The convergence of vulnerable characteristics and health insurance in the US
Section snippets
Defining vulnerability
From a health perspective, vulnerability refers to the likelihood of experiencing poor health and is determined by a convergence of predisposing, enabling, and need characteristics at both individual and ecological levels. Poor health can be manifested physically, psychologically, and/or socially. Since poor health along one dimension is likely to be compounded by poor health along others, the health needs are greater for those with problems along multiple dimensions than those with problems
Data
Data for this study came from the household component (HC) of the 1996 panel of the medical expenditure panel survey (MEPS), a nationally representative survey of the US civilian non-institutionalized population cosponsored by the agency for healthcare research and quality (AHRQ) and the National Center for Health Statistics (NCHS). Since several of the policy-relevant vulnerable population sub-groups were oversampled including Hispanics and blacks, those with functional problems, and
Results
Table 1 displays the sample and population distributions of insurance coverage by vulnerability measured as the convergence of race, income, and self-perceived health status. Note, due to the exclusion of those with Medicare (an entitlement program for those over 65) and missing values as a result of coding, the sample of 19,116 individuals can be generalized to over 236 million or over 87% of US population. First of all, it is important to note that minorities were more likely to be classified
Discussion
This study defines vulnerability as a multi-dimensional construct, reflected in the convergence of predisposing, enabling, and need attributes of risk. This broad definition of vulnerability presumes that vulnerable populations are those that experience risks in clusters and that those susceptible to multiple risks (e.g., being of racial/ethnic minority, children, and poor) are likely to be more vulnerable than those susceptible to single risk (e.g., high-income minority or children of high
Acknowledgements
We thank Wei Hua and Xiao Hu for the excellent computer programming assistance in producing the analyses. Comments and suggestions from the editor and three anonymous reviewers are greatly appreciated.
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