how does health insurance buffer the consequences of intimate partner violence in ohio? kenneth j....
TRANSCRIPT
How does Health Insurance Buffer the Consequences of Intimate Partner
Violence in Ohio?
Kenneth J. Steinman, PhD, MPHPhyllis Pirie, PHD
The Ohio State University College of Public Health
Erinn M. Hade, MSThe Ohio State University Center for Biostatistics
July 29, 2011Ohio Employer and Ohio Family Health Research Conference
Background
• IPV (intimate partner violence) is associated with greater health care utilization– $943 million / year (Corso et al., 2007)
• Common data sources– Insurance claims data (e.g., Coker; Rivara)
– Surveys (e.g., Breiding; Tjaeden)
Three Questions
• How common is IPV among select groups?
• How is IPV associated with adverse consequences?
• Does the association of IPV with emergency room use vary by insurance type?
Policy Implications
• Cost of covering the uninsured– Medicaid vs. employer-sponsored insurance
• Value of health-care-based IPV intervention
Ohio Family Health Survey
• Conducted most recently in 2008 & 2010
• Computer-Assisted Telephone Interviews
• Random Digit Dialing
• Over-sampling of ethnic minorities, select counties
• Representative of Ohio adults & households
Ohio Family Health Survey
2008 2010
n
(women 18-64)50,944 (23,083)
8,276
(3,468)
Response rate 34.6% 42.7% / 21.9%
Outcomes• Financial distress
– During the last 12 months, were there times when you had problems paying or were unable to pay for medical bills for yourself or anyone else in the family or household?
• Serious psychological distress– During the past 30 days, how often did you feel so sad that nothing
would cheer you up?• Unmet health needs
– Did you delay or avoid getting care that you needed, but that you could not afford?
• Fair or poor self rated health status– In general, would you say your health is excellent, very good, good,
fair, or poor?• ER use
– During the past 12 months, how many times were you a patient in a hospital emergency room?
Intimate Partner Violence
• Only measured physical abuse
• Past year
• Different measures in 2008, 2010
IPV measure - 2008
• During the past 12 months, how many times, if any, has anyone hit, slapped, pushed, kicked or physically hurt you?
• Think about the time of the most recent incident involving a person or persons who hit, slapped, pushed, kicked or physically hurt you. What was that person’s relationship to you? (open-ended)
What was that person’s relationship to you?
IPV measure - 2008
0 times
1+ times
04 Male/Female first date05 Someone you were dating06 Former boyfriend/girlfriend07 Current boyfriend/girlfriend or fiancé08 Spouse or live-in partner09 Former spouse or live-in partner
How many times…?
intimate partner violence
01 Stranger02 Coworker03 Professional caretaker 10 S/he is my Child11 S/he is my Stepchild12 Another family member13 Acquaintance/friend 97 OTHER98 DK99 REFUSED
Other violence
Not a case
IPV measure - 2010
• Has an intimate partner EVER used physical violence against you? This includes hitting, slapping, pushing, kicking, or hurting you in any way.
• When was the last time an intimate partner used physical violence against you?
Other Variables
• Age, ethnicity, region, marital status
• Socioeconomic status– Income, education
• Insurance status– Uninsured; Medicaid; Employer-sponsored;
Other
Data Analysis
• Generalized Linear Model– Poisson distribution, log link– Controlling for age, ethnicity, income, education,
marital status
• Weighted data; complex survey design
Three Questions
• How common is IPV among select groups?
• How is IPV associated with adverse consequences?
• Does the association of IPV with emergency room use vary by insurance type?
IPV prevalence
Lifetime Past-year
Unweighted n Prevalence 95% CI Prevalence 95% CI
Men 2,351 8.8% 7.5-10.1 3.1% 2.3-4.0
Women 3,473 18.4% 16.9-19.9 2.5% 1.8-3.2
Past-Year IPV prevalence among women
n Weighted % 95%CI
Uninsured 500 5.3 [2.9-7.7]
Medicaid 470 6.0 [3.0-8.5]
ESI (self) 1,282 1.2 [0.4-2.0]
ESI (spouse) 799 0.5 [0.0-1.1]
Other insurance 422 2.3 [0.5-4.1]
Veterans 79 1.4 [0.0-4.3]
Non-Veterans 3,394 2.5 [1.8-3.2]
In relationship with women
13 -- --
Ohio women experiencing past-year IPV: Proportions by insurance type
N=94,465
IPV past-year prevalence
2008 2010
Women 18-64 1.8% 2.5%
Uninsured 4.5% 5.3%
Medicaid 5.2% 6.0%
ESI 0.7% 0.9%
Three Questions
• How common is IPV among select groups?
• How is IPV associated with adverse consequences?
• Does the association of IPV with emergency room use vary by insurance type?
Prevalence of adverse consequences by length of time since most recent IPV
Note: results are unadjusted
Prevalence ratios (with 95%CI) of IPV with adverse consequences
PR=Prevalence Ratio, adjusted for age, ethnicity, income, education, marital status
Prevalence Ratio
Estimate 95%CI
Serious psychological distress 1.4 [1.1-1.8]
Fair/Poor self-rated health status 1.2 [0.8-1.8]
Financial distress 1.3 [1.0-1.6]
Three Questions
• How common is IPV among select groups?
• How is IPV associated with adverse consequences?
• Does the association of IPV with emergency room use vary by insurance type?
Association of IPV with ER Use: Variation by Insurance Status
PR=Prevalence Ratio, adjusted for age, ethnicity, income, education, marital status
Uninsured MedicaidEmployer-Sponsored Other
PR 95% CI PR 95% CI PR 95% CI PR 95% CI
2008 1.7 [1.3-2.3] 1.4 [1.1-1.7] 1.4 [0.9-2.2] 1.9 [1.1-3.2]
2010 1.9 [1.4-2.5] 1.0 [0.7-1.6] 0.8 [0.4-1.7] 0.8 [0.3-2.5]
Discussion
• IPV prevalence varies by insurance status
• IPV – ER use association varies by insurance status
• Less ability to pay delayed utilization more severe abuse greater utilization
Implications
• Providing health insurance to uninsured women may reduce ER use costs
• Other studies may underestimate IPV-HCU association
• Include insurance as a component of SES
• Supports value of health-care-based intervention
