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Objectives-This report presents national estimates of different types of health insurance coverage and lack of coverage (uninsured). Estimates are presented by selected sociodemographic characteristics, including age, sex, race and Hispanic origin, poverty status, education level, employment status, and marital status.

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KEY FINDINGS: Data from the National Health Interview Survey, 2013-2015 •From 2013 through 2015, the percentage of adults aged 18-64 who were uninsured at the time of interview decreased for poor (40.0% to 26.2%), near-poor (37.8% to 23.9%), and not-poor (11.7% to 7.7%) adults. •The percentage of adults aged 18-64 who had a usual place to go for medical care increased for poor (66.9% to 73.6%) and near-poor (71.1% to 75.9%) adults. •The percentage of adults aged 18-64 who had seen or talked to a health professional in the past 12 months increased for poor (73.2% to 75.8%) and near-poor (71.9% to 75.9%) adults. •The percentage of adults aged 18-64 who did not obtain needed medical care due to cost at some time during the past 12 months decreased for poor (16.8% to 12.4%), near-poor (14.6% to 11.0%), and not-poor (4.9% to 3.8%) adults. In 2014, U.S. adults could purchase a private health insurance plan through the Health Insurance Marketplace or state-based exchanges established as part of the Affordable Care Act (ACA). Additionally, under ACA some states opted to expand Medicaid coverage to low-income adults. Individuals living in or near poverty may have benefited disproportionately from these changes given their lower rates of health insurance coverage (1). Data from the 2013-2015 National Health Interview Survey (NHIS) are used to describe recent changes in health insurance coverage and selected measures of health care access and utilization for adults aged 18-64 by family poverty level.

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In 2014, U.S. adults could buy a private health insurance plan through the Health Insurance Marketplace or state-based exchanges established as part of the Affordable Care Act. Moreover, some states opted to expand Medicaid coverage to low-income adults. Data from the 2013 and 2014 National Health Interview Survey (NHIS) are used to describe recent changes in health insurance coverage and selected measures of health care access and utilization for adults aged 18­64, by race and Hispanic origin.

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The purpose of this research was to examine the relationship between psychological distress and aspects of health insurance status, including lack of coverage, types of coverage and disruption in coverage, among US adults. Data from the 2001-2010 National Health Interview Survey were used to conduct analyses representative of the US adult population aged 18-64 years. Multivariate analyses regressed psychological distress on health insurance status while controlling for covariates. Adults with private or no health insurance coverage had lower levels of psychological distress than those with public/other coverage. Adults who recently (≤1 year) experienced a change in health insurance status had higher levels of distress than those who had not recently experienced a change. An interaction effect indicated that the relationship between recent change in health insurance status and distress was not dependent on whether an adult had private versus public/other coverage. However, for adults who had not experienced a change in status in the past year, the average absolute level of distress is higher among those with no coverage versus private coverage. Although significant relationships between psychological distress and health insurance status were identified, their strength was modest, with other demographic and health condition covariates also being potential sources of distress. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

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Objectives-This report presents both age-adjusted and unadjusted health statistics from the 2011 National Health Interview Survey (NHIS) for the civilian noninstitutionalized population of the United States. Estimates are disaggregated by sex, age, race, Hispanic origin, education, family income, poverty status, health insurance coverage (where appropriate), place of residence, and region of residence. The topics covered are respondent-assessed health status, limitations in activities, special education or early intervention services, injury and poisoning episodes, health care access and utilization, and health insurance coverage. Data Source-NHIS is a household, multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics. In 2011, household interviews were completed for 101,875 persons living in 39,509 households, reflecting a household response rate of 82.0%. Selected Highlights-Nearly 7 in 10 persons were in excellent or very good health in 2011. About 40 million persons (13%) were limited in their usual activities due to one or more chronic health conditions. About 5 million persons (2%) required the help of another person with activities of daily living, and about 10 million persons (4%) required the help of another person with instrumental activities of daily living. About 7% of children received special education or early intervention services. Among persons under age 65, about 45 million (17%) did not have any health insurance coverage. The most common reason for lacking health insurance was cost, followed by a change in employment.

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OBJECTIVE: This report presents both age-adjusted and unadjusted health statistics from the 2010 National Health Interview Survey (NHIS) for the civilian noninstitutionalized population of the United States. Estimates are disaggregated by sex, age, race, Hispanic origin, education, family income, poverty status, health insurance coverage (where appropriate), place of residence, and region of residence. The topics covered are respondent-assessed health status, limitations in activities, special education or early intervention services, injury and poisoning episodes, health care access and utilization, and health insurance coverage. DATA SOURCE: NHIS is a household, multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics. In 2010, household interviews were completed for 89,976 persons living in 34,329 households, reflecting a household response rate of 79.5%. SELECTED HIGHLIGHTS: Nearly 7 in 10 persons were in excellent or very good health in 2010. About 38 million persons (12%) were limited in their usual activities due to one or more chronic health conditions. About 5 million persons (2%) required the help of another person with activities of daily living, and about 9 million persons (4%) required the help of another person with instrumental activities of daily living. About 7% of children received special education or early intervention services. Among persons under age 65 years, about 48 million (19%) did not have any health insurance coverage. The most common reason for lacking health insurance was cost, followed by a change in employment.

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OBJECTIVES: This report presents both age-adjusted and unadjusted health statistics from the 2009 National Health Interview Survey (NHIS) for the civilian noninstitutionalized population of the United States, classified by sex, age, race, Hispanic or Latino origin and race, education, family income, poverty status, health insurance coverage (where appropriate), place of residence, and region of residence. The topics covered are respondent-assessed health status, limitations in activities, special education or early intervention services, injury and poisoning episodes, health care access and utilization, and health insurance coverage. DATA SOURCE: NHIS is a household, multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics. In 2009, household interviews were completed for 88,446 persons living in 33,856 households, reflecting a household response rate of 82.2%. SELECTED HIGHLIGHTS: Nearly 7 in 10 persons were in excellent or very good health in 2009. About 40 million persons (13%) were limited in their usual activities due to one or more chronic health conditions. About 4 million persons (2%) required the help of another person with activities of daily living, and about 9 million persons (4%) required the help of another person with instrumental activities of daily living. About 7% of children received special education or early intervention services. Among persons under age 65 years, about 46 million (18%) had no health insurance coverage. The most common reason for lacking health insurance was cost, followed by a change in employment.

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OBJECTIVES: Building on Andersen's behavioral model for the utilization of health care services, we examined factors associated with utilization of physician and hospital services among adults in Canada and the United States, with a focus on socioeconomic status (enabling resources in Andersen's framework). METHODS: Using the 2002-2003 Joint Canada/United States Survey of Health, we conducted country-specific multivariate logistic regressions predicting doctor contacts/visits and overnight hospitalizations in the past year, controlling for predisposing characteristics, enabling resources, and several factors representing perceived need for health care. All analyses were appropriately weighted to yield nationally representative results. RESULTS: Several measures of socioeconomic status-having a regular medical doctor, education, and, in the US income and insurance coverage-were associated with doctor contacts or visits in both countries, along with various predisposing and need factors. However, these same measures were not associated with hospitalizations in either country. Instead, only the individual's predisposing characteristics (eg, age and sex) and his/her need for health care predicted utilization of hospital services in Canada and the United States. Insurance coverage status in the United States became a significant predictor of hospitalizations when count data were analyzed via Poisson regression. CONCLUSIONS: Given our particular outcome measures, adults in Canada and the United States exhibited similar patterns of hospital utilization, and socioeconomic status played no explanatory role. However, relative to Canadian adults, we found disparities in doctor contacts among US adults-between those with more income and those with less, between those with health insurance and those without-after adjusting for health care needs and predisposing characteristics.

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Data from the National Health Interview Survey. In 2007, 17.3% of persons under 65 years of age with private health insurance were enrolled in a high deductible health plan (HDHP), 4.5% were enrolled in a consumer-directed health plan (CDHP), and 14.8% were in a family with a flexible spending account for medical expenses (FSA); Persons with directly purchased private health insurance were more likely to be enrolled in a high deductible plan than those who obtained their private health insurance through an employer or union; Higher incomes and higher educational attainment were associated with greater uptake and enrollment in HDHPs, CDHPs, and FSAs. National attention to consumer-directed health care has increased following the enactment of the Medicare Prescription Drug Improvement and Modernization Act of 2003 (P.L. 108-173), which established tax-advantaged health savings accounts (1). Consumer-directed health care enables individuals to have more control over when and how they access care, what types of care they use, and how much they spend on health care services. This report includes estimates of three measures of consumer-directed private health care. Estimates for 2007 are provided for enrollment in high deductible health plans (HDHPs), plans with high deductibles coupled with health savings accounts also known as consumer-directed health plans (CDHPs), and the percentage of individuals with private coverage whose family has a flexible spending account (FSA) for medical expenses, by selected sociodemographic characteristics.

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OBJECTIVES: We use the Joint Canada/United States Survey of Health (JCUSH) to examine use of mammograms and Pap tests among Canadian and US women during 2002 and 2003. Unlike previous data, the JCUSH data are bi-nationally comparable, in that the same instrument was used for interviewing both Canadian and US respondents at the same time. Furthermore, when appropriately weighted, these data are representative of the populations of both countries. METHODS: Descriptive statistics were used to provide a basic profile of screening practices among women in Canada and the United States. Logistic regression was then used to examine the determinants of compliance with mammogram and Pap test guidelines in the 2 countries, statistically controlling for demographic and socioeconomic characteristics, health status, and other indicators suggested from previous research. To increase comparability, these analyses were restricted to the age ranges covered in common by the screening guidelines of both countries. RESULTS: Among women covered by the guidelines in both countries, screening rates were higher in the United States than in Canada at all ages, which is puzzling given the existence of Canada's universal health care system. Multivariate analyses revealed that whether a woman had had a mammogram within the last 2 years (when predicting last Pap test) or had had a Pap test within the last 3 years (when predicting last mammogram) were the strongest and most consistent predictors of compliance in both countries. Race/ethnicity, nativity, marital status, socioeconomic status, insurance coverage in the United States, and various health status indicators also predicted compliance in some, but not all, models.

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Results from the Joint Canada/United States Survey of Health (2002-2003) reveal that health status is relatively similar in the two countries, but income-related health disparities exist. Americans in the poorest income quintile are more likely to have poor health than their Canadian counterparts; there were no differences between the rich. In general, Canadians were more like insured Americans regarding access to services, and Canadians experienced fewer unmet needs overall. Despite higher U.S. levels of spending on health care, residents in the two countries have similar health status and access to care, although there are higher levels of inequality in the United States.

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The goal of this investigation was to use a community-based participatory research approach to develop, pilot test, and administer an asthma screening questionnaire to identify children with asthma and asthma symptoms in a community setting. This study was conducted as the recruitment effort for Community Action Against Asthma, a randomized trial of a household intervention to reduce exposure to environmental triggers of asthma and was not designed as a classic prevalence study. An asthma screening questionnaire was mailed and/or hand delivered to parents of 9,627 children, aged 5 to 11 years, in two geographic areas of Detroit, Michigan, with predominantly African American and Hispanic populations. Additional questionnaires were distributed via community networking. Measurements included parent report of their child's frequency of respiratory symptoms, presence of physician diagnosis of asthma, and frequency of doctor-prescribed asthma medication usage. Among the 3,067 completed questionnaires, 1,570 (51.2% of returned surveys, 16.3% of eligible population) were consistent with asthma of any severity and 398 (12.9% of returned surveys, 4.1% of eligible population) met criteria for moderate-to-severe asthma. Among those meeting criteria for moderate-to-severe asthma, over 30% had not been diagnosed by a physician, over one half were not taking daily asthma medication, and one quarter had not taken any physician-prescribed asthma medication in the past year. Screening surveys conducted within the context of a community-based participatory research partnership can identify large numbers of children with undiagnosed and/or undertreated moderate-to-severe asthma. These children are likely to benefit from interventions to reduce morbidity and improve quality of life.

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