than 12 years

0.82

1.12

1.19

1.24

12 years

0.51

0.62

0.72

0.82

More than 12 years

0.34

0.45

0.63

0.72

 

Marital status and childrene

Married without children

0.48

0.70

0.77

0.88

Married with children 5 and under

0.31

0.62

0.62

0.90

Married with children 6-18

0.46

0.69

0.87

1.05

Single without children

0.78

0.92

0.98

1.11

Single with children 5 and under

0.69

1.29

1.49

1.79

Single with children 6-18

0.52

1.10

1.47

1.61

 

Income

Poor/near-poor

0.90

1.10

1.21

1.40

Low income

0.96

1.08

1.29

1.32

Middle income

0.48

0.64

0.74

0.91

High income

0.42

0.55

0.64

0.71

 

Insurance status f

 
 
 
 

Under age 65:

 
 
 
 

Private

0.21

0.32

0.41

0.50

Public only

1.53

2.00

1.88

2.26

Uninsured

0.50

0.91

0.92

1.27

 

Age 65 and over:g

 
 
 
 

Medicare only

2.48

2.33

2.56

2.68

Medicare and private

1.24

1.56

1.88

1.84

Medicare and other public

3.66

4.04

4.03

3.92

 

Employmenth

Employed full year

0.28

0.43

0.52

Employed part year

0.93

1.05

1.40

Not employed

0.95

1.26

1.23

1.45

 

Metropolitan statistical area (MSA)

MSA

0.34

0.43

0.52

0.57

Non-MSA

0.69

1.09

1.16

1.31

 

a Activities of daily living (ADLs) include activities such as bathing and dressing. Instrumental activities of daily living (IADLs) include activities such as shopping and paying bills.

b The measure of any limitations combines indicators of any activity limitations, functional limitations, and problems with ADLs or IADLs. In addition, it includes social role limitations and cognitive limitations not reported here. Measures of limitations were collected in Round 1.

c Perceived health status was collected during Round 1 and refers to health status during the first half of 1996. The estimated population excludes less than 0.7 percent missing data resulting from item nonresponse.

d Perceived mental health status was collected during Round 1 and refers to mental health status during the first half of 1996. The estimated population excludes less than 0.7 percent missing data resulting from item nonresponse.

e Marital status and number of parents in the home were collected during Round 1 and refer to the first half of 1996.

f Health insurance status was collected during Round 1 and refers to health insurance status during the first half of 1996. Public and private insurance categories refer to individuals with public or private insurance at any time during this period; individuals under age 65 with both public and private insurance are considered privately insured.

g Health insurance for persons age 65 and over excludes less than 1.0 percent missing data resulting from item nonresponse.

h Employment reflects the employment status over Rounds 1 and 2 and indicates if the person worked throughout those two periods, worked for only a portion of those two periods, or did not work at all during those two periods. Employment is measured only for women ages 18-64. The estimated population of women ages 18-64 is 81,745,971.

Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1996.

Table D. Standard errors for health insurance status of civilian noninstitutionalized women by sociodemographic characteristics: United States,1996

Corresponds to Table 3

  

 Private insurancea


  
  

Population
characteristic

Total   

Policyholder   

Dependent 

Public only  

Uninsured

  

 Standard error


Total

0.72

0.73

0.72

0.56

0.44

  

Age in years

18-29

1.51

.51

1.51

1.05

1.19

30-44

1.08

1.33

1.10

0.74

0.71

45-64

1.02

1.21

1.26

0.67

0.71

65-74

1.76

1.87

1.70

1.76

75-84

2.25

2.40

1.73

2.25

85 and over

4.24

4.28

1.69

4.24

  

Race/ethnicity

White

0.75

0.86

0.87

0.59

0.44

Black

1.84

1.55

1.17

1.87

1.25

Hispanic

2.23

1.85

1.50

1.73

1.74

Other

3.78

3.09

3.56

3.15

2.58

  

Perceived healthb

Excellent/very good

0.67

0.92

0.87

0.49

0.50

Good

1.36

1.32

1.18

1.06

0.86

Fair/poor

1.84

1.55

1.49

1.45

1.16

  

Perceived mental healthc

Excellent/very good

0.68

0.86

0.81

0.54

0.46

Good

1.41

1.37

1.17

1.05

0.96

Fair/poor

2.34

2.05

2.08

2.33

1.60

  

Any limitationd

No

0.73

0.84

0.78

0.52

0.51

Yes

1.53

1.43

1.16

1.39

0.71

  

Education

Less than 12 years

1.41

1.22

1.16

1.30

1.15

12 years

1.06

1.03

0.97

0.96

0.69

More than 12 years

0.66

1.05

1.05

0.42

0.52

  

Marital status and childrene

Married without children

0.85

1.08

1.28

0.66

0.52

Married with children 5 and under

1.44

1.68

1.80

0.85

1.12

Married with children 6-18

1.19

1.62

1.72

0.65

1.01

Single without children

1.13

1.25

0.91

0.95

0.76

Single with children 5 and under

2.65

2.65

1.53

3.11

2.31

Single with children 6-18

2.54

2.58

0.90

2.10

1.92

  

Income

Poor/near-poor

1.41

1.16

0.96

1.46

1.27

Low income

1.62

1.58

1.45

1.23

1.13

Middle income

0.83

1.11

1.10

0.55

0.65

High income

0.61

1.20

1.18

0.42

0.41

  

Employmentf 

Employed full year

0.68

0.98

0.89

0.36

0.56

Employed part year

2.35

1.59

2.08

1.70

1.62

Not employed

1.65

1.08

1.68

1.39

1.20

  

Metropolitan statistical area (MSA)

MSA

0.79

0.83

0.80

0.65

0.48

Non-MSA

1.81

1.65

1.57

1.11

1.12

  
a Health insurance status was collected during Round 1 and refers to health insurance status during the first half of 1996. Public and private insurance categories refer to individuals with public or private insurance at any time during this period; individuals under age 65 with both public and private insurance are considered privately insured.

b Perceived health status was collected during Round 1 and refers to health status during the first half of 1996. The estimated population excludes less than 0.7 percent missing data resulting from item nonresponse.

c Perceived mental health status was collected during Round 1 and refers to mental health status during the first half of 1996. The estimated population excludes less than 0.7 percent missing data resulting from item nonresponse.

d The measure of any limitations combines indicators of any activity limitations, functional limitations, and problems with activities of daily living and instrumental activities of daily living. In addition, it includes social role limitations and cognitive limitations not reported here. Measures of limitations were collected in Round 1.

e Marital status and number of parents in the home were collected during Round 1 and refer to the first half of 1996.

f Employment reflects the employment status over Rounds 1 and 2 and indicates if the person worked throughout those two periods, worked for only a portion of those two periods, or did not work at all during those two periods. Employment is measured only for women ages 18-64. The estimated population of women ages 18-64 is 81,745,971.

Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1996.

Table E. Standard errors for usual source of care for civilian noninstitutionalized women by sociodemographic characteristics: United States,1996

Corresponds to Table 4

  
  
  

 Usual source of health care


Population characteristic

No usual source of health care

Office based

Hospital outpatient

Emergency room

 

 Standard error


Total

0.52

0.68

0.54

0.10

 

Age in years

 
 
 
 

18-29

1.39

1.60

1.03

0.35

30-44

0.80

1.03

0.76

0.09

45-64

0.77

0.97

0.82

0.15

65-74

1.24

1.66

1.24

0.24

75-84

1.33

1.86

1.43

0.53

85 and over

1.80

2.24

1.42

 

Race/ethnicity

White

0.61

0.75

0.58

0.11

Black

1.30

1.65

1.30

0.49

Hispanic

1.49

1.67

1.23

0.29

Other

2.74

3.50

2.98

 

Perceived healtha

Excellent/very good

0.66

0.82

0.58

0.13

Good

0.97

1.25

0.89

0.14

Fair/poor

0.92

1.35

1.11

0.33

 

Perceived mental healthb

Excellent/very good

0.61

0.77

0.59

0.10

Good

0.85

1.07

0.88

0.25

Fair/poor

1.58

2.13

1.53

0.40

 

Education

Less than 12 years

1.18

1.29

0.94

0.30

12 years

0.90

1.12

0.74

0.16

More than 12 years

0.74

0.87

0.65

0.12

 

Any limitation c 

No

0.59

0.77

0.58

0.10

Yes

0.91

1.23

0.86

0.29

 

Marital status and childrend 

Married without children

0.84

1.03

0.74

0.12

Married with children 5 and under

1.42

1.65

1.01

0.26

Married with children 6-18

1.02

1.30

0.97

0.16

Single without children

0.84

1.03

0.81

0.21

Single with children 5 and under

2.54

2.84

2.26

0.60

Single with children 6-18

1.98

2.15

1.28

0.73

 

Income

Poor/near-poor

1.28

1.42

1.03

0.35

Low income

1.41

1.71

1.25

0.36

Middle income

0.86

1.06

0.79

0.14

High income

0.70

0.92

0.66

0.04

 

Insurance statuse

Under age 65:

 
 
 
 

Any private

0.66

0.76

0.62

0.06

Public only

1.65

2.10

1.56

0.68

Uninsured

1.83

2.00

1.33

0.42

Age 65 and over f

Medicare only

1.88

2.54

2.23

Medicare and private

0.94

1.39

0.99

0.34

Medicare and other public

2.05

3.04

2.21

0.54

 

Employmentg

Employed full year

0.71

0.87

0.66

Employed part year

1.70

1.80

1.35

Not employed

1.13

1.90

0.88

 

Metropolitan statistical area (MSA) 

MSA

0.61

0.75

0.57

0.10

Non-MSA

1.12

1.57

1.44

0.27

 

a Perceived health status was collected during Round 1 and refers to health status during the first half of 1996. The estimated population excludes less than 0.7 percent missing data resulting from item nonresponse.

b Perceived mental health status was collected during Round 1 and refers to mental health status during the first half of 1996. The estimated population excludes less than 0.7 percent missing data resulting from item nonresponse.

c The measure of any limitations combines indicators of any activity limitations, functional limitations, and problems with activities of daily living and instrumental activities of daily living. In addition, it includes social role limitations and cognitive limitations not reported here. Measures of limitations were collected in Round 1.

d Marital status and number of parents in the home were collected during Round 1 and refer to the first half of 1996.

e Health insurance status was collected during Round 1 and refers to health insurance status during the first half of 1996. Public and private insurance categories refer to individuals with public or private insurance at any time during this period; individuals under age 65 with both public and private insurance are considered privately insured.

f Health insurance for persons age 65 and over excludes less than 1.0 percent missing data resulting from item nonresponse.

g Employment reflects the employment status over Rounds 1 and 2 and indicates if the person worked throughout those two periods, worked for only a portion of those two periods, or did not work at all during those two periods. Employment is measured only for women ages 18-64. The estimated population of women ages 18-64 is 81,745,971.

Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1996.

Table F. Standard errors for use of preventive care services by civilian non-institutionalized women by sociodemographic characteristics: United States,1996

Corresponds to Table 5

Population characteristic

Any use of ambulatory services

Pap smear  in past 2 years

Mammograma in  past 2 years

Complete physical in past 2 years

 

Standard error


Total

0.51

0.64

0.87

0.74

 

Age in years

18-29

1.34

1.50

1.61

30-44

0.84

0.86

1.82

1.12

45-64

0.83

1.08

1.16

1.03

65-74

1.12

1.74

1.84

1.57

75-84

1.29

2.29

2.49

2.25

85 and over

1.95

3.71

4.10

4.24

 

Race/ethnicity

White

0.58

0.73

0.95

0.90

Black

1.50

1.60

2.18

1.56

Hispanic

1.40

1.64

2.69

1.72

Other

3.00

3.08

3.93

3.26

 

Perceived healthb

Excellent/very good

0.70

0.79

1.10

0.94

Good

1.04

1.29

1.52

1.28

Fair/poor

0.84

1.57

1.90

1.33

 

Perceived mental healthc

Excellent/very good

0.61

0.73

1.01

0.85

Good

1.00

1.47

1.64

1.30

Fair/poor

1.58

2.50

2.89

2.19

 

Any limitationd

No

0.61

0.72

0.99

0.83

Yes

0.68

1.42

1.55

1.27

 

Education

Less than 12 years

1.18

1.51

1.95

1.40

12 years

0.82

0.95

1.24

1.11

More than 12 years

0.68

0.83

1.20

1.00

 

Marital status and childrene

Married without children

0.78

1.03

1.19

1.14

Married with children 5 and under

1.37

1.20

5.14

1.61

Married with children 6-18

1.35

1.48

2.25

1.41

Single without children

0.92

1.16

1.44

1.25

Single with children 5 and under

2.56

2.25

12.09

3.21

Single with children 6-18

2.27

2.36

3.68

2.46

 

Income

Poor/near-poor

1.13

1.47

1.99

1.26

Low income

1.39

1.60

2.25

1.61

Middle income

0.85

1.00

1.35

1.22

High income

0.82

0.93

1.24

1.11

 

Insurance statusf

 
 
 
 

Under age 65:

 
 
 
 

Private

0.61

0.69

1.03

0.94

Public only

1.33

1.76

3.47

2.11

Uninsured

1.96

1.87

2.98

1.96

Age 65 and over: g

 
 
 
 

Medicare only

1.92

2.94

3.04

2.91

Medicare and private

0.94

1.73

1.79

1.40

Medicare and other public

2.02

3.45

3.65

3.19

 

Employment h

Employed full year

0.68

0.69

1.11

0.98

Employed part year

1.77

1.92

3.29

1.95

Not employed

1.15

1.34

1.90

1.39

 

Metropolitan statistical area (MSA)

MSA

0.55

0.67

0.95

0.86

Non-MSA

1.46

1.80

1.97

1.54

 

a Data on mammograms were limited to women age 40 and over. The population total reflects the number of women this age. Approximately 37,317,000, or 64.1 percent, of women age 40 and over (37 percent of all women age 18 and over) received a mammogram in the past 2 years.

b Perceived health status was collected during Round 1 and refers to health status during the first half of 1996. The estimated population excludes less than 0.7 percent missing data resulting from item nonresponse.

c Perceived mental health status was collected during Round 1 and refers to mental health status during the first half of 1996. The estimated population excludes less than 0.7 percent missing data resulting from item nonresponse.

d The measure of any limitations combines indicators of any activity limitations, functional limitations, and problems with activities of daily living and instrumental activities of daily living. In addition, it includes social role limitations and cognitive limitations not reported here. Measures of limitations were collected in Round 1.

e Marital status and number of parents in the home were collected during Round 1 and refer to the first half of 1996.

f Health insurance status was collected during Round 1 and refers to health insurance status during the first half of 1996. Public and private insurance categories refer to individuals with public or private insurance at any time during this period; individuals under age 65 with both public and private insurance are considered privately insured.

g Health insurance for persons age 65 and over excludes less than 1.0 percent missing data resulting from item nonresponse.

h Employment reflects the employment status over Rounds 1 and 2 and indicates if the person worked throughout those two periods, worked for only a portion of those two periods, or did not work at all during those two periods. Employment is measured only for women ages 18-64. The estimated population of women ages 18-64 is 81,745,971.

Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1996.

 

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Suggested Citation:
Altman, B. M. and Taylor, A. K. Research Findings #17: Women in the Health Care System: Health Status, Insurance, and Access to Care. November 2001. Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov/data_files/publications/rf17/rf17.shtml