Household Reports of Managed Care. The variable UPRHMO identifies records for HMO coverage when the household respondent reported that the insurance was purchased through an HMO, reported the insurance company was an HMO, or described the plan as an HMO. In all cases the respondent answered a question using the term “HMO.” UPRHMO is set to “yes” if any of the three following conditions are met:
1. If the respondent reported purchasing the insurance directly through an HMO (HX03, HX23)
2. If the respondent identified the type of insurance company as an HMO (HX49, HX51)
3. If the respondent answered yes to the following question (MC01): Now I will ask you a few questions about how (POLICYHOLDER)’s health insurance through (ESTABLISHMENT) works for non-emergency care. We are interested in knowing if (POLICYHOLDER)’s (ESTABLISHMENT) plan is an HMO, that is, a Health Maintenance Organization. With an HMO, you must generally receive care from HMO physicians. For other doctors, the expense is not covered unless you were referred by the HMO or there was a medical emergency. Is (POLICYHOLDER)’s (INSURER NAME) an HMO? UPRHMO is set to “no” when the plan was not an HMO. UPRHMO is set to inapplicable when the plan was not hospital/physician or Medicare supplemental coverage. The variable UPRMNC identifies records for gatekeeper plans. The household respondent has not identified the plan as an HMO but has identified a characteristic of the plan that requires plan members to sign up with a gatekeeper for all routine care (the exact question is given below). In 1998, this gatekeeper feature was associated with HMO plans and with some Preferred Provider Organization (PPO) plans. Users of the data can decide how to classify these persons. UPRMNC is set to “yes” if the following condition is met: If the respondent answered “no” to the HMO question (MC01) and “yes” to the following question (MC02): (Do/Does) (POLICYHOLDER)’s insurance plan require (POLICYHOLDER) to sign up with a certain primary care doctor, group of doctors, or a certain clinic which (POLICYHOLDER) must go to for all of (POLICYHOLDER)’s routine care? Probe: Do not include emergency care or care from a specialist you were referred to. UPRMNC is set to “no” when the plan does not require a gatekeeper and when the plan is an HMO. UPRMNC is set to “inapplicable” when the plan is not hospital/physician or Medicare supplemental coverage. For plans other than HMOs and those with gatekeepers, the variable DRLIST identifies records for plans that the...
Household Reports of Managed Care. The variable UPRHMO identifies records for HMO coverage when the household respondent reported that the insurance was purchased through an HMO, reported the insurance company was an HMO, or described the plan as an HMO. In all cases the respondent answered a question using the term “HMO.” UPRHMO is set to “yes” if any of the three following conditions are met:
1. If the respondent reported insurance purchased directly through an HMO (HX03, HX23)
2. If the respondent identified the type of insurance company as an HMO (HX49, HX51)
3. If the respondent answered yes to the following question (MC01): {Is/Was} (POLICYHOLDER)’s {NAME OF INSURER BEING LOOPED ON} an HMO {as of (END DATE)}? {When answering this question, do not consider (POLICYHOLDER)’s insurance through Medicare.} [With an HMO, you must generally receive care from HMO physicians. For other doctors, the expense is not covered unless you were referred by the HMO or there was a medical emergency.] UPRHMO is set to “no” when the plan was not an HMO. UPRHMO is set to “inapplicable” when the plan was not hospital/physician or Medicare supplemental coverage. As of Panel 17 Round 5 and Panel 18 Round 3, a series of variables regarding managed care and private insurance were dropped from the interview. These include questions MC02 – MC05 from the Managed Care section. Consequently, the following variables have been removed from this delivery: UPRMNC, DRLIST, VISITPAY.
