Common use of Household Reports of Managed Care Clause in Contracts

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 respondent said had a book or list of doctors. The household respondent has not identified the plan as a PPO but has identified a plan characteristic associated with PPO plans. If both the following conditions were met: 1. If the person did not say the plan is an HMO (HX03, HX23, HX49, HX51, MC01) 2. If the respondent answered “no” to the gatekeeper question (MC02) then the respondent was asked MC03: Is there a book or list of doctors associated with the plan? DRLIST is set to “inapplicable” when the plan is not hospital/physician or Medicare supplemental coverage, when the plan is an HMO, or when the plan requires a gatekeeper. For HMOs and for plans with gatekeepers and lists of doctors, the variable VISITPAY identifies records for plans that the household respondent said paid for out-of-network visits. The household respondent has not identified the plan as a PPO or a Point of Service (POS) plan but has identified a plan characteristic associated with PPO and POS plans. When the respondent answered “yes” to the gatekeeper question (MC02), or answered “yes” to the list of doctors question (MC03), then VISITPAY has the responses to MC04: Will (POLICYHOLDER)’s plan pay for any of the costs of visits to doctors who are not associated with (POLICYHOLDER)’s plan, even if (POLICYHOLDER) (do/does) not have a referral? When the respondent said the plan is an HMO (HX03, HX23, HX49, HX51, MC01), then VISITPAY has the responses to MC05, HX60A, OE11B, OE25B, and OE38B: Will (POLICYHOLDER)’s plan pay for any of the costs of visits to doctors who are not part of (POLICYHOLDER)’s HMO, even if (POLICYHOLDER) (do/does) not have a referral? VISITPAY is set to “inapplicable” when the plan is not hospital/physician or Medicare supplemental coverage, or when the plan does not require a gatekeeper and does not have a list of doctors.

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, HX54) 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 respondent said had a book or list of doctors. The household respondent has not identified the plan as a PPO but has identified a plan characteristic associated with PPO plans. If both the following conditions were met: 1. If the person did not say the plan is an HMO (HX03, HX23, HX49, HX51, HX54, MC01) 2. If the respondent answered “no” to the gatekeeper question (MC02) then the respondent was asked MC03: Is there a book or list of doctors associated with the plan? DRLIST is set to “inapplicable” when the plan is not hospital/physician or Medicare supplemental coverage, when the plan is an HMO, or when the plan requires a gatekeeper. For HMOs and for plans with gatekeepers and lists of doctors, the variable VISITPAY identifies records for plans that the household respondent said paid for out-of-network visits. The household respondent has not identified the plan as a PPO or a Point of Service (POS) plan but has identified a plan characteristic associated with PPO and POS plans. When the respondent answered “yes” to the gatekeeper question (MC02), or answered “yes” to the list of doctors question (MC03), then VISITPAY has the responses to MC04: Will (POLICYHOLDER)’s plan pay for any of the costs of visits to doctors who are not associated with (POLICYHOLDER)’s plan, even if (POLICYHOLDER) (do/does) not have a referral? When the respondent said the plan is an HMO (HX03, HX23, HX49, HX51, HX54, MC01), then VISITPAY has the responses to MC05, HX60A, OE11B, OE25B, and OE38B: Will (POLICYHOLDER)’s plan pay for any of the costs of visits to doctors who are not part of (POLICYHOLDER)’s HMO, even if (POLICYHOLDER) (do/does) not have a referral? VISITPAY is set to “inapplicable” when the plan is not hospital/physician or Medicare supplemental coverage, or when the plan does not require a gatekeeper and does not have a list of doctors.

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 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): 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 “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 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 respondent said had a book or list of doctors. The household respondent has not identified the plan as a PPO but has identified a plan characteristic associated with PPO plans. If both the following conditions were met: 1. If the person did not say the plan is an HMO (HX03, HX23, HX49, HX51, MC01) 2. If the respondent answered “no” to the gatekeeper question (MC02) then the respondent was asked MC03: Is there a book or list of doctors associated with the plan? DRLIST is set to “inapplicable” when the plan is not hospital/physician or Medicare supplemental coverage, when the plan is an HMO, or when the plan requires a gatekeeper. For HMOs and for plans with gatekeepers and lists of doctors, the variable VISITPAY identifies records for plans that the household respondent said paid for out-of-network visits. The household respondent has not identified the plan as a PPO or a Point of Service (POS) plan but has identified a plan characteristic associated with PPO and POS plans. When the respondent answered “yes” to the gatekeeper question (MC02), or answered “yes” to the list of doctors question (MC03), then VISITPAY has the responses to MC04: Will (POLICYHOLDER)’s plan pay for any of the costs of visits to doctors who are not associated with (POLICYHOLDER)’s plan, even if (POLICYHOLDER) (do/does) not have a referral? When the respondent said the plan is an HMO (HX03, HX23, HX49, HX51, MC01), then VISITPAY has the responses to MC05, HX60A, OE11B, OE25B, and OE38B: Will (POLICYHOLDER)’s plan pay for any of the costs of visits to doctors who are not part of (POLICYHOLDER)’s HMO, even if (POLICYHOLDER) (do/does) not have a referral? VISITPAY is set to “inapplicable” when the plan is not hospital/physician or Medicare supplemental coverage, or when the plan does not require a gatekeeper and does not have a list of doctors.

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 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 respondent said had a book or list of doctors. The household respondent has not identified the plan as a PPO but has identified a plan characteristic associated with PPO plans. If both the following conditions were met: 1. If the person did not say the plan is an HMO (HX03, HX23, HX49, HX51, MC01) 2. If the respondent answered “no” to the gatekeeper question (MC02) then the respondent was asked MC03: Is there a book or list of doctors associated with the plan? DRLIST is set to “inapplicable” when the plan is not hospital/physician or Medicare supplemental coverage, when the plan is an HMO, or when the plan requires a gatekeeper. For HMOs and for plans with gatekeepers and lists of doctors, the variable VISITPAY identifies records for plans that the household respondent said paid for out-of-network visits. The household respondent has not identified the plan as a PPO or a Point of Service (POS) plan but has identified a plan characteristic associated with PPO and POS plans. When the respondent answered “yes” to the gatekeeper question (MC02), or answered “yes” to the list of doctors question (MC03), then VISITPAY has the responses to MC04: Will (POLICYHOLDER)’s plan pay for any of the costs of visits to doctors who are not associated with (POLICYHOLDER)’s plan, even if (POLICYHOLDER) (do/does) not have a referral? When the respondent said the plan is an HMO (HX03, HX23, HX49, HX51, MC01), then VISITPAY has the responses to MC05, HX60A, OE11B, OE25B, and OE38B: Will (POLICYHOLDER)’s plan pay for any of the costs of visits to doctors who are not part of (POLICYHOLDER)’s HMO, even if (POLICYHOLDER) (do/does) not have a referral? VISITPAY is set to “inapplicable” when the plan is not hospital/physician or Medicare supplemental coverage, or when the plan does not require a gatekeeper and does not have a list of doctors.

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.” AHMO.@ UPRHMO is set to “yes” Ayes@ 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, HX54) 3. If the respondent answered yes to the following question (MC01): Now I will ask you a few questions about how (POLICYHOLDER)’s POLICYHOLDER)=s health insurance through (ESTABLISHMENT) works for non-emergency care. We are interested in knowing if (POLICYHOLDER)’s 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 POLICYHOLDER)=s (INSURER NAME) an HMO? UPRHMO is set to “no” Ano@ 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” Ayes@ if the following condition is met: If the respondent answered “no” Ano@ to the HMO question (MC01) and “yes” Xxxx@ to the following question (MC02): (Do/Does) (POLICYHOLDER)’s 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 POLICYHOLDER)=s routine care? Probe: Do not include emergency care or care from a specialist you were referred to. UPRMNC is set to “no” Ano@ when the plan does not require a gatekeeper and when the plan is an HMO. UPRMNC is set to “inapplicable” Ainapplicable@ 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 respondent said had a book or list of doctors. The household respondent has not identified the plan as a PPO but has identified a plan characteristic associated with PPO plans. The respondent was asked MC03: Is there a book or list of doctors associated with the plan? If both the following conditions were met: 1. If the person did not say the plan is an HMO (HX03, HX23, HX49, HX51, HX54, MC01) 2. If the respondent answered “no” Ano@ to the gatekeeper question (MC02) then the respondent was asked MC03: Is there a book or list of doctors associated with the plan? DRLIST is set to “inapplicable” Ainapplicable@ when the plan is not hospital/physician or Medicare supplemental coverage, when the plan is an HMO, or when the plan requires a gatekeeper. For HMOs and for plans with With gatekeepers and lists of doctors, the variable VISITPAY VISTPAYX identifies records for plans that the household respondent said paid for out-of-network visits. The household respondent has not identified the plan as a PPO or a Point of Service (POS) plan but has identified a plan characteristic associated with PPO and POS plans. When the respondent answered “yes” to the gatekeeper question (MC02), or answered “yes” to the list of doctors question (MC03), then VISITPAY VISTPAYX has the responses to MC04: Will (POLICYHOLDER)’s POLICYHOLDER)=s plan pay for any of the costs of visits to doctors who are not associated with (POLICYHOLDER)’s POLICYHOLDER)=s plan, even if (POLICYHOLDER) (do/does) not have a referral? When both the respondent said following conditions are met: 1. If the person did not say the plan is an HMO (HX03, HX23, HX49, HX51, HX54, MC01), then VISITPAY has ) If the responses respondent answered Ayes@ to MC05, HX60A, OE11B, OE25B, and OE38B: Will the gatekeeper question (POLICYHOLDER)’s plan pay for any MC02) or answered Ayes@ to the list of the costs of visits to doctors who are not part of question (POLICYHOLDER)’s HMO, even if (POLICYHOLDERMC03) (do/does) not have a referral? VISITPAY VISTPAYX is set to “inapplicable” Ainapplicable@ when the plan is not hospital/physician or Medicare supplemental coverage, when the plan is an HMO, or when the plan does not require a gatekeeper and does not have a list of doctors. An additional managed care question (MC05) was asked to differentiate between HMOs and POS plans, but due to an error in the skip logic of the questionnaire, the data were not collected for all relevant plans, and this variable will not be publicly released.

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.” AHMO.@ UPRHMO is set to “yes” Ayes@ 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, HX54) 3. If the respondent answered yes to the following question (MC01): Now I will ask you a few questions about how (POLICYHOLDER)’s POLICYHOLDER)=s health insurance through (ESTABLISHMENT) works for non-emergency care. We are interested in knowing if (POLICYHOLDER)’s 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 POLICYHOLDER)=s (INSURER NAME) an HMO? UPRHMO is set to “no” Ano@ 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” Ayes@ if the following condition is met: If the respondent answered “no” Ano@ to the HMO question (MC01) and “yes” Xxxx@ to the following question (MC02): (Do/Does) (POLICYHOLDER)’s 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 POLICYHOLDER)=s routine care? Probe: Do not include emergency care or care from a specialist you were referred to. UPRMNC is set to “no” Ano@ when the plan does not require a gatekeeper and when the plan is an HMO. UPRMNC is set to “inapplicable” Ainapplicable@ 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 respondent said had a book or list of doctors. The household respondent has not identified the plan as a PPO but has identified a plan characteristic associated with PPO plans. The respondent was asked MC03: Is there a book or list of doctors associated with the plan? If both the following conditions were met: 1. If the person did not say the plan is an HMO (HX03, HX23, HX49, HX51, HX54, MC01) 2. If the respondent answered “no” Ano@ to the gatekeeper question (MC02) then the respondent was asked MC03: Is there a book or list of doctors associated with the plan? DRLIST is set to “inapplicable” Ainapplicable@ when the plan is not hospital/physician or Medicare supplemental coverage, when the plan is an HMO, or when the plan requires a gatekeeper. For HMOs and for plans with With gatekeepers and lists of doctors, the variable VISITPAY VISTPAYX identifies records for plans that the household respondent said paid for out-of-network visits. The household respondent has not identified the plan as a an PPO or a Point of Service (POS) plan but has identified a plan characteristic associated with PPO and POS plans. When the respondent answered “yes” to the gatekeeper question (MC02), or answered “yes” to the list of doctors question (MC03), then VISITPAY VISTPAYX has the responses to MC04: Will (POLICYHOLDER)’s POLICYHOLDER)=s plan pay for any of the costs of visits to doctors who are not associated with (POLICYHOLDER)’s POLICYHOLDER)=s plan, even if (POLICYHOLDER) (do/does) not have a referral? When both the respondent said following conditions are met: 1. If the person did not say the plan is an HMO (HX03, HX23, HX49, HX51, HX54, MC01), then VISITPAY has ) If the responses respondent answered Ayes@ to MC05, HX60A, OE11B, OE25B, and OE38B: Will the gatekeeper question (POLICYHOLDER)’s plan pay for any MC02) or answered Ayes@ to the list of the costs of visits to doctors who are not part of question (POLICYHOLDER)’s HMO, even if (POLICYHOLDERMC03) (do/does) not have a referral? VISITPAY VISTPAYX is set to “inapplicable” Ainapplicable@ when the plan is not hospital/physician or Medicare supplemental coverage, when the plan is an HMO, or when the plan does not require a gatekeeper and does not have a list of doctors. An additional managed care question (MC05) was asked to differentiate between HMOs and POS plans, but due to an error in the skip logic of the questionnaire, the data were not collected for all relevant plans, and this variable will not be publicly released.

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, HX54) 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 respondent said had a book or list of doctors. The household respondent has not identified the plan as a PPO but has identified a plan characteristic associated with PPO plans. The respondent was asked MC03: Is there a book or list of doctors associated with the plan? If both the following conditions were met: 1. If the person did not say the plan is an HMO (HX03, HX23, HX49, HX51, HX54, MC01) 2. If the respondent answered “no” to the gatekeeper question (MC02) then the respondent was asked MC03: Is there a book or list of doctors associated with the plan? DRLIST is set to “inapplicable” when the plan is not hospital/physician or Medicare supplemental coverage, when the plan is an HMO, or when the plan requires a gatekeeper. For HMOs and for plans with gatekeepers and lists of doctors, the variable VISITPAY identifies records for plans that the household respondent said paid for out-of-network visits. The household respondent has not identified the plan as a PPO or a Point of Service (POS) plan but has identified a plan characteristic associated with PPO and POS plans. When the respondent answered “yes” to the gatekeeper question (MC02), or answered “yes” to the list of doctors question (MC03), then VISITPAY has the responses to MC04: Will (POLICYHOLDER)’s POLICYHOLDER)=s plan pay for any of the costs of visits to doctors who are not associated with (POLICYHOLDER)’s POLICYHOLDER)=s plan, even if (POLICYHOLDER) (do/does) not have a referral? When the respondent said the plan is an HMO (HX03, HX23, HX49, HX51, HX54, MC01), then VISITPAY has the responses to MC05, HX60A, OE11B, OE25B, and OE38B: Will (POLICYHOLDER)’s POLICYHOLDER)=s plan pay for any of the costs of visits to doctors who are not part of (POLICYHOLDER)’s POLICYHOLDER)=s HMO, even if (POLICYHOLDER) (do/does) not have a referral? VISITPAY is set to “inapplicable” when the plan is not hospital/physician or Medicare supplemental coverage, or when the plan does not require a gatekeeper and does not have a list of doctors. Questions HX60A, OE11B, OE25B, and OE38B were first added to the survey in round 3 of Panel 5 and round 1 of Panel 6. Therefore, for many HMOs first reported in rounds 1 or 2 of Panel 5, VISITPAY is set to “not ascertained.”

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 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): Now I will ask you a few questions about how {Is/Was} (POLICYHOLDER)’s health insurance through {NAME OF INSURER BEING LOOPED ON} an HMO {as of (ESTABLISHMENT) works for non-emergency care. We are interested in knowing if END DATE)}? {When answering this question, do not consider (POLICYHOLDER)’s (ESTABLISHMENT) plan is an HMO, that is, a Health Maintenance Organization. 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. Is (POLICYHOLDER)’s (INSURER NAME) an HMO? .] UPRHMO is set to “no” when the plan was not an HMO. UPRHMO is set to inapplicable “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 The respondent answered “no” to the HMO question (MC01) and “yes” to the following question (MC02): {(Do/Does) /As of (END DATE), did} (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 respondent said had a book or list of doctors. The household respondent has not identified the plan as a PPO but has identified a plan characteristic associated with PPO plans. If both the following conditions were met: 1. If the person did not say the plan is an HMO (HX03, HX23, HX49, HX51, MC01) 2. If the respondent answered “no” to the gatekeeper question (MC02) then the respondent was asked MC03: Is {Is/As of (END DATE), was} there a book or list of doctors associated with the plan? DRLIST is set to “inapplicable” when the plan is not hospital/physician or Medicare supplemental coverage, when the plan is an HMO, or when the plan requires a gatekeeper. For HMOs and for plans with gatekeepers and lists of doctors, the variable VISITPAY identifies records for plans that the household respondent said paid for out-of-network visits. The household respondent has not identified the plan as a PPO or a Point of Service (POS) plan but has identified a plan characteristic associated with PPO and POS plans. When the respondent answered “yes” to the gatekeeper question (MC02), or answered “yes” to the list of doctors question (MC03), then VISITPAY has the responses to MC04: Will {Will/As of (END DATE), WOULD} (POLICYHOLDER)’s plan pay for any of the costs of visits to doctors who are not associated with (POLICYHOLDER)’s plan, even if (POLICYHOLDER) {(do/does) does)/did} not have a referral? When the respondent said the plan is an HMO (HX03, HX23, HX49, HX51, MC01), then VISITPAY has the responses to MC05, HX60A, OE11B, OE25B, and OE38B: {Will /As of (END DATE), would} (POLICYHOLDER)’s plan pay for any of the costs of visits to doctors who are not part of (POLICYHOLDER)’s HMO, even if (POLICYHOLDER) {(do/does) does)/did} not have a referral? VISITPAY is set to “inapplicable” when the plan is not hospital/physician or Medicare supplemental coverage, or when the plan does not require a gatekeeper and does not have a list of doctors.