Health Insurance Coverage Among North Dakotans
May 10, 2004
Alana Knudson, PhDKyle Muus, PhDMike Cogan, MA
North Dakota Phone Survey
Partners Development Geographic Groups Descriptive Statistics
North Dakota Phone Survey
Collaborative Endeavor North Dakota Department of Health University of North Dakota Center for
Rural Health UND Social Science Research Institute Mathematica Policy Research, Inc.
Survey Development
Review of national literature Review of CPS and CDC survey results Review of existing state surveys Review of previous state results Customize survey to address North
Dakota concerns Survey instrument developed by SSRI
Respondents
Three population groups Urban (greater than 16,718)
Bismarck, Fargo, Grand Forks & Minot Large Rural (5,000 to 16,717)
Devils Lake, Dickinson, Jamestown, Minot AFB, Valley City, Wahpeton, & Williston
Small Rural (under 5,000) Remainder of the state
Overview of Survey Findings
Gender
Male49.6%Female
50.4%
Age
9.9%
14.8% 14.8%15.6%
14.0%
8.8%
22.1%
0%
5%
10%
15%
20%
25%
0-17 18-24 25-34 35-44 45-54 55-64 65 orover
Age Groups
% o
f re
spo
nd
ents
Health Insurance Coverage
17.4
1.04.9 6.3
1.2 0.7
36.530.8
9.4
0.8 0.30
10
20
30
40
50
60
70
80
90
100
Medic
are
Railroad R
etire
Champus
or VA
Medic
aid
Health
y Ste
ps
CHAND
Work
or U
nion
Other
Purchase
d-Tar
get
COBRA
Studen
t Heal
th
%
Number of Health Insurance Policy Types Per Person
87.2
11.7
1.1
0 20 40 60 80 100
1
2
3+
# o
f P
oli
cies
per
per
son
%
Is there a particular doctor you see?
Yes75.4%
No24.6%
How many miles do you travel to receive health care services?
11.5%
2.0%
12.6%9.2%
58.3%
6.4%
0%
10%
20%
30%
40%
50%
60%
70%
5 or less 6 to 10 11 to 20 21 to 50 51 to 100 100 or more
Miles
% o
f p
op
ula
tio
n
When was the last time you received a routine check up?
11.2%
1.4%
42.5%
8.1%
3.6%
33.2%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
1 to 6 7 to 12 13 to 24 25 to 36 37 to 48 More than 48
Months
Are you confident that you can get health care when you need it?
Strongly Agree52.6%
Neutral5.4%
Agree35.6%
Strongly Disagree
1.8%Disagree
4.6%
How many times have you visited the doctor in the past 6 months?
34.7%
6.6%4.7% 5.9%
10.2%
23.3%
14.6%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
1 2 3 4 5 6 7 or more
# of Visits
How would you describe your health?
Good23.6%
Very Good32.6%
Excellent34.5%
Poor1.9%
Fair7.4%
What is your marital status?
18.4%
4.0%0.3%
6.0%
67.6%
3.7%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Single Married Partner Divorced Separated Widowed
% o
f p
op
ula
tio
n
What is your level of education?
High School Graduate
25.9%
Less than High School
Diploma9.9%College
Graduate33.1%
Some College31.1%
What is your employment status?
12.3%
3.7%
17.5%
5.0% 4.3%0.1%
57.1%
0%
10%
20%
30%
40%
50%
60%
Self Employed Employed bysomeone
Homemaker Volunteer Retired Full-timeStudent
Unemployed
Do you have more than one paying job?
Yes13.3%
No86.7%
Is this job permanent, temporary or seasonal?
Seasonal4.2%
Permanent91.9%
Temporary3.9%
Prior Active Duty in the Military?Yes
13.7%
No86.3%
North Dakota’sUnderinsured
UNDERINSURANCE
Situations where: a) too few services are covered or the coverage is
inadequate; b) the amount of out-of-pocket expenses, regardless of family
income, is excessive; c) some combination of the above
..cost-sharing places such an economic hardship on the insured that its presumed benefits are lost
Based on economic, experiential & attitudinal factors
Typical Characteristics of the Underinsured
Self-employed, PT employees, and FT employees of small companies
Aged 19-24 and 55-64 Fair/poor health status Ethnic minorities Below 200% of poverty level
Economic Conditions
Out-of-pocket expenses, with or without regard to family income, are excessive
Out-of-pocket expenses >10% of income Inadequate insurance against large bills The financial impact of serious illness Unable to obtain needed health care due to
economic reasons <200% of poverty level & their employer
makes no contribution
Experiential Measures Too few services are covered Ineligible for or cannot afford certain plan
benefits of interest Pre-existing condition prevents person from
obtaining coverage Coverage prevents them from reaching their
health potential Waiting periods before a condition is covered Difficulty in obtaining referrals Basic health needs (prenatal, immunizations,
etc.) are not covered
Attitudinal Factors
Insurance is perceived to be inadequate
Quality of care is considered inadequate
Desired services are not included in the plan
Needed to see a doctor but could not because of the cost (past 12 months)
7.1
0
2
4
6
8
10
12
14
16
18
IA NE MA HI NJ ND IL RI SD WI CT MN DE KS P A VT NY WA MD MI NH TN MO VA OK CO IN OH DC MT UT ME AZ GA NC WY AL AK SC FL NM LA OR CA R KY ID NE TX MS WV
State
% w
ho a
nsw
ered
yes
ND
Source: BRFSS, 2000
Estimated Annual Out-of-Pocket Medical Expenses for the Past Year
0
10
20
30
40
50
60
70
80
90
100
<500 500-999 1000s 2000s 3000s 4000s 5000-9999
10000+
($)
%
Range=$2-100,000; Mean=$1496; Median=$400
Health Underinsurance* in ND
Insured, 275709, 92%
Under-Insured, 25479, 8%
*Annual out-of-pocket >10% of median annual household income
Insured, 272131, 83%
Under-Insured, 55417, 17%
Target Target’s Household
Health Underinsurance* of Target, by Age Group
96.189 94.3 93.6 90.7 87.8 82.7
3.911 5.7 6.4 9.3 12.2 17.3
0%
100%
0-17 18-24 25-34 35-44 45-54 55-64 65+
Age Group
Insured Underinsured
*Annual out-of-pocket >10% of median annual household income
Health Underinsurance* by Gender
Insured, 148460, 91%
Under-Insured, 15435, 9%
*Annual out-of-pocket >10% of median annual household income
Insured, 127248, 93%
Under-Insured, 10045, 7%
Females Males
Health Underinsurance*by Race/Ethnicity
9281 85.3
819 14.7
0%
100%
Caucasian Native American Other
Insured Underinsured
*Annual out-of-pocket >10% of median annual household income
Underinsurance* by geographic group
7.36.910.2
05
101520253035404550
Small Rural Large Rural Urban
% o
f pop
ulat
ion
*Annual out-of-pocket >10% of median annual household income
Where do the underinsured reside?
Small Rural , 13,086,
51%
Large Rural,
4,251, 17%
Urban, 8,142, 32%
Health Underinsurance* of Target, by Income Level
46
72.3
88.6 86.897 95.6 97.4
54
27.7
11.4 13.23 4.4 2.6
0%
100%
<10K 10-20K 20-25K 25-35K 35-45K 45-60K 60-80K
Annual Household Income
Insured Under-Insured
*Annual out-of-pocket >10% of median annual household income
Health Underinsurance* of Target’s Household, by Income
49.9 54.6
71.5 76.984.3 87.8
94.6
50.1 45.4
28.5 23.115.7 12.2
5.4
0%
100%
<10K 10-20K 20-25K 25-35K 35-45K 45-60K 60-80K
Annual Household Income
Insured Underinsured
*Annual out-of-pocket >10% of median annual household income
Health Underinsurance* of Target, by Policy Type
71.9 78.6 79.2 82.5 83.3 86.5 90.5 93.5 94.5 97
28.1 21.4 20.8 17.5 16.7 13.5 9.5 6.5 5.5 3
0%
100%
Insured Under-Insured
*Annual out-of-pocket >10% of median annual household income
Underinsurance* by Employment Status
93.7%87.5%
79.3%69.6%
6.3%11.5% 12.5% 16.2% 20.7%
30.4%
83.8%88.5%
0%
100%
Employed bysomeone
Self Employed Full-timeStudent
Retired Homemaker Unemployed
*Annual out-of-pocket >10% of median annual household income
Self-Perceived Health Status, Insured versus Underinsured*
Excellent36%
Very Good33%
Good24%
Fair6%
Poor1%
*Annual out-of-pocket >10% of median annual household income
Insured Underinsured
Excellent11%
Very Good28%
Good28%
Fair21%
Poor12%
North Dakota’s Uninsured
What is percentage and number of the uninsured in North Dakota?
8.2% of North Dakotans are uninsured 51,920 people
Similar to the population of Bismarck
How does North Dakota’s uninsured percentage compare with the U.S.?
15.28.2
05
101520253035404550
NorthDakota
U.S.
% o
f p
op
ula
tio
n u
nin
su
red
Who are the uninsured by gender?
Females42%
Males58%
Health Uninsurance*by Race/Ethnicity
93.1
68.3
93.3
6.9
31.7
6.7
0%
100%
Caucasian Native American Other
Insured Uninsured
What is the percentage of uninsured in each geographic group?
7.77.49.1
05
101520253035404550
Small Rural Large Rural Urban
% o
f p
op
ula
tio
n
Where do the uninsured reside?
Small Rural , 23120, 44%
Large Rural, 10303, 20%
Urban, 18498, 36%
Under 1822%
18 - 2419%
25 - 3417%
35 - 4415%
45 - 5417%
55 - 648%
65 and over2%
Who are the uninsured by age?
Among the uninsured, have you ever been insured?
No28.8%
Yes71.2%
Marital Status
0102030405060708090
100
Single Married Partner Divorced Separated Widowed
% o
f p
op
ula
tio
n
Uninsured Insured
0
5
10
15
20
25
30
35
40
45
50
<$10,000 $10,001-$20,000
$20,001-$25,000
$25,001-$35,000
$35,001-$45,000
$45,001-$60,000
$60,001-$100,000
>$100,000
% o
f popula
tion
Uninsured Insured
Household Income by Insurance Status
Educational Level
0
10
20
30
40
50
Grade School Some HighSchool
High SchoolGrad
SomeCollege/Voc
College Grad Postgrad
% o
f p
op
ula
tio
n
Uninsured Insured
Employment Status
0
20
40
60
80
100
Self Employed Employed bySomeone
Homemaker Full-timeStudent
Retired Unemployed
% o
f p
op
ula
tio
n
Uninsured Insured
Types of Employment
0 20 40 60 80 100
Permanent
Temporary
Seasonal
% of population
UninsuredInsured
Firm Size
0
10
20
30
40
50
1 2 to 10 11 to 50 51 to 100 101 to 500 500+
Number of Employees
% o
f p
op
ula
tio
n
UninsuredInsured
Are you offered health insurance through employer or union?
Yes15%
No52%
Don't Know4%
Not Applicable
29%
Do you have access to health insurance through your spouse?
Yes10%
No46%
Spouse not employed
4%
No spouse40%
Why not buy insurance on your own?
Do not need5%
Could not afford76%
Rarely sick2%
Other17%
Would you enroll in Medicaid if eligible?
Yes69%
No 14%
Don't Know17%
Describe your health…
0
10
20
30
40
50
Excellent Very Good Good Fair Poor
% o
f p
op
ula
tio
n
Uninsured Insured
North Dakotans Indicating A Regular Place for Health Care
93.6
74.8
0102030405060708090
100
Uninsured Insured
% o
f p
op
ula
tio
n
Where do people seek health care?
0102030405060708090
100
ER/UrgentCare
Clinic Doctor'sOffice
Other
% o
f p
op
ula
tio
n
Uninsured Insured
Are you confident that you can get health care when you need it?
Uninsured
Strongly Agree29%
Agree42%
Neutral9%
Disagree11%
Strongly Disagree
9%
I nsured
Strongly Agree55%
Agree35%
Neutral5%
Disagree4%
Strongly Disagree
1%
Percent of Population With Dental Care Insurance
52.1
17.6
0102030405060708090
100
Uninsured Insured
% o
f p
op
ula
tio
n
For more information contact:
Center for Rural HealthUND School of Medicine and Health SciencesGrand Forks, ND 58202-9037
701-777-3848
http://medicine.nodak.edu/crh