NATIONAL CENTER I Series 2 

For HEALTH STATISTICS I Number 18 

PROPERTY OF WF 

PUBLICATIONSBRANCH 

EDITORIAL LIBRARY 

VITAL and HEALTH STATISTICS 

DATA EVALUATION AND METHODS RESEARCH 

Interview Response on 

Health Insurance Compared 

With Insurance Records 

United States- 1960 

Description of a cooperative study 

accuracy of information obtained in 

health insurance coverage. 

Washington, D.C. 

U.S. DEPARTMENT OF 

HEALTH, EDUCATION, AND WELFARE 

John W, Gardner 

Secretary 

measuring the 

interviews on 

August ] %6 

Public Health Service 

Wi I liam H. Stewart 

Surgeon Genera I 
Public Health Service Publication No. 1000-series z-No, IS 

For sale by the Superintendent of Documrmts, Gov.rnmrnt Printing Office 

Washington, DC., 20402 - Price 35 cents 
NATiONAL CENTER FOR HEALTH STATISTICS 

FORREST E. LINDER, PH. D., Director 

THEODORE D. WOOLSEY, @Wy ~irt?ctor 

OSWALD K. SAGEN, PH. D., ~f~i~~an~ Director 

WALT R. SIMMONS, M. A., Statistical Advi.ror 

ALICE M. WATERHOUSE, M. D., Medical ddvi~or 

JAMES E. KELLY, D.D.s., Dental Advi~or 

LOUIS R. STOLCIS, M. A., Executive Oj?cer 

OFFICE OF HEALTH STATISTICS ANALYSIS 

IWAO M. MORIYAMA,PH. D., Chief 

DIVISION OF VITAL STATISTICS 

ROBERTD. GROVE,PH. D., Chic\ 

DIVISION OF HEALTH INTERVIEWSTATISTICS 

PHILIP S. LAWRENCE,Sc. D., Chief 

DIVIS1ONOF HEALTH RECORDS STATISTICS 

MONROEG. SIIZICEN,PH. D., C’hiej 

D1VIS1ONOF HEALTH EXAM1NATION STATISTICS 

ARTHURJ. MCDOWELL, Chiej 

DIVISION OF DATA PROCESSING 

SIDNEY BINDER, Chief 

Public Health Service Publication No. 1000-Series 2-No. 18 

Library oj Congress Catalog Card Number 66-6007’1 
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CONTENTS 

Introduction


The Research Problem and Method of Approach


Background Material Relative to the Record Check


Health Insurance Council Estimates of Health Insurance


Health Interview Survey Estimates of HealthInsurance


Preliminary Evaluation of the NHSHealth Insurance Study --------------


Pilot Study of the Health Insurance Record Check


The Study Prmedure


Field Survey Procedures


Record Checks


Analysis of the Data ---------------------------------------------------


Limitations of Record-Check Studies


Allocation of Inconclusive Data From the Blue Cross-Blue Shield Record


Check


Summary


Detailed Tables-------------------------;------------------------------

Appendix I. Detailed Description of the Procedures Outlined for theStudy--


Preliminary Prmessing of Household Data ----------------------------


Preparation for Record Checks


Record-Check Pr~edure


Matching of Household Forms to RecordlSource


Preparation for Tabulating the Data ----------------------------------


Appendix II. Forms Used intheCollectionofData inthe Record-Check StudyAppendix III. Allocation of Unknown Data --------------------------------

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IN THIS REPOR T a methodological study designed to measu?’e the accuracy of information on health insurance coverage obtained in health inte?wiews is described. The study plan provided fo~ checking information 

obtained in a subsample of households in the Cuvvent Po@lation Survey 

against vecoyds maintained by insurance organizations. However, certain problems unforeseen duying the planning phase of the study made 

it impossible to carry out all of the Outlinedprocedures, thus preventing 

the full accomplishment of the study objectives. 

In addition to presenting the findings produced fvom the record-check 

procedure, this report includes information relating to the method of 

study, the problems encountered in the conduct of the study, and the 

characteristics of record-check studies in geneyal. 

SYMBOLS 

Data notavailable 

Category nonapplicable . . . 

Quantity zero -

Quantity more than O but less than 0.05---- 0.0 

Figure does not meet standards of 

* reliability or precision 
INTERVIEW RESPONSES ON HEALTH INSURANCE 

COMPARED WITH INSURANCE RECORDS 

This report describes a study carried out by personnel of the Division of Health Interview Statistics and the Statistical Research 

Division, U.S. Bureau of the Census. Assistance in the planning and conduct of the study wos provided by the Blue Cross Association and member associations of the Heolth Insurance Council. 

. 

INTRODUCTION 

In addition to its continuous program of data 

collection, the Health Interview Survey sponsors 

a number of research studies designed to evaluate 

the reliability of its collected data. During the 

past several years studies have been conducted in 

which information obtained by household interview 

was checked against records maintained by medical facilities. Information reported on hospitalizations, physician visits, and chronic conditions 

has been evaluated by record-check studies. 

The study described in this report was concerned with health insurance coverage. A pilot 

project conducted during late 1959 and early 

l!)bo led to procedures for a study which was 

planned for use in measuring the reliability of 

the health insurance data collected for the first 

time in the Health Interview Survey during the period July-December 1959. Because certain problems not foreseen during the planning phases 

precluded the complete fulfillment of the original 

objectives of the Health Insurance Record-Check 

Study, this report is chiefly concerned with the 

method of study as it exemplifies some of the 

advantages and disadvantages of evaluative studies 

of this kind. 

Since the U.S. Bureau of the Census carries 

out collection and processing activities in the ongoing program of the Health Interview Survey, the 

Bureau is interested in evaluative and methodological studies relating to Survey data. In this 

study, resources of the Current Population Survey—a monthly survey conducted by the Bureau— 

were used in obtaining the household data on 

health insurance coverage. Personnel in the 

Statistical Research Division carried out the 

operational and analytical phases of the study. 

Through the cooperation of the Blue Cross 

Association and the Health Insurance Council it 

was possible to obtain information from health 

insurance files maintained by the members of 

these organizations for the purpose of comparing 

the interview data to the record sources. 

THE RESEARCH PROBLEM AND 

METHOD OF APPROACH 

The initial purpose of this study was to 

assess the reliability and accuracy of data on 

health insurance coverage obtained from household respondents. In an attempt to accomplish 

this purpose, a subsample of households in the 

Current Population Survey was asked to complete 

a questionnaire on health insurance coverage. The 

information provided by respondents was then 

checked with records maintained by insurance 

organizations. 

The original objectives of the Health Insurance Record-Check Study were as follows: 

1. To provide estimates of the underreporting and overreporting of insurance coverage information collected by household 

interview. 

2.	 Given the fact of coverage, to provide 

some information on the quality of the 

reporting of details about the coverage. 

3.	 To provide some information on duplication of coverage for an individual by the 

various health insurance plans or companies. 

1

A study plan was devised which consisted of 

checking the information on insurance coverage 

obtained from forms mailed in by families and 

individuals living in 4,500 households included in 

the Current Population Survey. All forms, whether 

coverage was reported or not, were to be checked 

against records maintained by the Blue CrossBlue Shield Association. A subsample of the 

original group was to be checked against other 

record sources, namely, commercial insurance 

companies and carrier agencies such as insurance 

plans sponsored by employers or labor unions. It 

was hoped that a combination of record checks with 

these three sources would provide some measure 

of the duplication of insurance coverage. 

Even though the procedures for this study had 

been carefully outlined, certain problems that had 

not been foreseen during the planning phase prevented the full accomplishment of the objectives. 

On the basis of a pilot study, it had been assumed 

that information obtained from self-enumeration 

forms completed by household respondents would 

be sufficient to permit an adequate check against 

health insurance records. Moreover, it was believed that insurance record files were maintained 

in such a way that the checking procedure could 

be carried out, even though some difficulty was 

anticipated in relation to group policies, unionsponsored policies, and dependent insureds. 

Of the three sources used in the record check, 

information from only one, Blue Cross- Blue 

Shield, was completely evaluated, although findings from the other two sources were used in 

this evaluation when appropriate. Since the recordcheck procedure was controlled through a central 

source (the Blue Cross Association in New York), 

and because only Blue Cross had an opportunity 

to check all of the completed forms received from 

households, estimates have been prepared only for 

Blue Cross-Blue Shield coverage. Problems that 

arose with use of the other two sources will be 

described in a later sectiog of this report. 

Although the analysis was limited to the determination of whether or not persons in the study 

were covered by health insurance plans sponsored 

by the Blue Cross-Blue Shield organization, this 

determination could not be made for approximately 

one-sixth of the persons in the sample, The data 

have been adjusted on the basis of the distribution 

of persons whose status could be determined (see 

Appendix III for description of adjustment method). 

This adjustment made it difficult to assess th,: 

validity of the matching study results. For this 

reason, in the description of the project, majo. -

emphasis has been placed on the method of stud}, 

the problems encountered in the conduct of th ~ 

study, and the shortcomings of record -chec < 

studies in general, rather than on the subst ant iv: 

findings produced from the record-check pro ­

cedure. 

The data from the sample survey and fronl 

the record source have been expanded to produc,; 

estimates of the insurance coverage rates in 

civilian, noninstitutional population of the United 

States. However, the procedures used in analyzin[; 

the material were set up primarily to determint, 

the presence or absence of agreement between tht’ 

information provided by the respondents and thal: 

provided by insurance records. 

BACKGROUND MATERIAL RELATIVE 

TO THE RECORD CHECK 

Health Insurance Council Estimates 

of Health Insurance 

Prior to 1959 the annual report of the Health 

Insurance Council was the major source of estimates of health insurance in force in the United 

States.l The only other data came from occasional 

household interview surveys conducted by the 

Federal Government and private groups. 

Data presented in the annual publication 

issued by the Health Insurance Council (HIC), 

“The Extent of Voluntary Health Insurance in 

the United States as of December 31, 19— ,” 

come from three sources: (1) Insurance carrier 

information is compiled by the Council itself. 

(2) Plans affiliated with Blue Cross-Blue Shield 

(Blue Plans) and the American Medical Association’s Medical Service Council assemble statis ­

lThe following discussion of the Health Insurance Council’s annual report is a summary of a paper, “The Metlsurr,. 

ment of Voluntary Health Ineurance Coverage in the United 

States, ” presented in October 195S by David Robbins, Assistant Director of Statistical Research for the Health Insurrmco 

Association of America. This paper appeared in theJuly 1959 

issue of the American Journal of Public Health, 

2 
tics and forward them to the Council. (3) The 

Social Security Administration, Division of Program Research, compiles data on independent 

plans and transmits these data to the Council. 

Insurance carrier information comes from 

a universe which is constructed on two related 

bases, a current census of companies and the 

total accident and health insurance premiums 

written in the United States. ‘Me response rate 

has always been high (86 percent of premiums 

written in 1958), and the Council feels that nonresponse has been properly taken into consideration. 

The resulting data are broken down into 

three groups. The first is the total number of 

persons covered against hospital, surgical, regular medical expenses, major medical expenses, 

and loss of income; second, the total primary 

insureds and total dependents; and third, distributions by State. 

The Blue Cross Commission receives from 

each of its recognized plans a quarterly report 

containing fiscal and enrollment information. The 

A.M.A. conducts a survey on an annual basis of 

enrollment under medical society sponsored or 

approved plans. A careful trend analysis is maintained for these statistics, and when necessary, 

followups are undertaken and verifications are 

obtained from the reporting agencies. 

The Division of Program Research of the 

Social Security Administration conducts an amual 

survey of independent plans and furnishes the 

HIC with totals for each plan. 

A major concern with this type of report is 

duplication of coverage. The Council conducts 

periodic examinations to measure this factor. 

In 1956 analyses were made of 1,000 consecutive 

applications for coverage and 1,000 consecutive 

claim applications, and the indications were that 

with individually purchased contracts, duplication 

amounted to about 22 percent. Another study of 

group insurance came up with 19 percent duplication among persons in group programs. Results of a third (and more recent) study consisting of an analysis of several thousand persons 

admitted to hospitals who were interviewed regarding multiple health insurance ownership confirmed the reasonableness of the estimates developed by the methods previously mentioned, 

according to the Council. 

To determine the net coverage under group 

and individual insurance, the duplication factors 

are split on a judgment basis into duplication within the insurance business and duplication between 

insurance and other coverages. 

There are various problems and limitations 

accompanying this type of study. First, there are 

two major sources of error: (1) the imputation 

procedures used to fill in data for nonresponding 

carriers and (2) the estimation procedures employed to adjust the counts of total insureds to 

eliminate double-counts for persons with two or 

more health insurance contracts. 

Second, the HIC report breaks down coverage 

among many specific types of carriers by regions 

and States and by primary insureds and dependents, but by no other characteristics of the 

population (such as age, sex, color, or income). 

In addition, the HIC definition of “regular 

medical expense” includes a great variety of 

plans providing widely differing extents of coverage. “Regular medical” policies apply primarily 

to inhospital physicians’ services other than the 

more common surgical coverage. Such policies 

usually do not cover home and office visits. Also 

included in this category, along with the limited 

type of policy just described, is the far broader 

protection provided by the Kaiser Foundation 

Health Plans, the Health Insurance Plan of Greater 

New York, and other comprehensive prepayment 

plans. 

Health Interview Survey Estimates of 

Health Insurance 

In early 1959 it was proposed that the Health 

Interview Survey collect information on health 

insurance coverage during fiscal year 1960. 

Several questions on health insurance were in 

fact added to the questionnaire for the two 

quarters including July-December 1959, although 

the continuing household questionnaire method for 

collecting such data was comparatively new and 

this procedure was in the nature of an experiment. 

Questions were designed to elicit information 

as to whether individuals had hospital, surgical, 

or doctor visit insurance (“doctor visit” insurance 

meaning coverage for a doctor’s visit to the home 

or a patient’s routine visit to his office). 

3 
The source data were derived from a continuing household interview survey based on a 

probability sample of the civilian, noninstitutional 

population in the United States. From July through 

December 1959 approximately 19,000 households 

containing 62,000 persons were interviewed. For 

52 percent of the population all of the information 

was obtained during the interview. For the other 

48 percent, all of the illness and demographic information was obtained at the time of interview, 

and the health insurance information was collected 

by a special mail-in form which was left at the 

household for the head of the reporting unit to 

complete and return. 

(Me of the limiting factors in the quality of 

data obtained by household interview may be the 

degree of nonresponse. Further limitations arise 

from the fact that the data are no better than the 

respondent’s knowledge of and willingness to 

discuss his own affairs. 

The total noninterview rate was 5 percent. 

Four percent was primarily due to the failure to 

find any eligible household respondent after repeated trials. Only 1 percent of the households 

scheduled for interview resulted in refusal to give 

any information. Of the persons for whom the 

regular interview was completed, 3.7 percent 

failed to give the information on health insurance. 

This additional nonresponse was due to the failure 

to return the mail-in form where one had been 

left. 

Some impression of the second limiting 

factor, lack of knowledge, can also be gained from 

the data. For hospital insurance an estimated 

1.9 percent of the population either did not know 

whether they were covered or else failed to 

understand the question. For surgical insurance 

the comparable figure was 4.8 percent, and for 

doctor visit insurance it was 6.3 percent. To 

compute the percentages of the various types of 

coverage shown in the NHS report, only those 

persons who responded “yes” or “no” as to 

whether they had health insurance were included. 

The third source of error in the data obtained 

by interview during July-December 1959 was in 

the quality of information given by the respondent. 

The survey design did not provide for a direct 

measure of the reliability and accuracy of the 

data; however, two indirect means were utilizwi 

for checking responses. The first was a compari -

son with data from other sources, such as result:] 

from other surveys and the estimates made from 

insurance company records. The second was :1 

check of a sample of questionnaires agains c 

published lists of insurance companies to deter.. 

mine whether such a company actually existed 

and whether it provided the type of insurance 

which had been reported. Only rarely did a re.. 

spondent name a plan which was not on the pub.. 

lished lists. 

The three forms of health insurance includecl 

in the study were (1) hospital insurance, whict [ 

pays all or part of the bill for a hospitalized 

person; (2) surgical insurance, which pays al~ 

or part of the bill of the operating doctor either 

in a hospital or at his office; and (3) doctor visil 

insurance, which pays the doctor’s bill for nonsurgical care including home or office visits or 

other services related to illness. 

Public welfare, Armed Forces care of dependents, Veterans Administration care, specified disease insurance, workmen’s compensation. 

loss of income insurance, accident and “dread 

disease” policies, and the like were not included. 

Insofar as types of insuring organizations 

were concerned, the responses were allocated 

among “Blue Plans ,“ “other than Blue Plan, ” 

and “Blue Plan and other. ” For the most part, 

“other” included insurance offered by commercial carriers and by independent prepaid comprehensive plans. 

The resulting data were broken down primarily by age and sex into tables of coverage 

by residence and region, family characteristics, 

health characteristics, and type of insuring 

organization. Population data for each of these 

classes were presented for use in computing 

sampling errors. 

The statistics produced by the survey are 

a result of two stages of ratio estimation. The 

effect of this adjustment is to make the sample 

closely representative of the civilian, noninstitutional population of the United States by age, sex, 

color, and residence, thus reducing sampling 

variance. 

4 
Data are adjusted for nonresponse by a 

procedure which imputes to persons in a noninterview household the characteristics of the 

persons in interview households from the same 

segment (small cluster of households). 

Preliminary Evaluation of the NI-IS 

Health Insurance Study 

Late in July 1959, it was decided to drop the 

health insurance questions from the questionnaire 

as of January 1, 1960. The basis for this decision 

was that the two-quarter sample would be sufficient for preliminary evaluation purposes. At the 

same time it was agreed to wait until after an 

internal analysis of the data—and a comparison 

with data from independent sources— to decide 

whether the results should be published. 

It was also agreed that studies would be 

carried out for evaluation purposes. Discussions 

with Blue Cross and other insurance companies 

were to be attempted to see what these groups 

could do in the way of providing check data. 

Pretesting was plamed for the autumn of 1959, 

leading to procedures for an evaluation study of 

the health insurance data from the household 

survey. 

Pilot Study of the Health Insurance 

Record Check 

In November 1959, the Boston, Cincinnati, 

Demoit, Philadelphia, and Pittsburgh regional 

field directors of the Bureau of the Census, 

which assists the Public Health Service on all 

aspects of the National Health Survey, were 

instructed in the procedures for a pilot study. 

In late 1959 and early 1960 Blue Cross and 

member associations of the Health Insurance 

Council were contacted and involved in discussions 

regarding the testing of procedures for checking 

insurance coverage. 

The conclusions based on evaluation of the 

pilot study were that Blue Cross and commercial 

insurance carrier checks could be made, although 

the carriers would not be able to undertake a largescale investigation. The particular problem in 

checking against records of the commercial and 

independent carriers was that to insure completeness of the checking of every name in the 

household sample it was necessary to examine 

the files of a large number bf carriers. For any 

one carrier, particularly a smaller one, to find a 

name would be a rare occurrence. To check for 

Blue Cross-Blue Shield coverage, on the other 

hand, required searching in the files of only one, 

two, or occasionally three plans covering the place 

of residence and the place of work of the individual. 

From the results of the pilot study and conversations with the carriers, procedures were set 

up for the Health Insurance Record Check, the aim 

of which was to investigate the soundness of the 

household interview survey method for collecting 

data on health insurance. 

THE STUDY PROCEDURE 

Field Survey Procedures 

The sample for the record-check study consisted of about 4,500 households included in the 

Current Population Survey (CPS). The households were selected in compact clusters averaging seven households throughout the United States. 

At each of the households included in the 

sample a self-enumeration form (PHS- 1) was 

left by the enumerator for each family and unrelated individual (see Appendix II). In Section A 

of the form the enumerator listed the line number, 

name, relationship to head of family, and date of 

birth for each member of the family. Section B 

consisted of probe questions about all possible 

kinds of health insurance the family might have. 

In Section C were detailed questions for the respondent to answer about each health plan claimed. 

Section D asked for employer-and sick-pay information. Finally, Section E requested the assent, 

by signature of the respondent, to the Bureau’s 

obtaining additional information about members of 

the family from insurance companies and employers. 

Respondents were asked to mail the completed forms to regional offices of the Bureau 

of the Census and were provided with postagefree self-addressed envelopes. TWO reminder 

notices— Form PHS-2 (identical to PHS-1 with the 

exception of rewording in the covering letter)— 

were sent by mail to households that had not re2Z2-101 0 -60-2 5 
turned their forms. If a completed form had not 

been received at the time of the September 1960 

Current Population Survey interview, the CPS 

interviewer tried to complete the form by visiting the household. 

Record Checks 

Following the initial processing, preceding, 

and identification of Blue Cross-Blue Shield and 

commercial plans, information for checking the 

reported insurance status of household members 

to insurance records was transcribed to another 

form and then forwarded to the Blue CrossBlue Shield Association and to employers, unions, 

and other groups who might sponsor group 

insurance plans. A small subsample of the household members’ names was also sent to nearly 

every commercial and independent carrier in 

the country, as a means by which individual or 

family coverage by these carriers could be 

ascertained. In no case was the carrier or 

employer informed of what coverage had been 

reported in the interview. Tflese procedures, of 

course, were dependent on whether the sample 

person had granted permission for record checking. 

Since the procedural steps followed in the 

conduct of the study are of limited interest 

except, perhaps, to those actually involved in 

the planning of such a study, the detailed description of this phase of the project is presented as supplementary material in Appendix I. 

ANALYSIS OF THE DATA 

Limitations of Record-Check Studies 

In the methodological program of the Health 

Interview Survey, the record-check study as a 

method of assessing the accuracy of reported 

data and of identifying factors related to response 

errors has been used with limited success. In 

general, the degree of success in these studies 

has been dependent on the type of health factor 

under investigation. Some reasons for their limitations have been described as (1) the difficulties 

in replicating the procedures and population composition of the Health Interview Survey, (2) inadequacies in the material maintained in the 

record source, (3) inherent differences in the 

record information and the knowledge that ha:; 

been made available to the respondent, and (4) 

the practice of carrying out a one-directional type 

of record check. References to the shortcoming:; 

of record-check studies as they apply to such 

health topics as chronic conditions, hospital.. 

zations, and physician visits have been presented 

in Vital and Health Statistics, Series 2, Nos, 6 and 

7 and Series 10, Nos. 18 and 19. 

In the present study all of these problem~; 

were taken into account in setting up the stud!~ 

procedure. To obtain a representative population, 

the probability sample in the Current Population 

Survey was used. Record systems used by the 

insurance companies were investigated during tht: 

pilot phase of the study so that the household infermation could be collected in a format which WOUIC1 

be convenient for checking purposes. The survey 

material was submitted by mail so respondent; 

would have an opportunity to consult other family 

members and to examine their insurance policies, 

The procedure called for checking all household 

information with the record source regardless o ! 

whether insurance coverage was reported. How -

ever, as mentioned earlier, problems encountered 

in the record-check phase prevented the ful ! 

accomplishment of the objectives, despite the 

careful detail that went into the planning of tht! 

study. 

Some of the reasons advanced for the in. 

adequacy of the checking procedure were the 

following: 

1.€In many cases, policy numbers were nol 

available for checking against insuranc~ 

company files which were maintained ir 

numerical order rather than alphabetical, 

2.€Individual policy holders or dependent 

insureds were oftentimes not identified,, 

in group plans. 

3.	 Sufficient staff and time were not alway~ 

available for thorough checking of insurance files. 

4.€In instances where permission to obtair 

insurance information from the employer 

was not granted by the respondent, coverage status could not be determined for 

specific employees. 

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5.	 Respondents in some cases named employers as the carrier agency, when an 

employee union was in factthesponsoring 

agency (or vice versa). 

6.	 As in all studies where handwritten forms 

are involved, there was a certain amount 

of confusion due to incorrect names and 

addresses. 

Allocation of Inconclusive Data From the 

Blue Cross-Blue Shield Record Check 

The outcome of the Blue Cross-Blue Shield 

record check was inconclusive on hospital insurance coverage for 790, or 17.8 percent, of the 

households for which respondent data were submitted to the Blue Cross-Blue Shield organization. 

As shown below, the variation in inconclusive Blue 

Plan reports was quite marked from region to 

region: 

Proportion 

of 

Rep”on pevsons with 

inconclusive 

reports 

United States 16.8 percent 

Northeast 2.2 percent 

North Central 40.8 percent 

south 14.0 percent 

West -------------------------- 1.1 percent 

The reports on surgical and doctor visit insurance 

coverage showed similar patterns, indicating that 

the inadequate reports were highly clustered. 

Of the 790 forms with inconclusive reports, 

561 had no indication of the coverage status from 

the record source (no check in question 5 on NHSPHS-2; see Appendix II), nor was the signature of 

the person responsible for the checking entered 

in item 8 on the back of the form. On some of the 

other forms, there was a signature indicating that 

checking had been done, but there was no conclusive information about the insurance coverage 

status. On other forms there were notes indicating 

cancellation of the policy, inability to locate records, or transfer from group to other type of 

policy, but there was no signature on the form 

to indicate that the checking process had been 

completed. 

Unfortunately, the tabulation and analysis of 

the record-check material were not carried out 

immediately following the receipt of the material 

from the record sources. This delay made it 

impossible to recheck the material with the record sources or to determine if the procedures 

outlined in the study plan had been followed. 

Of the 16.8 percent of the persons for 

whom inconclusive results were obtained from 

the Blue Cross-Blue Shield record source, a 

high proportion (16. 1 percent of the total records or 96.4 of the “inconclusive”) were persons for whom no Blue coverage was reported 

from the respondent source. As a consequence, 

a correspondingly high proportion of these records were allocated to the category “no Blue 

coverage” (according to the record source) in 

the data-adjustment process used in the study 

(see Appendix III). 

The allocation of inconclusive data is a 

difficult problem to handle in any statistical 

study. In a record-check study, the problem is 

compounded by the presence of such data in both 

sources, the respondent report and the check 

source. In the present study, a high percentage 

of the inconclusive from the check source were 

among persons for whom no Blue coverage had 

been reported on the respondent form. h the 

allocation procedure used in the study, it was 

assumed that the record search was not properly carried out for these Fersons; they were 

therefore allocated to coverage status in the 

same proportion as those for whom a record 

search was known to have been made. 

If, on the other hand, it is assumed that the 

record search was carried out but the results 

were not recorded properly, an imputation procedure more inclined to this assumption would 

be appropriate. Such a procedure, based on the 

concept of the “best available response,” was 

developed for comparative purposes during the 

analysis of the data. In this method of allocation, 

check-source information was accepted, but where 

it was not available the respondent information 

was substituted. Similarly, in cases where respondent data were not available, check-source 

information was substituted. This latter substi7 
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Table A. Estimates of hospital insurance coverage using alternative methods of allocating unknown coverage status, by geographic region: United States, 1960 

I Inconclusive hospital insurance data allocated: 

Region Proportionally According to “best 

estimate of coverage” 

I 

Respondent Check Check 

report source source 

I Percent of persons with Blue Cross-Blue Shield 

United States 

Northeast 

:::; Central 

West 

tution was necessary in only a small numberof 

cases. Where aresponse was not available from 

either source, the case was in effect regarded 

as a noninterview and was excluded from the 

calculation of error rates. While this procedure 

is biased in some respects, it does minimize the 

gross error and also the variance of the net 

error because it treats the inconclusive data 

as cases of agreement between respondent and 

check-source reports. 

Since a high proportion of the inconclusives 

were in the check-source data, this alternate 

method ofalloc ationdid not affect the respondent 

information to any extent. Table A shows its 

effect ontheBlueCross -BlueShieldcheck- source 

data relating to hospital insurance coverage in 

the four geographic regions. 

In the two regions where the amount ofinconclusive data was large (North Central and 

South Regions), the allocation method based on 

“best estimate of coverage” reduced the rates 

considerably. In the Northeast and West Regions, 

where the amount of inconclusive informationwas 

negligible, there was no appreciable differencein 

the coverage rates produced by the alternative 

imputation procedures. 

The material shown in table A exhibits 

clearly the importance of the imputation pro27.1] 27.9 26.3 

43.0 41.0 41.0 

29.2 32.7 ;;.: 

18.0 19 � 5. 

15.7 14.4 14:4 

cedure and points up one of the reasons why it 

was considered appropriate to place emphasis 

in this report on the method of study rather than 

on the evaluation of the interview survey. It is 

evident from this table that one method of imputation implies that the estimate of insurance 

coverage based on interview data was an underestimate of the coverage rate derived from records, while the other method implies an overstatement from the interview data (see table 4). 

SUMMARY 

The estimates in tables 1-3 show thecomparative coverage status of the study group by 

geographic region according to the respondent 

and check sources, using the proportional methoc 

of adjustment for inconclusive reports. For hospital, surgical, and doctor visit insurance, the 

gross differences inthe two sources (summatior 

of nonmatching records) approximated ll-14percent for the United States, were slightly higher 

(14-19 percent) for the Northeast andthe Nortk 

central Regions, and were considerably lower 

(6-9 percent) for the South and We=t Regions 

(table 4). Among those identified by the Blue 

Cross organization as insured, 78.9 percent oi 

8 
-----

-----

Table B. Estimated percent of persons showing disagreement in the respondent report 

and the check source, by type of coverage: United States, 1960 

Blue coverage Blue coverage 

reported by reported by Gross Net 

respondent record source, difference difference Type of coverage report, but not but not by rate rate 

by record source respondent report 

(1) 

Hospital insurance 5.1 

Surgical insurance 5.4 

Doctor visit insurance- 2.8 

the respondents reported hospital insurance 

coverage and 75.0 percent reported surgical 

insurance, but only 20.1percent reported doctor 

visit insurance. 

An interesting finding relation to doctor 

visit insurance was that the major source of 

disagreement between the respondent and check 

sources was among persons who reported no 

Blue coverage on the household form, yetwere 

found in the record source to have Blue Plan 

insurance coverage for doctor visits (see table 

B). 

The percentages shown in columns (1) and 

(2) of table B represent, in effect, estimates of 

the amount of underreporting and overreporting 

that could be expected on insurance coveragein 

a household survey. When the net difference rate 

is small, the underreporting is offset by the 

overreporting, with the gross difference rate 

serving as a measure of the variance. When the 

amount of underreporting is disproportionately 

higher than the overreporting, asis the case for 

dcctor visit insurance coverage, thesurveyestimate for such an item will be markedly lower 

than the true estimate, 

This finding may explain why the estimates 

obtained for hospital and surgical insurance 

coverage from the most recent data collected in 

the Health Interview Survey (July1962 -June1963) 

were not appreciablydifferentfromthose obtained 

from some other sources. On the other hand, the 

estimates for doctor visitinsuranceweresomuch 

Iower than those from othersources thatseparate 

estimates for this type of health insurance were 

not published. 

(2) (1) + (2) (1) - (2) 

Percent 

5.9 

1::: 

The counterbalancing 

and overreporting may 

fact that one-directional 

underreporting only)on 

frequency of physician 

11.0 -0.8 

11.5 -0.7 

13.6 -8.0 

effectofunderreporting 

also shedsomelight onthe 

checks (thosemeasuring 

other topics, suchas the 

visits, have indicated a 

marked degree of underreporting in the survey, 

even though estimates from the survey are quite 

similar to or even higher than those from certain	 other sources. 

Individual tables showing cotiparative coverage information from the respondent andrecord sources (tables 5-7) are summarized and 

evaluated in table 8, Since the inconclusive 

check-source reports were allocated independently within geographic regions, recombining the 

estimates to the total U.S. level will not give the 

estimates shown in tables 1-3. No appreciable 

differences were noted in the comparative data 

for males and females. The net difference rates 

for hospital insurance indicate that respondent 

data for persons under 65 years underestimate 

coverage by a small amount. However, for 

persons 65 years and over, the respondent reports show an overestimate of coverage when 

comparedwith the check source data. 

The general purpose of the record-check 

study was to provide estimates of the underreporting and overreporting of insurance in 

household interviews. More specifically, its goal 

was to provide some evaluation of the statistics 

on health insurance derived from the data collected in the Health Interview Survey during the 

period July-December 1959. However, the special Current Population Survey interviews conducted in August 1960 produced an estimate of 

9 
hospital insurance coverage that was more than 

10 percent lower than the 1959 Health Interview Survey estimate. One of the chief contributors to the difference in the estimates 

derived from the two surveys was the introduction of data collection procedures in the CPS 

survey which would increase the feasibility of 

the record check itself. For example, respondents were asked more specific information on 

1	 coverage—such as the names of insurance plans 

and companies and the identification of individual 

policies— than was asked in the Health Interview Survey interview. 

The fact that the method of interview was 

modified to make the record check a feasible 

undertaking is perhaps the most severe limitation 

of the project. When added to the other limitations 

described above, it suggests that, as presently 

conceived, the record-check approach in this 

area may be of limited validity. The entire 

project certainly indicates that when a recordcheck study is undertaken, consideration should 

be given to (1) the preparation of procedures 

which will produce meaningful results, (2) arrangements with the check source that will be 

carried through to the completion of the study, 

and (3) a time schedule which is reasonable in 

relation to the scope of the study and which will 

maximize the likelihood of continuity of personnel involved in the study. 

000 
DETAILED TABLES 

Page


Table 1.


2.


3.


4.


5.


6.


7.


8.


Blue Cross-Blue Shield hospital insurance coverage status accordingto respondent


and check-source data, by geographic region: United States, 1960----------------


Blue Cross-Blue Shield surgical insurance coverage status accordingto respondent


and check-sourcedata, by geographicregion:United States, 1960----------------


Blue Cross-Blue Shield doctor visit insursnce coverage status according to re­
 spondent and check-source data, by geographic region: United Statea, 1960-------


Indexes of net and gross error among persons reported as having Blue Cross-Blue


Shield insurance coverage in respondentreport or in check source, by type of


coverage and geographicregion: United States, 1960-----------------------------


Blue Cross-Blue Shield hospital insurance coverage status accordingto respondent


and check-source data, by sex and age: United States, 1960----------------------


Blue Cross-Blue Shield surgicsl insurance coverage status according to respondent


and check-source data, by sex and age: United States, 1960----------------------


Blue Cross-Blue Shield doctor visit insurance coverage status acording to re­


spondent and check-source data, by sex and age: United States, 196i)-------------


Indexes of net and gross error among persons reported as having Blue Cross-Blue


Shield insurance coverage in respondentreport or in check source, by type of


coverage,sex, and age: United States, 1960------------------------------------­


12


13


14


15


16


17


18


19


11

-------------------------------------------

------------------------------------

-------------------------------------------

-------------------------------------------

------------------------------------

-------------------------------------------

----------------------------------------

------------------------------------

-------------------------------------------

------------------------------------

Table 1. Blue Cross-Blue Shield hospital insurance coverage status according to respondent and


check-source data, by geographic region: United States, 1960


Respondent data


Region and check-source data II Blue Plan 

All 

persons Not Covered 

All regions


All persons


Covered by Blue Plan----------------------------------------


Not covered by Blue Plan


Northeast


All persons


Covered by Blue Plan----------------------------------------


Not covered by Blue Plan------------------------------------


North Central


All persona


Covered by Blue Plan----------------------------------------


Not covered by Blue Plan


South


All persons


Covered by Blue Plan


Not covered by Blue Plan


West


All persons


Covered by Blue Plan----------------------------------------


Not covered by Blue Plan


covered


Percent distribution


100.0 27.1 72.9 

27.9 22.0 5.9


72.1 5.1 67.0


100.0 43.0 57.0 

41.0 34.5 6.6


59.0 8.5 50.5


100.0 29.2 70,8


32.7 24.0 8.7


67.3 5.2 62.1


100.0 18.0 82.0 

19.5 14.9 4.5


80.5 3.0 77.5


100.0 15.7 84.3 

14.4 12.2 2.3


85.6 3.6 82.0


12

-------------------------------------------

----------------------------------------

----------------------------------------

------------------------------------

Table 2. Blue Cross-Blue Shield surgical insurance coverage status according to respondent and


check-source data, by geographic region: United States, 1960


Respondent data


Region and check-source data


m


All regions


All persons-------------------------------------------


Covered by Blue Plan----------------------------------------


Not covered by Blue Plan------------------------------------


Northeast


All persons


Covered by Blue Plan


Not covered by Blue Plan------------------------------------


North Central


All persons-------------------------------------------


Covered by Blue Plan


Not covered by Blue Plan------------------------------------


South


All persons-------------------------------------------


Covered by Blue Plan----------------------------------------


Not covered by Blue Plan------------------------------------


West


All persons-------------------------------------------


Covered by Blue Plan----------------------------------------


Not covered by Blue Plan


Percent distribution


100.0 23.6 76.4 

24.4 18.? 6.1 

75.6 5.4 70.3 

100.0 36.0 64.0 

34.4 27.9 6.5


65.6 8.1 57.5


100.0 25.5 74.5 

28.7 19.6 9.0


71.3 5.9 65.5


. 

100.0 16.2 83.8 

17.7 12.8 5.0


82.3 3.5 78.8


100.0 15.1 84.9 

13.4 11.2 2.2


86.6 3.9 82.7


222-7o1 0-80-3 
-------------------------------------------

-------------------------------------------

----------------------------------------

------------------------------------

-------------------------------------------

------------------------------------

-------------------------------------------

----------------------------------------

------------------------------------

-------------------------------------------

----------------------------------------

------------------------------------

� 

Table 3. Blue Cross-Blue Shield doctor visit insurance coverage status according to respondent 

and check-source data, by geographic region: United States, 1960 

Respondent data


Region and check-source data II Blue Plan 

All 

persons Not Covered 

All regions


All persons


Covered by Blue Plan----------------------------------------


Not covered by Blue Plan------------------------------------


Northeast


All persons


Covered by Blue Plan


Not covered by Blue Plan


North Central


All persons


Covered by Blue Plan----------------------------------------


Not covered by Blue Plan


South


All persons


Covered by Blue Plan


Not covered by Blue Plan


K


AH persons


Covered by Blue Plan


Not covered by Blue Plan


covered


Percent distribution


100.0 5.5 94.5 

13.5 2.7 10.8


86.5 2.8 83.7


100.0 8.6 91.4 

17’;2 3,7 13.4


82.9 4.9 78.0


100.0 5.0 95.0 

18.7 2.5 16.2


81.3 2.6 78.7


100.0 3.1 96.9


9.5 2.0 7.6


90.5 1.2 89.3


100.0 6.0 94.0 

5.7 3.0 2.7


94.3 3.1 91.2


14

------------ -------- ----------------

-----------------

------------ -------- ----------------

-----------------

------------

-------- ----------------

---------

-----

Table 4. Indexesof net and gross errorlamongpersonsreported as having Blue Cross-Blue Shield insurance coverage in respondent report or in check source, by type of coverage and geographic region: 

United States, 1960 

ercent with Blue Net error indexes Gross error indexes 

coverage 

Percent 

Type of coverage 

Index 

Net of 

Index Gross of Index of 

classified 

identically 

and region espondent Check difference net differgross inconsist­


report source ence
 rate shift shift ency


rate


~ &
 a+c a+b (a+c)-(ai-b)a+b c+b a+b 2(a+fic+d)


Hospital ercent


All 

Surgical 

regions---- 23.6 24.4 -0.7 -2.9 

T

11.5 47.0 31.1 75.0 

Northeast 

North Central 

36.0 

25.5 

34.4 

28.7 

4.7 14.5 42.2 -H -11.1 14.9 51.9 

32.2 

36.4 

81.2 

:;.; South 16.2 L7.7 -1.5 -8.4 8.4 47.5 28.9 

West 15.1 13.4 1.7 12.5 6.2 46.0 26.6 83:2 

All regions---P- 27.1 27.9 -0.8 -2.8 11.0 39.5 27.4 78.9 

Northeast 43.0 41.0 15.0 36.7 31.1 84.0 

North Central 29.2 32,7 -::; -1::: 14.0 42.7 31.7 73.3 

South 18.0 19.5 -1.5 -:.; 38.9 24.1 76.7 

West 15.7 14.4 1.3 ;:; 40.3 23.6 84.3 

Doctor visit


t 

West 5:8


All regiona---- 5.5 13.5 -8.0 -59.3 13.6 100.5 58.1 20.1 

Northeast 8.6 17.2 -8.5 -49.8 18.3 106.6 64.3 21.8 

North Central 5.0 18.7 -13,7 -73,1 1;.; 1;:.; 61.8 13.2 

South 9.5 -6.4 -67.3 50.6 20.5 ----------------- ::; 5.7 0.3 5.3 T100:9 53.5 52.2 

lTh{~ind~,~(,s *rCIb,~sed on results of theraspondent report and the check source for identical persons. The letters on the following table, which reproscnt proportions of tba total civilian, noninstitutional population with a given characteristic, are used @ indicate the measures basic to the indexes 

shown uhnw: 

Respondent report 

Check source 

Blue No Blue 

:overage coverage 

Blue cOverage a b a+b 

No Blue coverage c d c+d Ba+c b+d 100.0 

1. Thepmportion ofpersons wiith Rluecoverage according ~respondent report is pl=a+c 

!?. Thepmportion of persons witb Rluecoverage according tothecheck source is p2=a+h 

.3. The net difference rate between tbe two proportions is la + c) - (a +b)] 

4. Tbegmss difference rate is g=b+c 

b+c 1 B. Theindex ofinconsistencyis ?=— 

[

z(a+b)(c-bd)] 

6. The index of net sbiftis the net difference relati~,e to the check source is ~~ 

7. The index of gross shift is tbe gross difference relative to tbe cbeck source is !2&. 

8. Theproportion classified identically as having Blue coverage is ~~b 

tlnd,,r m,rtainconditions, g(thegross difference rate)is ameasure ofresponse variability, and~(the index ofinqonsistency) measures tbe proportion 

of tho tatul vuriabiIity arising frnm the response variability. These conditions are described in “The Estimates and Interpretation of Gross Differences 

and tho Simple Reepruw Variance, ” byhl. A. Hansen, W. N. Hunvitz, and L. Pritzker, Contributions to Statistics Presented to Prof. P. C.lfahalanobis 

on the C)mmionof His 7i)th Birt&iay, Oxford, England, Pergamon Press, June 1963. 

15 
---------

-------------------------------------------

---------------------------------------

-----------------------------------

------------------------------------------

---------------------------------------

-----------------------------------

------------------------------------------

-----------------------------------

------------------------------------------

------------------------------------------

---------------------------------------

-----------------------------------

Table 5. Blue Cross-Blue Shield hospital insurance coverage status according to respondent and


check-source data, by sex and age: United States, 1960


Respondent data


II 

Sex, age, and check-source data


persons
 “1t==i=

All ages Percent distribution 

All persons------------------------------------------, 100.0 27.0 73.0 

Covered by Blue Plan---------------------------------------, 27.7 22.0 5.7 

Not covered by Blue Plan --------------------------! 72.3 5.0 67.3 

Under 65 years


All persons 100.0 27.8 72.2 

Covered by Blue Plan 28.7 22.8 5.9 

Not covered by Blue Plan 71.3 5.0 66.4 

65 years and over 

All persons 100.0 19.7 80.3 

Covered by Blue Plan 18.5 14.3 4.2 

Not covered by Blue Plan 81.5 5.5 76.0 

FEMALE


All ages


All persons 100.0 27.1 72,9 

Covered by Blue Plan---------................-----------... 27.0 21.9 5,1 

Not covered by Blue Plan 73.0 5.2 67.8 

Under 65 years 

All persons 100.0 28.3 71.7 

Covered by Blue Plan.........---------..................... 28.4 23.1 5.3 

Not covered by Blue Plan................................... 71.6 5.: 66.3 

65 years and over 

All persons 100.0 17.4 82.6 

Covered by Blue Plan 14.9 12.4 2.5 

Not covered by Blue Plan 85.1 5.C 80.1 

16

-------------------------------------------

----------------------------------------

-------------------------------------------

Table 6. Blue Cross-Blue Shield surgical insurance coverage status according to respondent and


check-source data, by sex and age: United States, 1960


Respondent data


I


Sex, age, and check-source data Blue plan


All 1 I persons Not
 Covered
 I 

W 

All ages


All persons-------------------------------------------


Covered by Blue Plan----------------------------------------


Not covered by Blue Plan------------------------------------


Under 65 years


All persons------------------------------&------------


Covered by Blue Plan----------------------------------------


Not covered by Blue Plan------------------------------------


65 years and over


All persons


Covered by Blue Plan


Not covered by Blue Plan------------------------------------


FEMALE


All ages


persons-------------------------------------------


Covered by Blue Plan----------------------------------------


Not covered by Blue Plan------------------------------------


Under 65 years


All persons-------------------------------------------


Covered by Blue Plan----------------------------------------


Not covered by Blue Plan------------------------------------


65 years and over


All persons


Covered by Blue Plan----------------------------------------


Not covered by Blue Plan------------------------------------


1 covered


Percent distribution


100.0 23.7 76.3 

24.3 5.9


75.7 70.5


100.0 24.6 75.4 

25.2 19.2 6.0


74.8 5.4 69.4


100.0 14.4 85.6 

14.8 10.2 4.6


85.2 4.2 81.0


100.0 23.6 76.4 

23.4 18.1 5.3 

76.6 5.4 71.1 

100.0 24*E 75.1 

24.9 19.2 5.7


75.1 5.6 69.4


100.0 12.6 87.4 

10.0 8.6 1.4 

90.0 4.0 86.0 

17

-------------------------------------------

------------------------------------

-------------------------------------------

----------------------------------------

-------------------------------------------

----------------------------------------

------------------------------------

-------------------------------------------

----------------------------------------

------------------------------------

----------------------------------------

------------------------------------

-------------------------------------------

------------------------------------

Table 7. Blue Cross-Blue Shield doctor visit insurance coverage status according to respondent


and check-source data, by sex and age: United States, 1960


Respondent data


Blue Plan


Sex, age, and check-source data


All


persons


Ail ages


All persons


Covered by Blue Plan----------------------------------”------


Not covered by Blue Plan


Under 65 years


All persons


Covered by Blue Plan


Not covered by Blue Plan..............................-.----


65 years and over


All persons


Covered by Blue Plan


Not covered by Blue Plan


FEMALE


All ages


All persons


Covered by Blue Plan


Not covered by Blue Plan


Under 65 years


All persons-..-....................................---


Covered by Blue Plan


Not covered by Blue Plan


65 Years and over


All persons


Covered by Blue Plan..................................------


Not covered by Blue Plan


T


Percent distribution


100.0 5.6 94.4 

13.0 2.8 10.2


87.0 2.8 84.2


100.0 5.9 94.1 

13.7 3.0 10.6


86.3 2.9 83.4


100.0 2.1 97.9 

6.0 0.5 5.5


94.0 1.6 92.4


100.0 5.4 94.6


12.6 2.7 9.9


87.4 2.8 84.7


100.0 5.8 94.2 

13.4 2.8 10.6 

86.6 3.0 83.6 

100.0 1.9 98.1 

4.7 0.9 3.8


95.3 1.0 94.3


18

-------

-------

-------

-------

-------

-------

-------

-------

-------

-------

-------

Table 8. Indexes of net and gross errorl among persons reported as having Blue Cross-Blue Shield insurance coverage in respondent report or in check source, by type of coverage, sex, and age: United 

States, 1960 

Percent with Blue Net error indexes Gross error indexes 

coverage 

Percent 

classified 

Type of coverage, Net Index Gross Index Index of identically 

sex, and age Respondent Check difference of differ- Of inconsist- report source rate net ence gross 

shift rate shift I ency 

~ I & Ia+c a+b (a+c)-(a+b) a+b I c+b I St!& 

2(a+~?c+d) a+b 

HOSPITAL 

Male 

All ages 

linder65 years 

65 years and over----

Female 

All ages 

Under 65 years 

65 years and over----

SURGICAL 

Male 

All ages 

Under 65 years 

65 years and over----

Female 

All ages 

Under 65 years 

65 years and over----

DOCTOR VISIT 

Male 

All ages-------

Under 65 years 

65 years and over----

Female€

All ages€

Under 65 years€

65 years and over----

I Percent 

27.0 27.7 -0.7 -2.5 10.7 38.7 26.t 79.4 

27.8 28.7 -0.9 -3.1 10.8 37.8 26.! 79.6 

19.7 18.5 1.2 6.6 9.7 52.? 32.1 77.2 

27.1 27.0 0.1 0.5 10.3 38.0 26.1 81.2 -

28.3 28.4 -0.1 -0.3 10.6 37.1 26.1 81.2 

17.4 14.9 2.5 16.6 7.5 50.0 29.4 83.3 

23.7 24.3 -0.6 -2.4 11.1 45.8 30.3 75.9 

24.6 25.2 -13.6 -2.4 1;.; 45.0 30.1 76.3 

14.4 14.8 -0.4 -2.9 . 59.5 34.9 68.8 

23.6 23.4 0.1 0.5 — 10.7 45.8 29.9 77.4

24.8 24.9 -0.1 -0.3 11.3 45.4 30.3 77.1 

12.6 10.0 2.6 25.8 5.5 54.5 30.3 85.7 

5.6 13.0 -7.4 -57.0 13.0 99.9 57.4 21.5 — _ — _ 

5.9 13.7 -7.7 -56.7 1-305 99.0 :;.: 22.1 

2.1 6.0 -3.9 -65.0 7.2 119.0 . 8.0 

5.4 12.6 -7.1 -56.9 12.7 100.9 57.7 21.1 

5.8 -7.6 -56.8 13.6 101.3 58.5 20.9 

1.9 -2.8 -60.3 4.8 102.1 53.6 18.8 

lSee table 4. 

19 
APPENDIX I 

DETAILED DESCRIPTION OF THE PROCEDURES OUTLINED FOR THE STUDY 

Preliminary Processing of Household Data 

After the household questionnaires were received 

in the regional field offices they were forwarded to 

the Bureau of the Census for screening and preceding. 

There were seven steps in the preliminary processing: 

1. 

2. 

3. 

4. 

5. 

6. 

7. 

Incoming forms (PHS- 1 or PHS-2; see Appendix 

II) were examined to determine whether more 

than one form had been left at the household. 

When there were two or more families in a


household, a check was made to ascertain that


relationships were to the head of the family and


not to the head of the household,


The third step was to determine whether plans


reported on Section C of the form were Blue


Plans, non- Blue but on the universe carrier


list, not a Blue Plan and not on the universe


carrier list, not identifiable as Blue or non-


Blue, or not a health plan at all.


The fourth check point was Section C, item


3(d), method of paying premiums. The respond­


ent’s answer to this question for each claimed


plan was coded according to whether premiums


were paid at a place of work, directly to the


insurance company, or some other way.


Next, Section E of the form was coded according


to whether or not it contained the signature


(or initials) of the person filling out the form.


The sixth precede was to distinguish claimed


non-Blue universe plans from other types and


individual or family plans from group plans


(see the third and fourth steps above). The


purpose here was to determine whether a


carrier inquiry was to be made.


Finally, Section D was examined to determine


whether any employers were to be queried.


If the person named in Section D was also the


policyholder of a Blue Plan in Section C for


which premiums were paid at work, and no


other plan of a, non-Blue type was carried at


work by this person, the employer was not


checked. If the above was not the case in all


respects, section E was examined for a signa­


ture authorizing the necessary record checks


to be undertaken. If there was no name or 

address of an employer in Section D or if 

“self-employed” was written in, X was entered 

by the .preccder for this item. 

Preparation for Record Checks 

Blue Cyos.s-Blue Shield. —Blue Plans include any 

health plans connected to Blue Cross or Blue Shield. 

The State and local Blue Cross Plans are coordinated 

by the Blue Cross Association in New York. The local 

units of Blue Shield are coordinated by the Blue Shield 

Medical Care Plans organization. For administrative 

purposes, most Blue Shield Plans are associated with 

the Blue Cross organization in the same geographic 

area. 

Following the initial processing, preceding, and 

identification of Blue and commercial plans, a form— 

Blue Cross-Blue Shield Questionnaire (see NHS-PHS-2 

in Appendix 11)—was created by the Census Bureau 

for every known family and unrelated individual in the 

sample. 

This form contained, first, a guarantee of confidentiality. Filled in were the address and control 

number of the family, the names, relationships, and 

dates of birth for all family members, and supplemental 

employment information where applicable and available. 

There was a coverage question and a place for Blue 

Cross to-mark the persons covered by each certificate 

issued. On the back of the form were questions dealing 

with the details of any plans in effect, such as name of 

subscriber, group or nongroup contract, major medical 

expense attachment, and benefits for hospital room and 

board and surgeons’ fees in hospital. 

An original and two copies of the form were sent 

to the Blue Cross Association in New York City. On 

the original and control copy, the Blue Cross or Blue 

Shield Plan and policy number, if a plan was claimed 

and such information was given, were recorded for 

the Blue Cross Association’s use in reconciling cases 

in which a plan was claimed by the respondent and not 

confirmed by the local Blue Plan organization. 

Seventy-eight Blue Cross and fifteen Blue Shield 

organizations, as well as the Federal Employees 

20 
Master Tape at Camp Hill, Pa., were involved in this 

operation. , 

Etnployey, union, OYother .gwup.-Employers of 

persons in the sample were queried to determine 

whether there was health insurance coverage and 

whether it was available through the place of employment (Form NHS- PHS-3). In some cases a carrier 

agency other than an employer (such as a union or other 

group) might have been mentioned on the reporting 

form, in which case a query (Form NHS-PHS-1) was 

mailed to this source. 

If a person was self-employed there was no 

employer inquiry. In addition, when a Blue Plan was 

carried at work by a person and no other plan of a 

non-Blue type was carried at work by the same person, 

there was no employer inquiry. 

In instances where permission to check records 

had been given by the respondent, the form used for 

employer query (NHS-PHS-3) was similar to the 

form sent to Blue Cross-Blue Shield, although no 

supplementary information on the characteristics of 

the person was supplied and there was an additional 

question on the method of handling insurance claims 

(cash indemnity or service). The employer was asked 

to list dependents covered by the employee’s insurance 

if there was, in fact, coverage. 

When permission for record checking had not been 

given by the respondent, a different kind of form was 

mailed to employers (or unions or other groups). No 

mention was made of the employee (or member) by 

name, The coverage question asked whether health 

insurance was available to employees. An additional 

question sought to determine what types of employees 

were eligible if coverage was not available to all. 

Insuvance companies. —The record sources were 

essentially of two types IYom the point of view of the 

record check: (1) Those for which there was, in effect, 

no limitation of the number of cases from the household survey which could be checked. These sources 

included employers and the Blue Plan organizations. 

The reason why no limitation was involved for these 

sources waa that the number of persons required to 

be checked by any one employer or Blue Plan organization was small. (2) hose for which the number of 

cases that could be checked was sharply limited. These 

sources included the commercial ~nsurance companies 

and independent plans. Because these organizations 

operate in a number or all of the States, any member 

of the sample could have been covered by a policy issued 

by any company or plan. It would have been virtually 

impossible for each of these organizations to check 

every member of the sample. ~us, only a relatively 

small subaample could be investigated. 

In order to check on coverage claimed by respondents and to check a subsample of the respondents with 

all commercial and independent carriers for purposes 

of estimating underreporting, the Universe List of 

Commercial Insurance Companies was compiled from 

the 1960 Survey Number of Accident and Sickness 

Review prepsred by National Underwriters. It comprised, in general, companies writing more than 

$500,000 of accident and health premiums during 1959. 

The Universe List of Independent Medical and Hospitalization Plans comprised, in general, those plans on the 

master list maintained by the Social Security Administration, Division of Program Research, which had total 

earned income of over $500,000 during 1959. 

A subsample of 200 families was selected from the 

household sample. Each insurance company was queried 

about these 200 families as well aa any families reporting insurance coverage with the specific company. 

The company was not informed as to which families 

reported coverage with the company. 

Record-Check Procedure 

Blue Cross-Blue Shield. —The Blue Cross Association in New York directed the search by the 10CSIBlue 

Plans for all the families in the sample. The general 

approach was to query the plan having jurisdiction in 

the place of employment as a first possibility. The 

plan in the area of residence was the second primary 

possibility, although this querying may, in some cases, 

have been done simultaneously with that in the area of 

employment. 

Early in 1961 the Blue Cross-Blue Shield Questionnaires were mailed to the local plans by the Blue Cross 

Association. Accompanying the questionnaires was a 

covering letter which explained to the local plans the 

purposes and procedures of the Health Insurance Record 

Check. 

The local Blue Cross Plans were requested to investigate the possibility that any member of the family 

listed on the questionnaire was enrolled, and a thorough 

search was encouraged. There was also a request for 

a brief summary of the methods used to complete the 

search and the time involved. If the local Blue Cross 

records did not indicate whether the enrollees had Blue 

Shield as well, the plan was asked to notify the headquarters office so that the local Blue Shield Plan could 

be requested to undertake a similar investigation. 

In addition, the covering letter sought to clarify 

some of the items on the questionnaire. The local plans 

were asked to respond not later than February 28, 1961. 

During the spring of 1961, the Blue Cross Association created a followup letter and check list to be 

mailed to the local plans with questiomaires requiring 

further clarification due to disagreement between the 

household respondents’ answers on the original forms 

and the answers repxted by the local plans. 

Prior to commencing the record-check work, the 

Blue Cross Association anticipated possible problems 

with certain population groups. These included (1) 

21 
dependent children overage 19, (2)areaam which two 

or more plans had jurisdiction, (3) national accounts, 

e.g., persons with Blue Cross insurance maintained 

by large companies to cover their employees throughout the country, (4) coverage maintained by retired 

and other mobile population groups, and (5) persons 

residing in Nevada, where no individual Blue Cross 

policies were available. However, the percentage of 

those with coverage status undetermined from the 

record sources was not appreciably higher than comparable percentages in other population segments. 

Employer, union, or othergwup. —Employer Health 

Insurance Questionnaires (NHS-PHS-3, Appendix II) 

were sent, in general, to the employers of all working 

persons except those who claimed onljj Blue Cross or 

Blue Shield group coverage. In some cases these forms 

were sent to uniona or other groups if mentioned by 

the respondent on the form mailed in or by another 

source in the course of record check. 

The letter to the employer (on the front of each 

form) briefly explained the special health insurance 

survey and requested that the back of the form be 

filled in and returned within 5 days. No questions 

were asked about the methods of investigation used 

or about files kept by the employers on their employees 

(if health insurance coverage was available), so no 

analysis of methodology is possible. 

On approximately 3,200 of the 4,500 households in 

the sample, permission for contacting insurance companies and employers was give~ these households were 

involved in the employer record check. Nonresponse 

was quite small—less than 100. About 250 forms were 

sent out on those households where permission for 

record checking had not been given, and about 240 were 

returned @ the employers. 

Insurance companies.—The Health Insurance Carrier Questionnaire (see Appendix 11)was used to check 

on respondents who claimed coverage with a particular 

carrier on tlie self-enumeration form and, in addition, 

to check on a subsample (consisting of 200 households) 

of the entire sample with all carriers on the universe 

lists plus 19 nonuniverse plans which were reported 

by respondents. A letter enclosed with the Health Insurance Carrier Questiomaire explained the Health 

Insurance Record Check and the questionnaire. In 

addition, an endorsement of the study in the form of a 

letter from the general manager of the Health Insurance 

Association of America was enclosed. A guide was 

also attached for the insurance companies to follow in 

determining whether any family members held individual 

or family health insurance policies. 

A similar letter was mailed to the independent plans, 

and enclosed were endorsements from the president 

and general manager of the Group Health Association 

of America, Inc. Also attached was a similar check 

list for these plans to follow in determining whether 

persons had coverage. 

Matching of Household Forms to Record Source 

A limited amount of preceding had been carried 

out after the initial questiomaires were received 

from the respondents. The primary purpose of this 

initial processing was to determine what types of 

record checks were to be made for each family. 

After the record-check work was completed, additional coding was done in preparation for transcription. 

The questionnaires were screened and coded as 

follows: 

1.	 The final status of the schedules was indicated 

in Section 6 of the form (PHS- 1) as follows: 

no followup required, one mail followup, two 

mail followups, personal visit required, refused, no one home, moved, no information on 

control sheet. 

2.	 Each section of the questionnaire (B, C, D, and 

E) was edited for completeness; “edit failure” 

meant that the schedule was returned to the 

field. The results were shown in Section 

following the final status of the questionnaire. 

3.	 If there was more than one family or unrelated 

individual in the household, a white index card 

was attached to the face of each questiomaire 

bearing the same control number indicating the 

number of families or individuals involved. The 

white card facilitated the identification of such 

cases from among the many questionnaires 

involved in the survey. 

4.	 The questionnaires selected for the subsample 

were suitably identified. 

5.	 A two-digit code was assigned to each person 

shown in Section A of the questionnaire. The 

first digit reflected claimed insurance coverage 

for that person in Section C. The second digit 

represented employer check-source information on the work status of the person at the time 

of the survey. 

6.	 Section D was partially preceded in the initial 

processing steps; coding was apparently completed at this time. Some of the codes reflect 

the results of NHS-PHS-5 (see Appendix 11) 

mailings to get additional employer information from respondents. In addition, the line 

numbers from Section A were placed under the 

entries for each person named in Section D 

in order to simplify identification in the transcription process. 

7. The line number of the person named as policyholder and the numbers for other persons 

covered by each plan in Section C were placed 

next to each name, again to aid the transcription 

process. 

8.	 A three-digit code corresponding to the name 

of the commercial company, independent plan, 

22 

6 
Blue Plan, or other insurance carrier claimed 

in Section C was placed above Question 3-d. 

9. Finally, a seven-digit summary code of recheck 

information obtained from the respondent on 

Form NHS-PHS-7 (see Appendix II) was entered 

at the bottom of Section C for each claimed 

plan. The first digit represented the reason for 

mailing an NHS-PHS-7. The second digit reflected whether the form was, in fact, mailed. 

The third digit represented the type of answer 

reported on the NHS-PHS-7. The fourth digit 

indicated whether the policy contract numbers 

reported on the PHS- 1 and 2 and the NHS-PHS7 agreed. The last three digits represented the 

name of the insurance plan reported on the 

NHS-PHS-7, 

In addition to the coding of the questionnaires received from households, each check- source form was 

coded. 

1.	 The check-source form number (NHS-PHS- 1, 

2, 3, or 4) was left unchanged if the form was 

sent out and returned in a way not included in 

the variations mentioned below. If the form 

was not sent out for any reason, the form num ­

ber was modified to indicate the reason. The 

basic form number was altered to indicate if 

the form was sent out but (1) the form was sent 

in behalf of a policyholder who was not a 

family member, (2) the form turned up unclaimed coverage in the course of the subsample 

check, (3) the form was not returned or was 

undeliverable by the Post Office, (4) the NHSPHS-5 was the source of the check-source name 

End address, or (5) the check-source form was 

completed by the initial sample respondent. 

2.	 For check-source forms sent (or not sent) to 

etnployers, the line number of the person about 

whom the inquiry was made was coded on the 

form. 

3.	 For forms sent to insurance companies and 

Blue Cross a code was added indicating whether 

the form was completed and returned on the 

first or second attempt, whether it was a dummy 

substituted for a missing Blue Plan form, 

whether the company had refused to search its 

files, or whether the form was not returned at 

all. 

4.	 On all forms sent out a four-digit code was 

added indicating whether claimed coverage was 

confirmed, whether another plan was reported 

by the chech source, what column in Section C 

of the questionnaire the plan being checked on 

was claimed, and the name of the company issuing the policy if coverage was confirmed. 

5.	 An additional code was entered on check source 

forms sent to employers indicating differences 

in benefits between plans or between persons, 

and the first and last steps in the chain of check 

source contacts for this claimed plan. 

6. If the check source reported that there was 

coverage, the line numbers for all family members and other persons, if any, were entered 

on the form indicating whether the person was 

the policyholder and whether or not he was 

covered under the reported plan. 

In addition to the coding procedures listed above 

the coders did a certain amount of consistency checking 

and made some alterations in the information as reported for transcribing purposes. 

When the coding procedures had been completed 

on the responcient and record data, the forms were 

sent to the Census Operations Office at Jeffersonville, 

Ind., for transcription to FOSDIC in preparation for 

computer processing. 

Preparation for Tabulating the Data 

Records in the two sets of data, the household information and the record-check material, were trans ­

ferred to computer tapes. In the rearrangement of the 

tnatching records into identical locations on the two 

tapes, a certain amount of editing was necessary to 

correct erroneous identifications, to delete records 

of blank transcription sheets, and to resequence records 

that were out of numerical order. 

An additional edit was performed to determine if 

all available data for each sample person was on the 

tapes and if each person was assigned to the appropriate 

family record. Checking with the Current Population 

Survey data was necessary to identify families according to color. In order to take advantage of all the 

information on the source documents in determining 

the insurance status for the familjj, printouts were 

made CI all family records with impossible, unknown, 

or do~btful insurance plan identification codes. The 

rechecking of these records with the source documents 

was a painstaking professional review, which utilized 

all the information on both the respondent and the 

check-source forrcs to revise the check-source codes, 

and all the information of ‘he original respondent forms 

to revise the respondent codes. 

At this point in the processing, a separate record 

was created for each person in the sample. After 310 

noninterview households were removed, the remaining 

households of the original sample of 4,500 were the 

basis for 13,377 person-records. A tape was prepared 

for each of the four major geographic regions. Assigned 

to each person-record was a poststratified weight constructed from the U.S. civilian, noninstitutional population count (1960 census) by region, color, sex, and 

age (under 65 years, 65 years and older). 

A final examination and recode procedure was 

performed before actual tabulation of the data was 

attempted. In the examination phase, incomplete or 

23 
superfluous data were identified and correction procedures were implemented within the edit run. In the 

recode phase, a code was assigned for each of the 

three types of health insurance (hospital, surgery, and 

doctor visit) to identify the Blue Plan coverage categories to be used in the tabulations, as follows: 

L Respondent report of insurance coverage 

A. Coveved by Blue Plan. —Persons reporting 

one or more Blue policies with specified benefits, with premiums paid through place of work, 

directly to insurance company, or in some 

other way. 

B.	 Not coveved by Blue Plan. —Persons not reporting Blue Plan or policy of unknown type, 

but reporting one or more non-Blue Plans; 

persons not covered by any policy. 

C.	 CoueYage not determined. — Persons not reporting Blue Plan, but reporting one or more 

policies of unknown type; persons who may 

or may not have been covered by some policy. 

II. Record source report ofinsurance coverage 

A.	 Covered by Blue Plan. — Persons for whom Blue 

Plans reported coverage; those for whom Blue 

Plan reports showed noncoverage or were inconclusive, but other sources reported Blue 

insurance. 

B.	 Not covered by Blue Plan. — Persons for whom 

Blue Plan reported noncoverage, but there was 

some other indication of coverage other than 

Blue insurance or there was no other indication 

of coverage. 

C.	 Coverage not determined.—Persons for whom 

Blue Plan report was inconclusive, but there 

was either some other indication or no other 

indication of coverage other than Blueinsurance. 

As previously mentioned, persons whose coverage 

status could not be determined were distributed in the 

same proportion as those for whom status was known. 

The procedures used in adjusting thedata, as well as 

the formulas used in developing the net and gross 

error indexes, are shown in Appendix III. 

000 

24 
APPENDIX II


FORMS USED IN THE COLLECTION OF DATA IN THE RECORD-CHECK STUDY


FORM PH5.1 [7...,0\ 

m. . 

THE DIRECTOR U. S. DEPARTMENT OF COMMERCE 

BUREAU OF THE CENSUS 

WASHINGTON 25, D. C. 

Dear Friend: 

The Bureau of the Censuses conducing a special survey onhealch insurance as 

collecting agent for the U. S. Public Health Service. This study, when combined with 

uther information, will serve to answer important questions about health and medical 

care in our Nation. 

The Census enumerator who called at your household was asked toleavetbis 

formirr orderthat allof the family members could takepart inanswering these questions. 

Please mail the completed form within five days. A self-addressed envelope 

which requires no postage has been provided for your convenience. 

The questions inside are about Health Insurance Policies andother Plans that 

help to pay your medical tiIlsor pay fortime lost from work when you am sick. Some 

Policies you pay for by having the costs taken our of your wages; nrhers youpay for 

directly to the Company or Plan. Sumetimes the employer pays theentirecost of the 

insurance. We are interested in all Mods. 

Your cooperation in answering these questions will be a definite public service. 

The information will be given confidential treatmsrt byrhe Bureau oftbe Census and 

the Public Health Service. Nothing will be published excepr sraristical summaries. 

Thank you. 

(f2JtbtI@fAydL Robert W. Burgess 

Ditector 

Bureau of the Census 

CONFIOENTIAL -TMsinfomati.n iscollecred forrhe U.S. P&lie Health Semicemdec amhoricy of 

Publi. Law6520ftbe 84th Congress (70 Stat 4SS4 42 U.S.C. 305). Allinfc.cmacic.n wbichwoufd pennic 

identification of the individual wiIlhe beId srriccly confidential, wfllbe used ody by persons engaged 

in and for rhe purposes of rhe stuvey, and will not be disclosed orreleasedto.adwrs for any other 

DUCDOSCS (22 FR 1687). 

S“dget Buresu No. 41-R1214.4P 

U. COMM-DC ,OS, &PeO APPr.d .E.pi.e. D...mr.r 31. 19@3 

25 
---

---

SECTION A€

Listed below are the members of your family living here€

Date of Birth e Name Relationship (Month, & Yesr) 

(b) (c) 

:nsus Enumerator Enter name. of persons for Section D .nd ffll item 6 (R). (b), (c), 01 (d), if wuhed, on Page 4. 

lkase answer the questions in Section “B” below and continue with Sections C, D, and E. 

SECTION B€

Do any of the persons listed in Section A hava, or am they covered by, any of tho following kinds of Health€

Insurance Pkms€

Check “Yes” or “No” for EACH p.% 

a. A Blue Cress or Blue Shlt!d Plan? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . n Yes m No 

b. An I.s.mnee Company Plan that pays Lx hospital, surgical or other m.dlcol bills? . . . . . . . . . . . 0 Ye. a No€

. . A Medical Care Plan mm by on �mployer for whom a member of the t%mlly works? . . . . . . . . . . . aYes ON. 

d, A Medlcol Care Plan mm by a union, lodge or fmtemol organlzutlon to which o membw of n Yes m No th. famllyb.long.? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

� . Any other M.di..l Cam Plan run by a group of doctors, or by a wop.mt[ v., whwm YOU pay 

monthly pmmlums or other mguidr payments for medical cam? . . . . . . . . . . . . . . . . . . . . . . . . . n Yes I_J No 

A Any kind of pkm wh.m you pny nmrthly pmml.ms or other rw.1.r payrn.nts far dental car.? . . . . . m Yes I_J No 

g. Anyc.th.riype of HmIthlnsumn.* P.llcYor Plan? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . n Yes m No€

f you have checked “Yes” to any part of question 2, answer the questions in Section Con the next page.€

f you have checked “No” to ~ parts of question 2, turn to Sections D and E on the back of ibis form.€

)fes:€

FORM PHS-1 [7-6-601 PAGE 2€

26€
--- ------------------- ------------- -- ------------- -------

------- ------------------ ------ ------ -------

------- ----- --------------------

--------------------- ----------------------- ---------------- -------

SECTION C 

3. Fill out one column for each sepa.mte Plan which any member of ch.e Amil h=. Enter !he name of the plan at the cop of c&Jmn. Answer the questzons for each Plan m the $olumn.l? whlc“i you have wrltcen the name Of the plan. 

If more than three Plans, use extra sheet of paper to descuhe addmonal Plans. 

1.) What is the name of th* Plan or He.4th Insurance Heal;~J;~2r.an C. Heo~~o~&ance 

lns.ran.* Policy? Plan #1 

If Insurance Company Policy, Name of Plan: Name of Plan: Name of Plan: 

give oame ?f Company and 

type of Pcd,cy. 

(b) I. who.. mm. 1. the Plan or Name of Policy holdec Name of Policy holdec Name of Policy holde= 

Policy listed? 

Names of all P,,sOnS Names of .11 persons Names of all Pt,SOtlS 

coverd covered: covered. (.) ;:;: ~;::;o;;hj’;~ 

Plan cov.r? 

Enter names of all persons 

covered; be sure to encec 

your own name if the Plan 

covers you. 

(d)	 Ar. th. praml.ms paid through � Place of work n Place of work � PI... of work 

your ploce of work, directly to 

ths Insurance Company, or some D ~z;~:company n Directly co n Directly to 

oth*r Way? Insurance Company Insurance Company 

Check one box, If “some n some other way n Some other wan n Some other Ve+u 

other way” please explain. 

(*) ~;~ this Insurance Pollcy or 

(1) Cove, any patt of tho ho.. 

PI*OI tests wh.n a arson n Yes m No a Yes n No n Yes a No 

gaes to thm hospita 1’? 

. . . . . . . . . . . . . . . . . . . . . . . —----

(2)	 cover any putt of tho . ..ts 

:;;:::;:::d :J a P** n Yes a No m Yes n No a Yes a No 

. . . . . . . . . . . . . . . . . . .- . . . . . . . . . . . . . . . . . ..- ­

(3) Cov*r any Pati of the COSt. o Yes, but only if there G Yes, but only if there a Yes, but mdy if ther. 

whom o p.rsm goes to the was s urgecy. was surgery. was surgery. 

doctor or th. &c for corn.. n Y.., whether o: nor n Yes, whecber or net = ye:= ;:$CIE:;:;C 

to tho hem.? there was surgery. rhere was surgery. 

a No n No D No 

. . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

(’) ~:;:$:t:?:.$,$.?’t’ n Yes � No a Yes n No D Yes i_J No 

. . . . . . . . . . . . . . . . . . . . . . . . . . ­

(5) Does It pay YOU . COfidn l-+ Yes n No Yes � No ~ Yes n No 

omount of money pw day or 

per wnk when you ore sick 

and can’t WOtk? Check one: 

? 

Check MO: Ch.ok .“.: 

a pays extra money when n Pays extra money +.. n ~;~o~~;~lmo.ey when 

If w‘Yes,*’ check one of the m hospital. in hospital. 

boxes below to show type 

of payment. a Pays same money whech- 0:7, :~ny:p:c:pb- 0 :;YJ ~=myo:p:t:pber or not in hospital. 

(f) Is this Plan or Insumnc. ..* of 

the.. l-n. whw. y.tl flay thm n Yes a No a Yes U No a Yes n No 

first $!00 or $300 .nd th.. the Plonpo s70.r80p.rcant of the 

r..t of t\ � m.dlc.[ .xpenses? 

(These Pbms are often called 

“Maior Medical Expense” 

Plans.) 

(g) Do*sthls Pollcyc.ver .xpe”ses n Accidents O.IY n Accideots mdy m Accidents only 

lust for accldc.t or for illness a SS1ness and accidem � Ilfness and accidcm n I1lness and accident and accldmts both? 

(h) Does this Policy covnr only one � Special diseases n Special diseases a Special diseases 

o, *O Sp*CtOl diseases such 0S 

polls or .cmcmr? a Most illnesses n Most illnesses a Most illnesses 

(1) What Is th. Contmct Number or 

Policy N.mbm? Contract Number: Contract Number: Concracc Number: 

(This number is the one usually 

printed on the membership card 

or on the front of the Policy .) 

.Tum to Stctions”D and E on the back of this form. 

PAGE S “~co,.hl.nc 10.310-, 

27 
--------

--

SECTION D 

Answertbe questions in Section D for each person whose name appears below: 

Name: Name: Name: 

lames of persons co answer 

uestions 4 and 5 ~ 

1. What is the nome and address of Name of employer: Name of employer: Name of employer: 

the employer (company or business) 

where this person works? 

If more than one employer, give


nmr.e of main employer. If not Address: Address: Address:
 now employed, give nsme of last


employer.


;. (o) Is this person .ntitled to any 

a fmm hls emPk.y9r for time u y= n Yes n No n Yes n No 

!o~t from work when he lx sick? . ..---- .---..~.x... . . . . . . . . . . . . . . . . . ..- . . . . . . . . . ..-

If “Ycs” 

(b) Do.’ this p.rsan r.eeivc this D Regular arrangements U Regular arrangements D Regular arrangements 

sick pay undar a regular armnge. 

ment covering �mplOy *es wOrkIng tbwu .x is it scmt.thi.g the Cl other D other n Other 

employ.r makes up bls mind 

obaut when it happens? 

If more than o?e job, 

answer for mm lob. 

If not now employed, answer for last employer. 

SECTION E 

In some cases, fhe U. S. Public Health Service may need to obtain some additional information about the 

details of Health lnsumnce Plans from the records of the Insumnce Company or from the place where you 

or members of fhe family work. Please indicate by your signature beiow that you would have no o@ction 

to this. All such infmmation will be held in strict confidence and used for statistical purposes only. 

Signature of person filling this form 

Otes 

i. TO BE FILLED IN BY CENSUS ENUMERATOR: 

I) Control No. (b) Mailing Address: 

House NO. Skeet 

City State 

.— 

:) (d) ~ Ma,~ this box for households nOninteni.sw in 

August because NOH, TA, or OT-OCC. Form_ of — Forms 

,,.. 

. . . -””.”- . . . ,. S!,. PSO FORM PHS-1 (7-6-60) PACE 4 

28 
--

--

B.dr..c Bum.. No. 68-6012; Appmvnl Expires M.rch 31, 1961
 I


I


I


CON FII)EN71AL - The inf.armacion below is furnished under the mvisicms of Public Law 652 of the 84th Congress (70 Stat. 48% 

*4.2 U. S. C. 305) which authorizes the National Health Survey. Ar“I mfomw,tio” which would permit identification of the individual 

will b. held strictly cordidmtial, “ill be used c+ by persons engaged i“ and for the purposes of the survey, and wifl not be disclosed or released co others for any ocher purposes (22 F R 1687). 

U.S. DEPARTMENT OF COMMERCE 

FORM NHS-PHi-l BUREAU OF Ti-t E CENSUS 

(9-7.60) ACT, NG AS COl.l. ECT, NG AGENT l=OR THE 

U.S. PUBLIC HEALTH SERVICE 

NATIONAL HEALTH SURVEY 

HEALTH INSURANCE CARRIER QUESTIONNAIRE 

1, Cmrior 

2(.). Family 

3, Llstofp.rs.ns mcord.d a.members ofthisfamllfl


Date of binb


Nmne of person Relationship to head 1
 I 

Moncb I Day ~ Year


I 1


! I


J i


I I


I I


1 I


I I


1 I


11


1 I


I 1


1 1


I I


I I


i I


[ I


I I


I I


2 (b). Control No. 

I 

Health insurance coverage 

(“x”’ f.rwmm. Conmd 

Policy 

I I I 

No. lINO.21 No.31N0.4 

I , 

I I I 

I I I 

1 I 

I I I 

I I I 

1 I I 

I I I 

I I I 

I I I 

I I 

I I 1 

I I I 

I I 

I I I 

I I I 

I I I 

I I I 

I I i 

I I t , I 1 1 I


I I I I I


I I I I I


I I II 11111 

ITEMS 4-9 TO BE COMPLETED BY INSURANCE CARRIER 

4.	 Areanyof thepwsonsll<ted 

(Eml”d. Plinl.. whkh my 

I l_JNo Fill Items Band 

n Yes (a) In the lkchg 

the liae for


in the space


lnltcm3covered byonylndlvlduol orkmlly 

only I.rao.ldant. or.nly fo, dmaddl,e...m) 

90n the reverse ofthk form.


in Item 3 above, show the coverage of each each pecscm covered. If the per..”. covered 

in kem 7theruIes fordetennini.g eligibility 

hospl!al, m.dlcol, orsunlcal pllcles issued by you? 

I such pcdicy by tnsrkir.~ an “X” in the proper column on by the policy me not specifically identified by nsme, give 

of persons. I (b)~d:i:~tk H.tingin 1tem3che names ofanyperso"s covered bythepoKcy whowe.ot shown ss members of this 

(c) Describe each policy in Items S-7 on the reverse of this form, and complete Items 8 and 9. 

1


USCOMU.DC tlaal-Pso (FORM CONTINUED ON RE.VEIiSE) 

29 

I 

1 
15.	 f)..crlption of po[ky w centto.+ and s.k!.d b.n.fits covered for tns.red per . . . . . 

Pellcy No. 1 P.llcy No. 2 P.IICY N.. 3 P. IICY NC.. 4 

(.) Name of policy or type of comr.cc 

(b) Name .1 policy h.Idet 

(e)	 Are be.efitsp.id ona D Service a Semi.. m Service a Service service basis, cash 

indemnity hasis, or borb? 

(Check owl{cabfe box.,> n Cash 

(d) [sthcrc s.y”’majortidic.l nYe.s expense” provision in this policy? 

COVERAGE OF SELECTED BEN EFITS(F.r-ti @W, Ch.ck<,cor.md’’ 

Covered 

(e) Nospital rmm and homrd 

(fI Sur,vons’ fees in hospital 

“) %%7: %& ‘“ 

(h) Physician sewices in b.spir.l 

indemnity a Cash i.dmmity a C.sfI indemnity n Cash fndemnity 

ON. mYes ON. OY.. ON. OYCS ON. 

.h.ck.n. blo.kf. r..* WP..(bM.tJt t..h.wwk.th.,..~*d0rn0t -..=-+. llOnYbenelit. {n the.-t.a.r yamcovemdfo, th. ln,umdpemon..) 

Not Not Not c:;:r=d Covered cove:ed Covered covered COv=’d covered 

(Excl”d” hwd.ry) 

(i)	 Physician services either 

.fftce, .r both home and 

(Exclude .urgeryl 

(i)	 hntiscs’ services ocher 

than or.1 s.rgcry 

6.	 IF any of the persons shown 

nota th. exclus ion.. 

Name of person(s) 

7, Notes 

in 

office 

[n It.m 3 os covered by a policy CIM no* .ntltl.d fO 011 *h. b~neflf~ Of fhe pOlley cb*cked ObOV-I 

Pcdicy Benefirs noc covered 

No. (r.dIcale tfl. of b.n.flt by letter. (d)-()) m .Ppllable) 

I I 

completed this form 9. Date 8. Name of person who 

I I FORM NHS-PHS-9 {0.7-S0) “,COMM.DC ttaal.~ss 

30 

I 
--

--

Budget Bureau No. 68-@l% 4PPro$ml Exp,r.s March 31, 1961 

CONFJ OEN 71 AL - The information below is furnished under the ro.is ions of Public Law 672 of the 84th C.an.w.ss (70 Stat. 489; 

4: U, S. C. 30S) which authorizes the National }fealth Survey. Af“1 mfonnati.n which would permit identification of the individual 

will he held str,cdy confidential, will be used only by persom engaged i. .md for the purposes of the survey, and will not b. 

d,sclosed or released to others for any other purposes (22 FR 1687). 

U.S. DEPARTMENT OF COMMERCE 

FORM NHS-PHS-2 O“.., ” OF THE C!SNS”S 

(9-7.60) ACTING AS COLLECTING AGENT FOR THE 

U.S. PUSLIC HEALTH SERVICE 

NATIONAL HEALTH SURVEY 

BLUE CROSS - BLUE SHIELD QUESTIONNAIRE 

L Plnn 

2(.). Family 2(b). Control No. 

I 

1. Llstofp.rsons mcord.d c.m.mb.rs ofthl. famllfi 

Health insurance 

Dat. of birch Cov. r*s. 

(,sX8, f., $..,,ca cove,ed) 

Name of per... I

Rel.tiomhip co head	 I I I Cktificate 

Mc.nthl

II

Day ! Year No. I, I

N0.2:N0.3)N0.4 1 

I I !11 

I I 1 I I 

1 I I I I 

II Ill 

I I 1 ~ 

I I 1 i ! 

I I I I 1 

I I I I 1 

I I I I I 

1 I I I I 

I I I 1 I 

1 , , ! 

~“ Ill 1111 1 I 1 I I 

, 

I I I I I 

I I I I I I I I 

, Supplam.ntal lnf.rmatl.n for.rnployed p.rs.n.: 

Name of per,.” I Name a”d address of employer 

I 

1 

ITEMS 5.9 TO BE COMPLETED BY PLAN. 

. Armanyof theparsonn listed lnltem3cavmrad byanyhospltol, madlc.l, or.urgical contracts orc.tilflcot*s Isaued by you? 

n No Fill Items 8and9.n the reverse of this form. 

n Ye. (a)	 In th~ listing in Item 3 above, show the covemge of each certificate by marking . . “X”. i? the ~oape~ +m” o“ the lme foreach perso” covered. If the pcrsom covered by the cenificacc are not speczftc.lly ,dencificd by.ame, 

give in the space inltem7 the roles ford: termi”ing eligibility ofpermms. 

(b)	 Add co the listin~ in Item 3 the “antes of a“y persons covered by the certificate who we not show” .s members of 

thi= family. 

(.) Describe esch contract in Items 6 and 7.. the reverse of this form, and complete Items 8 and 9. 

I 

(FORM CONTINUEO ON REVERSE) US COMUOC !1a83. PeO 

31 
6. Description of cwtlfl..st. .nd benefits covered fornmnbers: 

C.rNflcme No. 1 CerNflc.ata No. 2 CerNflc.ate N.. 3 CwNftcateNe. 4 

(.) N.m, ortyp. .fc.rrificat. 

(b] Sm. oisub..riber 

(c) I. thi. .WO.P .omact? I_J Group: a Group: a Gmqx n GCO”F 

(Chock.me box, andl[ 

“itmm” 0!.. name> Q Non-grwp n Non-group D Non-group m Nm-grcmp 

(d)ls there.ny,amajormedical.x- mYes ON. mYes ON. w..c” attached? DYes ON. OYCS ON. 

COVERAGE OF 5ELECTE0 BENE.=IT5 (FO, .A C.diII=. Ie, heck . . . block k.rwchtm. .Ib...m io.howwhelher .o”.mdor.otcov.md. 

Check s,covomd,- i[ony benef ita in theoeladoryme .wvemd Ca,th.mmb-a,a) 

Not Not Covered covered Covered ,O:,ed Covered covered Covered .o~:;ed 

(.) }Iospital room ..dbo.rd 

(f) Surgeons’ fees in hospital 

(g)€Surgical expeme in 

d.ctorss office 

(h) Physician services in Iiospittd 

(E.chde ou,~.,y) 

(1)	 Physician s.rvices eitber inoffice, 

or both home md office 

(Exclude .I@.,y) 

(1) Dentist.’ serviccs other 

tbm oral smgety 

f. Notes 

1. Name of person who cc.rql. ted this form 9. Date 

OR’., t4HS. !=HS.2 [9.7..S01 USCOMWDC 11,,,.Pe~ 

32 
FORM NHSPHS3 U.S. OEPARTM EN T OF COMMERCE 

(0.28.40) B“flEA” OF THE CENSUS 

AC’T, N.3 As CO LL!SCT, ?4G AGENT FOR THE 

U..% PUBLIC WEALTH SERVICE 

NATIONAL HEALTH SURVEY 

EMPLOYER HEALTH INSURANCE QUESTIONNAIRE 

r 1 

L J 

The Bureau of the Census is conducting a special survey on health insurance 

for the U.S. Public Health Service. 

Certain basic facts ahout health insurance coverage will come [rem a survey we 

have just completed for a national sample of households. 

the information required as to coverage and benefits, it is 

tional information from employers to supplement that given 

We have obtained signed authorizations from thehouseholds 

ers for this information. 

One of your employees 

However, inorderto obtain all 

necessary that we have addiby the personsin the survey. 

in the survey to ask employis in our national sample. Please fill out the information for this person as requested on 

the back of this form, ’and return the completed form to us within five days. A selfaddressed reply envelope which requires no postage is enclosed for your convenience. 

Sincerely yours, 

Robert W. Burgess -

Director 

Bureau of the Census 

Budget Bureau No. GS-3412 

USCOMM-DC t,632.PeO APrm.v.lEx@esMs rch31. 1961 

33 
--

----- -----------------------

1. D,,ring A.g. ster Sept.mb.r 1960w.. thl. -ploy ..-v.r.d by..yb.ptt.l, 

y..r	 .mpl.y...?


Exclude Workmen’s Compemsatioa.nd policies -wKtch pay only for.ccidents.


n No Fill in iwms 9 and 10 .t the b.tmm of the pa~e .nd return this 

m	 Yes--Answer item, 2-1o .s cmnpletely .s possible. If tbcre is any 

because the Ian is unior.-oper.tedx please give in tbe sp.ce in item the U.S. Pub r“,. Heekh Service may obt.in chat information. 

m.dlcdor s.rglc.l ln..ra.c. avoll.bl. ti 

form 

i.	 fommti.n YOUdo not have (for example, 

8 below the rmme and address from which 

2.	 Nom. md oddr.ss of th. plan or Ins.r.ne. comprny: 5. 1. there any “maim m.dlc.l .xp.ns.n’ pmvt slon In ihls 

contract or policy? (That is, any provision under which 

you or the employee pay the first s 100 or $300 and then 

the insurance pays 70 or 80 percent of the rest of the 

medic.1 expenses. ) 

= Yes n No 

6. &V.,0~. of ‘d .cted bandits for thl s �MPIOY 9.: 

Check one box for each type of benefit. Check l’Coveted”’ 

if my ber.efics of the type n.med can be paid for this 

empJ ore e. 

3. Was thl’ em ploy.. cov.r.d “.d.r e group contract or on 

i“divldual	 policy? -

If . group co”tcacc, give name of group. 

m Group contract 

a I“divid”.1 policy 

m 

4.	 D... thls contract or policy pay bem.fits en o S*W!C8 

bad., a cash indemnity basis, or both? I “) ~:;&::y’”’osP”a’ 

Check one 

� Service 

n Cash 

7. Dnprnde.ts 

List in the 

for whom 

or policy. 

or both boxes as applicable. 

bnsis 

indemnity basis 

covered by this employ..’. insure..= 

ficsc COIUIIMIbelow the names of all dependents 

any benefits cam be paid under cbis contract 

(., Physiciaa serv 

O;x”de .hh...~~ .“ * , 

(f)	 Dentists’ 

surgery 

for this .mpl:yee 

these exzevmns. 

1 I 

services other than .rsl 

but not covered � all for the person list 

entitled co benefits under the policy � re 

identified by name, give the t“l. s fot deter­

(For cx.mple, “’wife �nd cbildrm under 

of benefits cotered for this person 

Exceptions 

! 

I 

I 

10. Dmte 

ulcOMl&Dc llasz.Pw 

Then, in rhe second coluum 

If the Person is If the dependents 

this emplo~ee is rot specifically 

the ho? for ‘same mining eligibility. 

beneftts covered 18 yezus of age.”) 

Types 

Same as r 

employee 1 

n: 

In: 

show the benefits covered for each person listed. 

entitled co .11 of the type. of benefits as evcn tho”~h for different amounts, check 

as employee”. [f there are any types of 

Name of p,rsOll 

1, 

I 

I 

8. Notes 

9. N.rne of person w~o fi!led out this form 

FORM NH S-P HS-S. [0.20.s0] 

34 
Pomu NHS.PHS.4 U.S. DEPARTMENT OF COMMERCE 

(!. S-*1) BUREAU OF THE CENSUS 

ACTING AS COLLECTING ACENT FOR THE 

U.S. PUBLIC HEALTH SERVICE 

NATIONAL HEALTH SURVEY” 

EMPLOYER HEALTH INSURANCE QUESTIONNAIRE 

r 1 

L J 

The Bureau of the Census isconducting aspecial survey on health insurance 

for the U. S, Public HeaIth Service. 

Certain basic facts about health insurance coverage will come from a survey 

we have just completed for a national sample of households. However, in order to obtain 

all the information required as to coverage and benefits, it is necessary that we have 

addi.tional information from employers to supplement that given by persons in the survey. 

Plesse fill out the information requested on rhe back of this form, and return 

the completed form to us within five days. A self-addressed reply envelope which 

reqaires no postage is enclosed for your convenience. 

Sincerely yours, 

tiw@4A%!p Robert W. Burgess 

Director 

Bureau of the Cei%us 

CONFIDENTIAL - fits iriformerion is Anuished under the provisions of Public L8w 6s2 of rhe S4th Congress (70 Smt. 48% 42 U.S. C. 305) which authorizes rhe National Hmlth Survey. All infonmtion which 

would permit i~cmtifimcioa of rhe individual will k held strictly con ftdentiml, will be used mly by person. .cga~ed m md for the purposes of the survey, md will not be disclosed or released to mhers for 

�y other purposes (22 FR 1687} 

Bud&et Bureau N.. 6s-6012 

USCOMM.DC !2S78.P60 Apjmoml Expires mmb 31, 1961 

35 
---------- ------------------

1. During A.wMt or S.pt.mb.r 1960 w.. any hospltul, medical or surgical Insurance cwoila610 to your employees? 

, Exclude Warkmenk Compm sacion and policies which pay only for accidents. 

ON. - Fill i“ km. 8 a“d 9 at the bottom of the page .“d return this form. 

a	 Ycs - Answer Items 2-6 =s completely .s possible for each plan available IO Your employ.=. ‘lb.. fill i. 

Items 8 and 9 and return &i? for,m. If there is any information you do not have (fot example, because the plan is u“io.-on.r.tedh rdeasc mve m che srmc’e i“ Irem 7 below the name and mddress frmn which the U.S. Pubfic I Hez M! %ei.i.c IT@. “obtni. ih.t in forma don. 

PfAN 7 PLAN 2 

, 

2. Name and addrtss of the plon or ins.rant. wmpay: Nom* and address of ihc plan or hisur.nem eampwry: 

z D... this .cI.t,.ct . . policy pay benefits on o s.,vI.. D... this contract or policy paY benefit. . . . SWVIC* Lm.ls, . ce’h Ind.crmlty bad., or both? b..i., a...h I.d.mnity basis, or both? 

Check one or both boxes u applicable. Check one or both fwxes as .pplic.ble. 

a Service basis m .%vice basis 

~ Cash indemnity bairn m Cash indemnity basis 

4.	 IS. th.r. o“y “moior medical .xp.ns.”’ pr.vls!on In this Isth.r. my ““moior medical .xpens.’’ provislonlnthls 

..mtroct ., policy? (T%.t is, .ny ccwisi.an under which cmtrmt orpoli.y? (l_b.t is, anf revision under wfdch 

You Or the employee pay the first i 100 or $3OO .nd thea you?rtbe employ .epaythefirsc J’1000r$300 and then 

the ,llSU,..CG p.~. 70 or 80 pC,Cent of tbe rest of tbe the !nsur.nce Pys 7001 80 percent of &e rest of the 

nE {,..1 expenses. ) me&cml expenses. ) 

n Yes u No n Yes n No 

5. Coverage of sdectsd bwwfits: Covarage of selected benefits: 

Check one box for each type of benefit. Check “Covered” Check oncboxfoc each tyw of benefit. Check’’Covered’J 

if any bemfit..of the type n.med C.LI be p.id under d+s if my benefits of the type n.med’c.nbe pid under this Corme,ct or Lml,c”. contmcc or policy. . ------. --, ~---- ~---­

l-l= (a) Hospital room .nd board II (a) Hospital rocm and board II 

(b) S.rgeo”s, fees, i“ ho=pical (b) Surge.”., fees, in hospital — 

(.) Su;~$aI expense in doctor% (.) suu:~al expense in doctor}. 

(d) Physicirm services in hospitsl (d) Physician services in hospital 

(Ex.rude .Uta.ry> (Excfud. .urd. r,) 

(.) ~,h~fio~~g~~f~c~ i. office, (0) F“~/t$h:fin~of;/$& in office, 

(Excl”d. �“,d.v> (Ex.lud. ..rg.ry) 

(f)	 Dentistse services other th.n oral 

surgery 

Is this plon avoilabl. to all your enQ1.Ye.s? 

m Yes 

mNo-Describetbe peso femployeesefkible. 

For example: ‘Trc%ction wockers,p~ “Full-time 

employees,” “SupervisOrye mplOyees.” 

Ncms 

8. Name ofperson who fiIledouc this form 9. E8te 

I 

L I 

FORM NH% PHS-4[1-S-41) USCOMM.DC 12S71-P

36 
BudgetBureauNo. 41-R1214.41 

FORM NHS.PHS.3 U.S. DEPARTMENT OF COMMERCE Ap?r..AEwi1..APZi13o. 1961 {S+*II wREAU OF THE CENSUS 

ACT(NE A. CO LLNCTINO A= Et It’ FOR TM= 

U.S. PUBLIC HEALTH SERVICE 

NATIONAL HEALTH SURVEY 

EbiPLOYER HEALTH INSURANCE QUESTIONNAIRE 

r 1 

L -1 

Dear 

The Bureau of the Census is conducting a speciaI survey on health insurance as collecting 

agent for the U. S. Public Health Service. This study, when combined with ocher information will 

serve to answer important questions about heakb and medical cswe in our nation. 

Last September your household was visited by a Census enumerator and you were asked 

questions about Health 2nsurance Policies and other Plans chat help to pay your medical bills. 

Your cooperation in answering these questions was a definite public service. 

We find that the Census enumerator failed to obtain the name and address of che empIoyer 

for the members of your family Iisted on the back of this form. We am therefore asking that you 

fill out this information on the back of this form. A self-addressed enveIope which requires no 

postage is enclosed for your convenience. Please mail the complete form within five days. 

Yow information will be given confidential treatment by the Bureau of tbe Census and the 

Public Health Service. Nothing will be pubkishcd except scacistical summaries. 

Thank you, 

Sincerely youcs, 

Lz-d-ae-aA A. Ross Eckler 

Acting Direccor 

Bureau of the census 

CONFIDENTIAL . This inf.m.ti.. is collected for the U.S. Public He.kb Service under authority of 

Public L.w 652 of tbe 84ch Congress (7o Stat 48X 42 U.S.C. 305). All inforina! ion which would Petit 

identification of the individual will be held stricdy confidential, will be used only by persons engaged 

in amd for the purpos.a of the s~vey, ,nd will not be di$closed or telexed co others for any other 

pupa,,, (22 FR 1687). 

USCOMM.DC,* S,7-PO, 

. . . . . . . . . . . . . . . . ...-

37 
Answer ~..sNon f., ~ch ~.,s.n who,. nom. .PP.CI,S Mow: 

What is th. nom. m.d address of th. .mploy.r (.oinpony o, bud ....) wham this F..,S0il w.,kd d.ring th. 

WEEK OF AUGUST 7.13, 1960? 

If more ttmn one employer dutimg ckx week, give rmme �nd address of CIA empl.ya. 

Name of px.cm, to answer qumcion NmIe of .MP1OYCZ Addr..s of employer 

1 

Name of pcc.on to answer questioa Name of employer Ad&ess of employer 

2 

!imnc of pas.. co .nsw.r question N.mc of employer Address of .UIP1OY.C 

I I 

FORM NIIs-PIIS-5 (3-2-611 “5COMM.OC ,,,,7-P, 

38 
FORM NNS.PNS.6 U.S. DEPARTMENT OF COMMERCE Budget Bureau No. 41-R1214.41 

[.-X4.. ,) .“... ” 0, T“E cm.!*”s APPM=I E-ice= June 30. 1961 AC T,t4G ., COL. ZC7$NC AO.N, P’0,7 ,!!= 

U.S. PUBLIC HEALTH SERVICE 

NATIONAL HEALTH SURVEY 

r 1 

J 

The Bureau of the Census is conducting a special survey on health insurance as 

collecting agent for the U.S. Public Healti Service. This study, when combined wizb ocher 

information wi22 serve to answer important questions about health and medical care in our nation. 

Last September your househoId was visited by a Census enumerator and you were 

asked questions about HcalA fnsurance Policies and ocher Plans char help to pay your medical 

bills. Your coop-zracion in answering cbese questions was a definite public service. 

To complete our wctk, we need certain additional information about Heakh 

fnsurance Policies and other PIans repoztcd for memkrs of ycw famiIy. We are therefore asking 

fhat you fill out this information on the enclosed form. A self-addressed envelope which 

requires no postage is enclosed for your convenience. Please maiI the completed form within 

five days. 

Your information will b-e given confidential treatment hy the Bureau of tle Gnsus 

and the Public Health Service. Nothing will be published except smtisrical summaries. 

lbnk YOU. 

Sincerely yours, 

A. Ross EckIer


Acring Director


Bureau of the Census


“CON FlDEt4TlAL - This in formntlo. is collected for tb. U.S. Public Health Service under ..thority of 

P.bfic L.w 652 cd the f14tb C.nF?e.s (70 Stat 48% 42 US.C. 305> All iakmnstio. which wouId permit 

identification of the iodlvidusl will be held strictly confidential, will be used only by pcm.m �ngaged rin .nd for the purpwee of the survey, tod will not disclosed or relessed to others for �y .arber

(22 FR 16S7). 

be 

purposes 

USCOMI.+DC 14?,72 P.el . . . 

39 

L 
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--

Budget Bureau No. 41-R1214.41i APP!OV=I ‘i%ire. JIWU 30, W 

FORM NH S-PHS-7 U.S. DEPARTMENT OF COMMERCE 

(3-24.41) BUREAU 0, THE CENSUS 

ACTING A, COLI. EC T,NG AGENT FOR ‘THE 

U.S. PUBLIC HEALTH SERVICE 

I NATIONAL HEALTH SURVEY 

I HEALTH INSURANCE INFORMATION 

INSTRUCTIONS- A separate column on this form is used fore.ch Health Insurance P1.n.r Policy focwhich additional in focrn.ti.nim 

.cc Jed. 

lnS.cti?n Ac.f the column is e“:ered i“formacio. about the Pl."oz P? ficy>h.t .wasreport.d intht N.rion.l He.lc] 

Surv. y at your household m September 1960. This mfornmcmn is co show the Plan or P.lIcy for wh!chad{ttion.1 information i. “.ed., 

PI.... c.rr..t.ny mistakes insp.lling of.am.s of p.rs..sw. m.y have mode. 

Please answer che questions in Section B of thecohmmaboucthe Plan or Policy described in Sectio” A, as o 

AUGUST-SEPTEMBER 1960. 

HEALTH INSURANCE PLAN NO. 1 HEALTH Insurance PLAN NO.2 

I section A Section A 

(l” formad.a” reported abut Plan or @i.y fn SEPTEMBER 1960) Tnfotm.tion reported .bo.t Pfan OrPoIicY in SEPTEMBER 1960) 

1. Plan or Policy in name of: . Plan .rP.licyinn.me Of: 

2.	 Member. .fth. f.mily.h.wn ascov.md by this Planar Policy Members of the family shown asc.verad by ihis P1.n or Policy 

“as ef AUGUST- SEPTEMBER, 1960, 

~ 

I 

I 

I 

I 

I 

I 

3. N.me.f Plan orlns.r.nce Policy: , N.nm of P1.ri orlnsura.c. Policy: 

m ::::”not 

4. M.ihod of poym.nt.fpr.mi.ms: 

n Some other way: a PI... of work u Some other Y+.y, 

n	 Directly to insurance n Directly to i“s”rance 

Cmllp.”y company 

n Method of payment “OC shown o Method of p.ym.nc noc show. 

SectionB 

(Additional inf.nn.tion “ceded about plan NO. 1 (Addltlonal infomation needed a&”t Pia No. 2) 

5,N.meofPlanorlns.rant. Polic~ . Name of Planer Insurance policy: Fa. P] . . . . Io.k.t yo.rp.l icy orrn.mb.r.hip (id.ntific.ti~) a, P1..ase Iookat o.r policy orm.mbership (identificotl.n) 

card	 and copy the FULL nanw .f the Plan or I“swanc. card and copy tz e FULL n.me of th. Plan or lnsu,anc. 

Company which is.ued this policy Company which issued this policy 

(Please print): 

Whotother ”amesoppear on the policy? What oth.rnam.s om.ar on the policy? 

I 

b. Pie.. ecopy.all the p.licy”. mbers or.ath.r fd.”vifi.ation b. P1..s. cowallth. policy ..mbers orother identification 

n.mbars	 that OPp.a to. your policy or membership “umber. th.tappe.ar o“yo.r policy or memb.rshlp 

(identification) card: (identification) card: 

_____________________________ . . No. on policy What is this “umber? No. on policy What is thb ““mber? ,, ,,,. er,,f,. (or card) (For example, “pollcy number,,1 “certlN- (or card) ‘~ae~~;$r; ,,

,, 

?,;l+&u#ub#b’@,, I I efc .) cate nmnber,,, ‘~.cmtrol number,,, etc.) 

I I 

6. Did the p.rs.a. who c.rriod this policy in AUGUST - . Did the per..” who c.rN.d this policy i“ AUGUST . 

SEPTEMBER, 1960 (person named i“ N.m 1 of Smxi.” A, abov, ~EPTEMB ER, 1960 (p.rso” named In It.m 1 of Section A, abov, 

lot. this Plon .r got this policy through a group such .s m his [0,. this plan oc get this policy through. gre.p s..h .’ .t hi. 

place of work, a union, fraternal o,g.ani zotiw, etc? (Check place of work, o union, fr.at.rml organization, ate? (Check Ccye=,, or <,No,,) ‘#yea#s ~t (t~o,!, 

\ ~Ycs-- Please give che name ofthc group n Yes Please give the name of the group . 

0 No 0 No 

Continueon reverse side of this form U, COMM.DC ,,z6,. P6, 

40 
--------------------------------- --------------------------------

-- --

HEALTH INSURANCE PLAN NO. 3 HEALTH INSURANCE PUN NO. .4 

Saction A Section A 

f7nfmmation repot:c% about PI.. or Pelf.Y in SEP!CJ3MBER 1960) fi’nfmnmtion repo.t.d abwt Plan of Policy in SEPTEhqER 1960) 

1. Plan or Policy in nmn* of: 1. pt.” 0, policy in “mm. of, 

2,	 Memb.r8 of tha faml Iy shown as covered by this Plan or Policy 

a, of AUGUST . SEPTEMBER, 1960: 

3. Nama of Pi.” .x Insu,anc. P.licyz 

n :;::n.ot 

4. M.thod of poym.n+ of pr.mlums: 

o PIUCC of wotk � Some abet way: 

n	 Directly co insurance 

company , 

o Method of payment notshow. 

Section B 

(Addif{cmal lnformatlm needed about plan No. 3) 

S Nonm of P30nor3nsuran.e Policy: 

a,	 PI.... look at our p.llcy wnmmb.rship (id.”tific.ti.an) 

card and .xpyt i . FULL n.anu of th. P3.” or lnmrmc. 

C.mpanywhieh iss..dthi. poli.y 

(P1ea*e print): 

What other “am.. appear on th. policy? 

b,	 Ple.aseco yallth. pollcynunb.rs woth.rid.”tificotim 

nurnberst i!.atapp.ar on your policy ornmmbwship 

(ld.ntiflcaN..) c.cd: 

What is this “umber? No. m policy (For example, ‘jwlicy mzm%r, *1 “certifi­ (or card) .Ete numb.rl’v %ontrol “mnber,,* etc. > 

,. Did the p.rson who carried this policy in AUGUST -

2.	 M.mb.rs of tfm family shown as covered by thl. Plan w Policy 

at of AUGUST . SEPTEfdBER, 1960: 

3. Name of Plan or 3nsumncb Policfi 

D ~::lnnor 

4. Method of p.ymmnt of pr.miums: 

a PIace of work D Some other way: 

D	 Directly to insurance company 

1=1 Method of payment not shown 

Section B 

(Addltimal information needed about Plan No. 4) 

5. Nsma of P1.n or Insuran.. Policy: 

e. P3. . . . Io.k.tyo.r poli.yorm.mb.,. hip (ide.Nfic.N a-.) 

card	 .nd copy th. FULL name of th. Plan or Ins.ra”c. 

C.mp.”ywhi.h Iss..dfhls policy 

(Please print): 

What othw n.rras app.r on th. po3icy? 

b.	 Ple.as. c. ymll thep.licy n.mbers or.ath.r id.ntiflcotion 

numbers t1ot appaaronyc+r policy c.rmembwship 

(identification) cord: 

What is this number? No. on p03icy (For oxemple, “policy number,’* %ertifi­ (m card) ~te mmh.r, JJCCccmtrolmmber,,, etc. 

6. Did the p.rsm who ..rried *his policy i. AUGUST -

SEPTEMBER, 1960 (person named in hem 1 of Saction A, above) 

loin this plan or get this p.llcy through a group such a. at hi. 

plac. of work, . union, frat.nm I organlwtion, t.? (Check c,yee,, ~, .,~o,,) 

� Yes Please give the -me of the group 

� No 

M** 

hrne of person who filkd out this form 

SEPTEMBER, 1960 ( erson named in Item 1 of Section A, ab.v 

IOIn this plan or get t\ IS policy through a grcup such as .at hfs 

PIOC* of work, a union, fraterno I orgonizatim, etc? (Check .,ye@,, ~ ,f~o,$) 

n Yes Please giVe the nmne of cbe group 

o No 

Date FOR CENSUS OFFICE USE 

Control No. 

41

-------------------

--------------------

------

APPENDIX 111 

ALLOCATION OF UNKNOWN DATA 

Pm illustration of the proportional method of allocating 

records for which insurance coverage could not be determined in the respondent and/or the record source isshown 

below:


Respondent


Blue No Coverage 

Record . coverage 

Blue undetermined 

coverage source


Blue coverage----, A B G A+B+G 

No Blue coverage c D H C+D+H 

Coverage undetemined---- ..........- E F J E+F-I-J 

A+C+E B-I-D+F G+H+J 1100.0 

No
 Bhe
 Blue


Record coverage coverage


source


Blue coverage a b a+b


No Blue coverage--- c d c+d


a-k b+d 100.0 

~ Where a = [ A + As +A+11-J 

c . -wL

[ c‘A%+ C+D 11-J 

lIn assigning poststratified weights to persons in the sample, a common factor was applied to


all weights to make the total persons sum to 100 percent. As a consequence, all tables can he


read directly as proportions of the total civilian, noninstitutional population with a given


characteristic.


42

------------------------

-------------------------------

----------------------------

-----------------------

------

---------------

For example,the following
tablesshow hospitalin­


surancecoveragestatuswhere theproportional
 method of


allocation
 hasbeenused:


Respondent


report


Total Blue No Blue Coverage


persons coverage coverage undetermined


Checlc


source


Total persons .- 100.0 26.8 72.4 0.[ 

Blue coverage 25.7 21.3 4.2 0.: 

No Blue coverage 57”5 5.0 52.2 oaL 

Coverageundetermined 16.8 0.5 16.1


i 

Total Blue No Blue


persons coverage coverage


Check


source


Total persons--


Blue coverage----


No Blue coverage-


Significant
 indexesofnetand grosserrorshave been


derivedfrom thetablesinthefollowingmanner:


Respondent 

\ Blue No Blue 

Record coverage coverage 

source
 \


Blue coverage a b a+b 

. No Blue coverage--- c d c-!-d 

a+c b+d 100.0


i 

— 

Net error indexes Gross error indexes


Proportion


Net classified


difference Index of Gross Index of Index of identically


rate net shift difference 

gross shift inconsistency
 rate


Covered by Blue .@ 

Plan (a+c)-(a+b) a+b 

43
 U.S. GOVEF.NMEN T PSINTING OFFICE:1966 0-222-701


0.1 
OUTLINE OF REPORT SERIES FOR VITAL AND HEALTH STATISTICS 

Public Health Service Publication No. 1000 

Sevzes 1. 

SeVies 2. 

Se7+es 3, 

Series 4. 

Scvies 10. 

Series 11. 

SeTies 12. 

SeYies 20. 

SeYies 21. 

SeYies 22. 

P~og~ams and collection pvoceduves. —Reports which describe the general programs of the National 

Center for Health Statistics and its offices and divisions, data collection methods used, definitions, and 

other material necessary for understanding the data. 

Reports number 1-4 

Data evaluation and methods research. — Studies of new statistical methodology including: experimental 

tests of new survey methods, studies of vital statistics collection methods, new analytical techniques, 

objective evaluations of reliability of collected data, contributions to statistical theory. 

Reports number 1-18 

Analytical studies. —Reports presenting analytical or interpretive studies based on vital and health statistics, carrying the analysis further than the expository types of reports in the other series. 

Reports number 1-4 

Documents and committee Yeports.— Final reports of major committees concerned with vital and health 

statistics, and documents such as recommended model vital registration laws and revised birth and 

death certificates. 

Reports number 1-5 

Data l+om the Health Interview Survey. —Statistics on illness, accidental injuries, disability, use of 

hospital, medical, dental, and other services, and other health-related topics, based on data collected in 

a continuing national household interview survey. 

Reports number 1-32 

Data From the Health Examination Survey.— Statistics based on the direct examination, testing, and 

mu,; surement of national samples of the population, including the medically defined prevalence of specific diseases. and distributions of the population with respect to various physical, physiological, and 

psychological measurements. 

Reports number 1-16 

Data FYom the Health Records Survey. —Statistics from records of hospital discharges and statistics 

relating to the health characteristics of persons in institutions, and on hospital, medical, nursing, and 

personal care received, based on national samples of establishments providing these services and 

samples of the residents or patients. 

Reports number 1-4 

Data on movtality. —Various statistics on mortality other than as included in annual or monthly reports— 

special analyses by cause of death, age, and other demographic variables, also geographic and time 

series analyses. 

Reports number 1 and 2 

Data on natality, man+age, and divorce, —Various statistics on natality, marriage, and divorce other 

than as included in annual or monthly reports— special analyses by demographic variables, also geographic and time series analyses, studies of fertility. 

Reports number 1-9 

Data From the National Natality and Mortality Surveys. —Statistics on characteristics of births and 

deaths not available from tbe vital records, based on sample surveys stemming from these records, 

including such topics as mortality by socioeconomic class, medical experience in the last year of life, 

characteristics of pregnancy, etc. 

Reports number 1 and 2 

For a list of titles of reports publisbed in these series, write to:	 National Center for Health Statistics 

U.S. Public Health Service 

Washington, D.C. 20201 

——