Health Insurance Access to Care Health Status

www.ahrq.gov

Agency for Healthcare Research and Quality

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Disparities and Gender Gaps

in Women’s Health, 1996

MEPS Chartbook No. 8

Medical Expenditure Panel Survey
Suggested citation:

Kass-Bartelmes BL,Altman BM,Taylor AK. Disparities and gender gaps in women’s health, 1996. Rockville (MD):Agency for

Healthcare Research and Quality; 2001. MEPS Chartbook No. 8. AHRQ Pub. No. 02-0003.

The estimates in this report are based on the most recent data available from MEPS at the time the report was written. However, selected

elements of MEPS data may be revised on the basis of additional analyses, which could result in slightly different estimates from those shown

here. Please check the MEPS Web site for the most current file releases—

www.meps.ahrq.gov

AHRQ is the lead Federal agency charged with supporting research designed to improve the quality of health care, reduce its cost, address

patient safety and medical errors, and broaden access to essential services.AHRQ sponsors and conducts research that provides evidence-based

information on health care outcomes; quality; and cost, use, and access.The information helps health care decisionmakers—patients and clinicians,

health system leaders, and policymakers—make more informed decisions and improve the quality of health care services.

MEPS Chartbook No. 8 by:

Barbara L. Kass-Bartelmes, M.P.H., C.H.E.S.

Barbara M.Altman, Ph.D.

Amy K.Taylor, Ph.D.
Medical Expenditure Panel Survey Agency for Healthcare Research and Quality

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i

Hispanic women were more likely

than women in any other

racial/ethnic group to be

uninsured in 1996.

Medicaid enrollment for women

increased from 1987 to 1996.

Higher proportions of women

than men were covered by

Medicaid in both 1987 and 1996.

Women ages 18-29 were less

likely than women in any other

age group to have a usual source

of care in 1996.

In 1996, women’s total health care

expenses were higher than men’s

for ambulatory care, prescription

medicines, and home health

services.

executive summary

In 1996, black women were more

likely than women from any other

racial/ethnic group to have had a

Pap smear or complete physical

exam within the past 2 years.

This report presents estimates of health insurance, access to care and

use of care, and health status among women of different ages and

racial/ethnic groups in America, as well as differences between men and

women. Key findings include:

Health insurance

Access to and use

of care

The majority of women in

America were in excellent, very

good, or good health in 1996.

Women were more likely than

men in 1996 to have functional

limitations.

Health status

Hispanic and black women were

more likely than white women to

be in fair or poor health during

1996.

Medical Expenditure Panel Survey Agency for Healthcare Research and Quality

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iii

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1 Introduction

3 Source of Data for This Report

5 Section 1

Health Insurance

11 Section 2

Access and Use of Care

23 Section 3

Health Status

29 Conclusions

31 Looking Ahead

Future MEPS Data

33 References

35 Notes

contents

Eliminating inequities in

health and health care while

promoting the prevention of

disease and disability in America's

women requires that women have

adequate access to medical care.

Gaps in health insurance status

still exist between men and

women, as do gaps in the use of

health services between females in

different racial/ethnic groups.

Education and income are

important factors that influence a

woman's health status. 

This report focuses on three

key aspects of women's health.

The first section introduces data

on health insurance status for

women as compared to men and

describes racial/ethnic differences

among women. The second

section presents information on

access to care and use of medical

services, including gender

differences and racial/ethnic

differences among women for

usual source of care, use of care,

and preventive services. Finally,

the third section depicts women's

health status, including functional

limitations. It compares men and

women, as well as women of

different racial/ethnic groups,

income levels, and educational

status.

Medical Expenditure Panel Survey Agency for Healthcare Research and Quality

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introduction

1

Medical Expenditure Panel Survey Agency for Healthcare Research and Quality

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3

The estimates presented in

this report are drawn from the

1987 National Medical

Expenditure Survey (NMES)

and the Household Component

of the 1996 Medical

Expenditure Panel Survey

(MEPS). MEPS is the third in a

series of medical expenditure

surveys conducted by the

Agency for Healthcare Research

and Quality. It is a nationally

representative survey that

collects detailed information on

health status, health care use and

expenses, and health insurance

coverage of individuals and

families in the United States.

The estimates presented here

are nationally representative of

the civilian noninstitutionalized

population age 18 and over.

Charts that are for only part of

the adult population—such as

workers age 19 and over, people

age 65 and over, or people ages

18-64—are labeled to show

which groups are included. All

other charts are for adults age 18

and over.

MEPS data are released to

the public in a number of

formats, including public use

data files and the printed MEPS

Research Findings and MEPS

Highlights series. The numbers

shown in this chartbook are

drawn from a variety of the

Research Findings reports as well

as additional analyses conducted

by the MEPS staff. Specific

sources for the information

presented here are listed in the

references section.

In some cases, totals may

not add precisely to 100% as a

consequence of rounding. The

category “other,” used in charts

depicting racial/ethnic

differences, includes a number of

individuals identified as Asians,

American Indians, Aleuts,

Eskimos, or other races. The

health of these groups is of

interest, but MEPS includes too

few individuals to present data

on them separately. Only

differences that are statistically

significant at the 0.05 level are

discussed in the text.

source of data

for this report

Health

Insurance

Although the majority of

women in America had either

public or private insurance in

1996, gender as well as

racial/ethnic disparities continued

to exist. The health insurance

data presented here come from

the 1996 MEPS and the 1987

NMES. Private health insurance

was defined as insurance that

provides coverage for hospital

and physician care, including

Medigap coverage but not

including single-service coverage

such as dental or vision insurance.

The public health insurance

category includes people who

were not covered by private

insurance but were covered by

Medicare, Medicaid, or other

public hospital/physician

coverage. See Note 1 for

information on health insurance

data collection.

Medical Expenditure Panel Survey Agency for Healthcare Research and Quality

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section 1

5
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In 1996, the majority of women age 18 and over (nearly 75%) had

private insurance, another 14.8% had public insurance only, and 10.7%

were uninsured.

Agency for Healthcare Research and Quality

6

Medical Expenditure Panel Survey

Overall, what is the health insurance

status of American women?

Private

Public only

Uninsured

74.5%

10.7%

14.8%

Women's health insurance coverage: 1996
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• In 1996, over three-fourths of

white women had private

health insurance, compared to

about half of black or Hispanic

women.

• White women were the least

likely of all racial/ethnic

groups to have public

insurance.

• Hispanic women were the

most likely to be uninsured.

Agency for Healthcare Research and Quality

7

Medical Expenditure Panel Survey

Does women's health insurance status

differ among racial/ethnic groups?

0

10

20

30

40

50

60

70

80

90

100

80.4

White

11.4

8.2

Other

Uninsured

Public only

Private

Women's health insurance coverage: 1996

Black

Percent

58.2

26.6

15.2

52.9

25.0

22.1

64.2

18.2

17.6

Hispanic
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• Overall, the percent of women

enrolled in Medicaid increased

for all age groups from 1987

to 1996.

• Women age 65 and over were

the age group most likely to

be enrolled in Medicaid.

Agency for Healthcare Research and Quality

8

Medical Expenditure Panel Survey

How has Medicaid enrollment among

women changed from 1987 to 1996?

0

10

20

30

40

50

8.0

4.9

1996

19-44

45-64

65 and over

Medicaid enrollment for women age 19 and over:

First half of 1987 and first half of 1996

1987

Percent

9.6 10.3

7.1

15.9
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• Among all age groups, a

higher proportion of women

than men were covered by

Medicaid in both years.

• The percent of both men and

women enrolled in Medicaid

increased from 1987 to 1996.

• Medicaid coverage increased

by 6.3 percentage points for

elderly women and 7.0

percentage points for elderly

men.

Agency for Healthcare Research and Quality

9

Medical Expenditure Panel Survey

How has Medicaid coverage changed for

men and women from 1987 to 1996?

0

2

4

6

8

10

12

14

16

18

20

2.5

8.0

45-64

Men

Women

Medicaid enrollment for men and women age 19 and over:

First half of 1987 and first half of 1996

45-64

Percent

2.7

4.9 4.7

9.6

5.6

10.3

4.9

7.1

11.7

15.9

19-44 65 and over 19-44 65 and over

1987 1996

Access and

Use of Care

One measure of access to

care is whether or not people

have a usual source of care—a

person or place they usually go to

if they are sick or need advice

about their health. Use of health

services can also serve as an

assessment of access. Health

insurance, income, and education

are all factors that have been

associated with a person's access

to health care. Other factors that

may influence access to care

include availability of providers,

facilities, and transportation.

This section describes

women's usual source of care and

use of services. Comparisons are

made with access and use for men

and among women of different

racial/ethnic groups.

Medical Expenditure Panel Survey Agency for Healthcare Research and Quality

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section 2

11
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Women ages 18-29 were

more likely than women in any

other age group to lack a usual

source of care, while women age

85 and over were the least likely

to be without a usual source of

care.

Agency for Healthcare Research and Quality

12

Medical Expenditure Panel Survey

Does access to care vary by women's age?

0

5

10

15

20

25

30

26.4

75-84

Women with no usual source of care: 1996

30-44

Percent

17.2

12.3

9.7 8.8

3.9

18-29 45-64 65-74 85 and over
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• Hispanic women were less

likely than white or black

women to have a usual source

of care during 1996.

• White women were the most

likely to have an office-based

source of health care.

Agency for Healthcare Research and Quality

13

Medical Expenditure Panel Survey

Does the usual source of care for women

vary by race/ethnicity?

0

10

20

30

40

50

60

70

80

14.5 17.1

Office-based

White

Black

Hispanic

Other

Women's usual source of care: 1996

No usual source

Percent

26.3

21.8

77.5

65.5

59.7 61.4

7.6

16.1 13.3

16.8

0.4 1.3 0.6 0

Hospital outpatient Emergency
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• Women were more likely than

men to have health care

expenses in 1996 (90.7%

compared to 80.0%). 

• Women's total health care

expenses in 1996 totaled about

$272 billion, compared to

only about $215 billion for

men.

Agency for Healthcare Research and Quality

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Medical Expenditure Panel Survey

Are health care expenses different for men

and women?

0

20

40

60

80

100

80.0

90.7

People with health care expenses, 1996

Men

Percent

Women

$0

$50

$100

$150

$200

$250

$300

$215

$272

Total health care expenses: 1996

Men

Billions of dollars

Women
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• The distribution of total health

care expenses by source of

payment was similar for

women and men, although

women paid a higher percent

out of pocket than men

(19.2% vs. 15.1%).

• About 12.5% of men's total

expenses were paid by public

programs other than Medicare

and Medicaid, such as the

Department of Veterans

Affairs. This "other public

programs" category covered

only 4.9% of expenses for

women.

See Note 2 for definitions of

payment sources.

Agency for Healthcare Research and Quality

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Medical Expenditure Panel Survey

Are payment sources different for men's

and women's health care?

24.3%

8.6%

Women

Total health care expenses: 1996

43.0%

19.2%

4.9%

23.4%

5.4%

43.6%

15.1%

12.5%

Men

Private insurance

Medicaid

Medicare

Other public programs

Out of pocket
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• Expenses for ambulatory care

were higher for women ($94.9

billion) than they were for

men ($64.9 billion).

(See Note 3.)

• Women had higher expenses

than men for prescription

medicines ($37.9 billion

compared to $23.2 billion)

and for home health services

($23.4 billion compared to

$10.0 billion). (See Note 4.)

Although women were more

likely than men to use these

services, women's average

expenses per person for

ambulatory care and home

health services were not

significantly different from

men's expenses. Women did,

however, have higher

prescription drug expenses

than men.

Agency for Healthcare Research and Quality

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Medical Expenditure Panel Survey

Which health care services cost more for

women than for men?

$0

$20

$40

$60

$80

$100

$64.9

$94.9

Home health services

Men

Women

Health care expenses: 1996

Prescription medicines

Billions of dollars

$23.2

$37.9

$10.0

$23.4

Ambulatory care

$0

$2,000

$4,000

$6,000

$1,046 $1,142

Home health services

Men

Women

Average per person health care expenses for people

who had an expense: 1996

Prescription medicines

Dollars

$414 $481

$4,775

$5,761

Ambulatory care
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A higher percentage of

women than men were

hospitalized in 1996. However,

among those with hospital stays,

men were hospitalized longer than

women.

Agency for Healthcare Research and Quality

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Medical Expenditure Panel Survey

Does inpatient hospitalization differ for

men and women?

0

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2

3

4

5

6

7

8

9

10

7.0

10.4

People with at least one inpatient

hospital stay: 1996

Men

Percent

Women

0

1

2

3

4

5

6

7

8

7.1

4.7

Average number of nights

per hospital stay: 1996

Men

Nights per stay

Women
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Elderly women were more

likely than elderly men to have at

least one formal home health care

visit in 1996.

Agency for Healthcare Research and Quality

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Medical Expenditure Panel Survey

Is use of home health services different for

men and women?

0

5

10

15

20

10.9

16.0

People age 65 and over with at least one

formal home health care visit: 1996

Men

Percent

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• Black women were more likely

to have had a Pap smear or a

complete physical exam within

the past 2 years than women

in any other racial/ethnic

category. 

• Women of other racial/ethnic

groups were the least likely to

have had a mammogram

within the past 2 years.

Agency for Healthcare Research and Quality

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Medical Expenditure Panel Survey

How does women's use of preventive

services differ among racial/ethnic groups?

0

10

20

30

40

50

60

70

80

70.6

76.5

Mammograma

White

Black

Hispanic

Other

Women using preventive services

in the past 2 years: 1996

Pap smear

Percent

69.0

58.2

64.9 63.3 63.8

50.4

65.4

78.5

65.1

55.9

Complete physical

aFor women age 40 and over.
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Women under age 65 who

had either private or public health

insurance were more likely than

uninsured women to have a Pap

smear, a mammogram, or a

complete physical examination

within the past 2 years.

Agency for Healthcare Research and Quality

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Medical Expenditure Panel Survey

What influence does health insurance have

on women's use of preventive health services?

0

10

20

30

40

50

60

70

80

90

79.6

Mammograma

Private

Public only

Uninsured

Women under 65 using preventive services

in the past 2 years: 1996

Pap smear

Percent

72.2

54.8

71.1

58.8

40.4

67.1

72.1

48.9

Complete physical

aFor women age 40 and over.
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Women with higher incomes

(who often have more education)

were more likely to have a Pap

smear or mammogram within the

past 2 years.

Agency for Healthcare Research and Quality

21

Medical Expenditure Panel Survey

Is income associated with women's use of

preventive health services?

0

10

20

30

40

50

60

70

80

61.7 64.4

Mammograma

Poor/near poor

Low income

Middle income

High income

Women using preventive services

in the past 2 years: 1996

Pap smear

Percent

72.4

76.7

51.3

56.3

64.1

72.6

63.3 65.4 66.6 68.9

Complete physical

a

For women age 40 and over.

Note: Poor or near poor refers to women with incomes under 125%

of the poverty line; low income, 125%-200%; middle income, 200%-400%;

high income, over 400%.

Health Status Health status is measured by

asking the question, "Would you

rate this person's health as

excellent, very good, good, fair,

or poor?" This section shows

gender differences in health status

and differences among women

according to various

characteristics.

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section 3

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In 1996, Hispanic and black

women were more likely than

white women to be in fair or poor

health. Overall, however, the

majority of women of all

racial/ethnic groups were in

excellent, very good, or good

health.

Agency for Healthcare Research and Quality

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Medical Expenditure Panel Survey

Is health status different for women in

various racial/ethnic groups?

0

10

20

30

40

50

60

70

62.7

50.7

Good

White

Black

Hispanic

Other

Women's perceived health status: 1996

Excellent/very good

Percent

48.6

57.4

23.9

28.8

31.7 29.9

13.4

20.5 19.6

12.7

Fair/poor
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Overall, more women than

men had functional limitations.

White, black, and Hispanic

women were significantly more

likely than their male counterparts

to report having any functional

limitations. Functional limitations

include difficulties walking,

climbing stairs, grasping objects,

reaching overhead, lifting,

bending or stooping, or standing

for long periods of time.

Agency for Healthcare Research and Quality

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Medical Expenditure Panel Survey

Do women have more functional

limitations than men have?

0

10

20

30

10.0

Hispanic

Men

Women

People with functional limitations: 1996

White

Percent

14.3

10.6

15.2

10.7

14.4

6.4

10.0

7.6 8.4

Total Black Other
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• Women in fair or poor health

were more likely than women

in excellent, very good, or

good health to have difficulty

with activities of daily living

(ADLs) or instrumental

activities of daily living

(IADLs). (See Note 5 for

definitions of ADLs and

IADLs.)

• Women in fair or poor health

were also more likely to have

any functional limitations or

any activity limitations. (See

Note 6.)

Agency for Healthcare Research and Quality

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Medical Expenditure Panel Survey

How are limitations related to health

status for women?

0

10

20

30

40

50

60

70

1.8

Excellent/very good health

Good health

Fair/poor health

Women with any limitations: 1996

ADLs/IADLs

Percent

5.6

27.1

8.4

23.0

59.3

Any limitations
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.

.

. . .

• Women with more than 12

years of education were the

most likely to be in excellent

or very good health. 

• Women with less than 12 years

of education were the most

likely to be in fair or poor

health.

Agency for Healthcare Research and Quality

27

Medical Expenditure Panel Survey

How is education associated with health

status?

0

10

20

30

40

50

60

70

80

90

100

32.0

Less than 12 years

30.9

37.1

More than 12 years

Excellent/very good health

Good health

Fair/poor health

Women's perceived health status: 1996

Percent

13.0

28.8

58.2

8.6

20.6

70.8

12 years

Years of education
. . .

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.

. . .

Women who were poor or

near poor were more likely than

women in any of the higher

income categories to have ADL or

IADL limitations, activity

limitations, or functional

limitations.

Agency for Healthcare Research and Quality

28

Medical Expenditure Panel Survey

How is income related to limitations?

0

5

10

15

20

25

30

35

3.4

5.2

Poor/near poor

Low income

Middle income

High income

Women with limitations: 1996

ADL/IADL limitation

Percent

13.0

9.4

30.7

26.1

17.0

13.4

Any limitation
The data presented in this

report show that women:

• Increased their Medicaid

enrollment from 1987 to

1996.

• Represented a higher

proportion covered by

Medicaid both in 1987 and

1996 compared to men.

• Used more health services

than men in 1996.

• Had more functional

limitations than men in 1996.

When women are compared

by racial/ethnic and income

groups, the data show that:

• Black and Hispanic women

were less likely than white

women to have private

insurance, and Hispanic

women were the most likely

of all racial/ethnic groups to

be uninsured in 1996.

• Hispanic women were less

likely than black or white

women to have a usual source

of care.

• Black and Hispanic women

were more likely than white

women to be in poor or fair

health.

• Women with higher incomes

were the most likely to use

preventive services and the

least likely to have functional

limitations.

Medical Expenditure Panel Survey Agency for Healthcare Research and Quality

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.

.

. .

conclusions

29

Future MEPS

Data

This report presents estimates

of health insurance coverage,

access to health care, and health

status. Future data from MEPS

will address additional aspects of

health care, including: • Quality of care and burden of

disease.

• Patient/customer satisfaction. • The impact of managed care. • Use of specific services. • Additional measures of health

status, including health

conditions and functional

limitations.

• Amounts families pay for

private health insurance

coverage.

MEPS is a unique data

resource for monitoring our

Nation's health care system. As

an ongoing survey, MEPS

produces data that can be used to

examine changes over time.

Medical Expenditure Panel Survey Agency for Healthcare Research and Quality

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.

looking ahead

31

The following references

served as source material for this

chartbook.

Altman BM, Taylor AK. Women in

the health care system: health status,

insurance, and access to care.

Rockville (MD): Agency for

Healthcare Research and Quality; to

be published. MEPS Research

Findings No. 17. AHRQ Pub.

No. 02-0004. 

Banthin JS, Cohen JW. Changes in

the Medicaid community population:

1987-96. Rockville (MD): Agency

for Health Care Policy and Research;

1999. MEPS Research Findings

No. 9. AHCPR Pub. No. 99-0042.

Cohen JW, Machlin SR, Zuvekas SH,

et al. Health care expenses in the

United States, 1996. Rockville

(MD): Agency for Healthcare

Research and Quality; 2000. MEPS

Research Findings No. 12. AHRQ

Pub. No. 01-0009.

Krauss NA, Machlin S, Kass BL. Use

of health care services, 1996.

Rockville (MD): Agency for Health

Care Policy and Research; 1999.

MEPS Research Findings No. 7.

AHCPR Pub. No. 99-0018. 

Vistnes JP, Monheit AC. Health

insurance status of the civilian

noninstitutionalized population:

1996. Rockville (MD): Agency for

Healthcare Policy and Research;

1997. MEPS Research Findings

No. 1. AHCPR Pub. No. 97-0030.

Medical Expenditure Panel Survey Agency for Healthcare Research and Quality

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references

33

Note 1: Unless otherwise noted, information

on health insurance status refers to the first half

of 1996. The household respondent was asked if

anyone in the family was covered by any sources

of public and private health insurance coverage

during that time. For additional details on

health insurance status measures in MEPS, see

Altman and Taylor (to be published) and Vistnes

and Monheit (1997).

Note 2: Private insurance includes CHAMPUS

and CHAMPVA (Armed-Forces-related

coverage). Other public programs include

Department of Veterans Affairs (except

CHAMPVA); other Federal sources (Indian

Health Service, military treatment facilities, and

other care provided by the Federal

Government); other State and local sources

(community and neighborhood clinics, State and

local health departments, and State programs

other than Medicaid); other public (Medicaid

payments reported for persons who were not

enrolled in the Medicaid program at any time

during the year);Worker's Compensation; other

unclassified sources (e.g., automobile,

homeowner's, liability, and other miscellaneous

or unknown sources); and other private

insurance (any type of private insurance

payments reported for persons without private

health insurance coverage during the year, as

defined in MEPS).

Note 3: Ambulatory care includes visits to

medical providers seen in office-based settings

or clinics, hospital outpatient departments,

emergency rooms (except visits resulting in an

overnight hospital stay), and clinics owned and

operated by hospitals. It also includes events

reported as hospital admissions without an

overnight stay.

Note 4: Home health care is defined as any

agency-sponsored or paid independent home

health care provider.

Note 5: ADLs are activities of daily living,

including personal care such as bathing, dressing,

or getting around the house. IADLs are

instrumental activities of daily living such as

using the telephone, paying bills, taking

medications, preparing light meals, doing laundry,

or going shopping.

Note 6: The measure "any limitations" is a

combined measure that indicates whether an

individual had one or more limitations, including

ADLs/IADLs, physical activity limitations (such as

difficulties walking, bending, or stooping), or

work/housework/school limitations. It also

included other limitations in social role behavior

and cognitive limitations. See Altman and Taylor

(to be published).

Medical Expenditure Panel Survey Agency for Healthcare Research and Quality

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notes

35
U.S. Department of Health and Human Services

Tommy G. Thompson, Secretary

Office of Public Health and Science

David Satcher, M.D., Ph.D., Surgeon General of the United States

Agency for Healthcare Research and Quality

John M. Eisenberg, M.D., M.B.A., Director
www.ahrq.gov

AHRQ Publication No. 02-0003

October 2001

ISBN 1-58763-060-5

ISSN 1531-5649

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