The Relationship Between Health Insurance Coverage and Self Rated Health: A Secondary Analysis of the HIV Cost and Services Utilization Study

PURPOSE: Due to the advances in medical treatments, HIV has become a chronic, manageable health condition for many individuals in the United States. Despite this progress, rates of HIV infection and access to care are disparate among individuals living in poverty. Federal initiatives have been set to engage people living with HIV/AIDS (PLHA) into early care, maintain those in care, and locate and reengage those who drop out of care. The most notable of these initiatives is the Ryan White CARE Act. Only 11% of CARE Act recipients have private or employee sponsored health insurance; 55% are covered by publicly-funded medical insurance such as Medicaid or Medicare, and 31% of individuals remain uninsured (USDHHS, 2006).

The purpose of this study is to examine the relationship among health insurance coverage, health care utilization, and self rated health (SRH) for PLHA in the United States. A repeated cross section analysis of data from the HIV Cost and Service Utilization Study (HCSUS) was conducted, testing the following hypotheses: 1) privately insured PLHA will report more frequent health care utilization and higher levels of SRH than publicly insured PLHA, controlling for gender and race, and 2) PLHA reporting less frequent health care utilization will report lower levels of self-rated health.

DESIGN: The HCSUS is a nationally representative sample of adults in care for HIV infection. Using a multistage design, investigators sampled 4,042 eligible participants and interviewed 76%, with 71% yielding long-form interviews (2864 interviews) and 5% yielding short-form or proxy interviews (Frankel et al., 1999). Computer-assisted personal interviewing instruments were used to collect data.

RESULTS: Of the 2864 PLHA interviewed at baseline, 70% were male and 29.6% were female. Almost half of the sample were white (n = 1399). Blacks comprised 33.5% of the sample, and Latinos represented 14.5% of the people interviewed. The remaining 3.2% of the respondents were of other racial and ethnic backgrounds. The majority of respondents (n = 1275) reported having Medicaid coverage at baseline. A third of the respondents (n = 953) were privately insured. Medicare recipients comprised 20% of the sample.

A one-way ANCOVA reveals statistically significant differences between the categories of health insurance coverage and SRH, controlling for gender and race/ethnicity (F = 37.02, df (5, 2856), p <.001). Significant differences on SRH were found for patients with private insurance coverage and dually eligible patients (patients with both Medicare and Medicaid coverage).

There is no relationship between health insurance coverage and frequency of office or clinic visit.

CONCLUSION: The results from this analysis reveal that neither public nor private health insurance is a significant predictor of health care utilization for PLHA. However, health insurance status is significantly correlated with SRH among PLHA. Results from this analysis demonstrate the disparities in health care utilization among PLHA in the U.S. Social workers must continue to advocate for equal access to health care for this population through assistance in determining eligibility for health insurance benefits.