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with only Indian Health Service (IHS) coverage were
considered uninsured. Although NHIS respondents who
report IHS coverage as their only source of coverage are
currently recoded to being uninsured, IHS provides a
comprehensive health service delivery system for
approximately 2.2 million American Indian and Alaska
Native persons. See: http://www.ihs.gov/newsroom/
factsheets/ihsyear2015profile/. Estimates of the
percentage of persons who were uninsured based on
NHIS may differ slightly from those based on other
sources because of differences in survey questions, recall
period, and other aspects of survey methodology.
In NHIS, on average less than 2% of people aged 65 and
over reported no current health insurance coverage, but
the small sample size precludes the presentation of
separate estimates for this population. Therefore, the
term ‘‘uninsured’’ refers only to the population under
age 65.
Two additional questions were added to the health
insurance section of NHIS beginning with the third
quarter of 2004 (Table VII). One question was asked of
persons aged 65 and over who had not indicated that
they had Medicare: ‘‘People covered by Medicare have a
card which looks like this. [Are/Is] [person] covered by
Medicare?’’ The other question was asked of persons
under age 65 who had not indicated any type of
coverage: ‘‘There is a program called Medicaid that pays
for health care for persons in need. In this state it is also
called [state name]. [Are/Is] [person] covered by
Medicaid?’’ Respondents who originally classified
themselves as uninsured, but whose classification was
changed to Medicare or Medicaid on the basis of a ‘‘yes’’
response to either question, subsequently received
appropriate follow-up questions concerning periods of
noncoverage for insured respondents. Of the 892 people
(unweighted) who were eligible to receive the Medicare
probe question in the third and fourth quarters of 2004,
55% indicated that they were covered by Medicare. Of
the 9,146 people (unweighted) who were eligible to
receive the Medicaid probe question in the third and
fourth quarters of 2004, 3% indicated that they were
covered by Medicaid. Estimates in Health, United States
were calculated using the responses to the two
additional probe questions. For a complete discussion of
the effect of the addition of these two probe questions
on the estimates for insurance coverage, see: Cohen RA,
Martinez ME. Impact of Medicare and Medicaid probe
questions on health insurance estimates from the
National Health Interview Survey, 2004. Health E-Stats.
NCHS; 2005. Available from: http://www.cdc.gov/nchs/
data/hestat/impact04/impact04.htm.
Survey respondents may be covered by health insurance
at the time of interview but may have experienced one
or more lapses in coverage during the 12 months prior to
interview. Starting with Health, United States, 2006, NHIS
estimates have been presented for the following three
exhaustive categories: (a) people with health insurance
continuously for the full 12 months prior to interview,
(b) those who had a period of up to 12 months prior to
interview without coverage, and (c) those who were
uninsured for more than 12 months prior to interview.
This stub variable has been added to selected tables. Two
additional NHIS questions were used to determine the
appropriate category for the survey respondents: (a) all
persons without a known comprehensive health
insurance plan were asked, ‘‘About how long has it been
since [person] last had health care coverage?’’; and (b) all
persons with known health insurance coverage were
asked, ‘‘In the past 12 months, was there any time when
[person] did NOT have ANY health insurance coverage?’’
(Also see Appendix II, Children's Health Insurance Program
[CHIP]; Fee-for-service health insurance; Health maintenance
organization [HMO]; Managed care; Medicaid; Medicare;
Uninsured.)
Health maintenance organization (HMO)—An HMO is a
health care system that assumes or shares both the financial
risks and the delivery risks associated with providing
comprehensive medical services to a voluntarily enrolled
population in a particular geographic area, usually in return
for a fixed, prepaid fee. Pure HMO enrollees use only the
prepaid, capitated health services of the HMO panel of
medical care providers. Open-ended HMO enrollees use the
prepaid HMO health services but may also receive medical
care from providers who are not part of the HMO panel.
There is usually a substantial deductible, copayment, or
coinsurance associated with use of nonpanel providers.
HMO model types are as follows:
Group model HMO is an HMO that contracts with a single
multispecialty medical group to provide care to the
HMO's membership. The group practice may work
exclusively with the HMO, or it may provide services to
non-HMO patients as well. The HMO pays the medical
group a negotiated per capita rate, which the group
distributes among its physicians, usually on a salaried
basis.
Staff model HMO is a closed-panel HMO (where patients
can receive services only through a limited number of
providers) in which physicians are HMO employees. The
providers see members in the HMO's own facilities.
Network model HMO is an HMO that contracts with
multiple physician groups to provide services to HMO
members. It may include single or multispecialty groups.
Individual practice association (IPA) is a health care
provider organization composed of a group of
independent practicing physicians who maintain their
own offices and band together for the purpose of
contracting their services to HMOs, preferred provider
organizations, and insurance companies. An IPA may
contract with and provide services to both HMO and
non-HMO plan participants.
Health, United States, 2014 Appendix II. Definitions and Methods 415