Racial and Ethnic Disparities in the Purchase of Nongroup Health Insurance: The Roles of Community and Family‐Level Factors

Abstract

Objective. To evaluate the influence of community-and family-level factors on racial/ ethnic disparities in the uptake of nongroup (individual) health insurance. Data Sources. Responses to the 1996-1997 Community Tracking Study Household Survey plus community-level descriptors from several sources including census data, the Area Resource File, and community and migrant health center Medicare cost reports. Study Design. Logistic regression was used to compare families in which at least one person had nongroup health insurance to families without nongroup insurance in which at least one person was uninsured. Sequential models were constructed examining family-and community-level factors. Results. Twenty-three percent of families with otherwise-uninsured persons purchased nongroup insurance, ranging from 11% to 41% among the 60 communities sampled. Disadvantaged minority group members, especially Spanish-speaking Hispanics, had half or less the odds of whites of purchasing nongroup insurance. Education had a weaker association with purchasing nongroup insurance among minority group members than among whites. Community-level factors had minimal effect on disparities in uptake, although greater housing segregation was associated with lower uptake among blacks. Conclusions. Minority group members are much less likely to purchase nongroup insurance than whites. Family income and community factors do not explain this gap. Programs aimed at stimulating voluntary insurance purchase will continue to underenroll disadvantaged minorities if nonfinancial barriers to acquiring insurance coverage, including the interplay between race/ethnicity and education, are not better understood and addressed.

Redressing the Limitations of the Affordable Care Act for Mexican Immigrants Through Bi-National Health Insurance: A Willingness to Pay Study in Los Angeles

“…Quality of services was the most important consideration that potential buyers would have to purchase BHI among respondents in all willingness to pay models compared to cost, distance or need factors. As highlighted by several studies, Mexican immigrants, both documented and undocumented, continue to face significant quality of care barriers in the US and are less likely to purchase individual health insurance [20]. BHI could potentially meet Mexican migrants' need for quality care through culturally competent providers and services.…”

“…Previous research has identified both demographic factors and health insurance plan characteristics that motivate consumers to purchase private non-group health insurance [20][21][22]. Attitudes towards health coverage and perceived need are important influences where individuals who consider themselves healthy are often less likely to perceive the need for insurance coverage [23].…”

“…Finally, those who are older, have higher educational attainment, and families with children have been shown to purchase private insurance [22]. While little research has explored predictors of the demand for private health insurance among Mexican immigrants in the US, studies have shown that Spanish-speaking Latinos in the US are significantly less likely to purchase non-group insurance when compared to non-Latino whites [20]. Moreover, health insurance data in Los Angeles found that the foreign born and undocumented had lower rates of enrollment in individual private insurance than native born respondents [25].…”

Do HMO Market Level Factors Lead to Racial/Ethnic Disparities in Colorectal Cancer Screening?

“…38,39 Such a comprehensive effort has the potential to identify the system-related sources of racial/ethnic disparities in cancer screening and ultimately, to hasten the reduction of the cancer burden among disadvantaged racial groups, particularly those we know little about. Policy makers may miss unmet needs of vulnerable groups that are masked by general population studies on HMO organizational structure.…”

Individual Insurance Benefits To Be Available Under Health Reform Would Have Cut Out-Of-Pocket Spending In 2001–08

“…[14][15][16][17] As a result, descriptive differences in out-of-pocket spending may understate the causal effect of employmentrelated insurance relative to individual insurance because people who currently have individual insurance are likely to need less care than those with employment-related insurance.…”