Sunday, January 23, 2011

Do Medical Students Know How It Feels to Be Uninsured?

Up in the Ivory tower, do tomorrow's doctors know what it feels like to be without insurance?  About one in three Americans between the ages of 18 and 24 is currently uninsured, and about one in four of those ages 24-64 is.  Harvard requires us to have insurance while we are in school.  Have our classmates ever been without?

N=55 for this survey.

Age (N=53)
The mean age of the respondents was 23.75 years, and the median was 23 years.  About 90% of those who answered were between the ages of 22 and 25.  The oldest student was 33.

Types of Insurance (N=55)

Respondents were not restricted to a single choice, and no time period for a type of coverage was specified.  Thus, coverage types may or may not have overlapped.  All students had had at least one type of insurance: 11 students had had one type, 22 had had two types, 19 had had three types, and 3 had had four types.  Age did not correlate with how many types of insurance a student had had.

All but one student (with private non-group) had been on either dependent or school-based coverage at some point.  All three students on Medicaid had also been on school-based insurance at some point.  One student ("other") had received coverage via an international organization during an internship.

Uninsured at any point? (N=55)

Since Harvard requires that we have health insurance to attend (and Massachusetts has an individual health insurance mandate), the base assumption was that all students are currently insured.  Only one student mentioned in the free-response that s/he was between insurance plans and was planning to get insured soon.

Just over one-third of students had been without insurance.  The average age of this group was 24.5 years, and the median was 24 years.

Regarding the two-thirds of students who had never been without insurance: the average age of this group was 23.35 years, and the median was 23 years.

An F test revealed equal variance between the two groups (p=.00015).  A two-tailed homoscedastic T test revealed a significant difference between the ages of the two groups (p=.039).

Characterization of uninsured period (N=20)

To determine the nature of the uninsured period, I asked two questions: 1) How long total have you been uninsured, and 2) Why were you uninsured?

Answers ranged from one month to 10 years, so a strict average would not be helpful for characterization.  Instead, I will divide time periods into short- (<6 months) and long-term (>1 year) periods.  The reason I chose this classification is that no one was uninsured for a time between 6 months and 1 year, suggesting a natural break in the data.

Short-term uninsured period (N=9)

Three students answered one month; the rest answered "several" or answers between 2 and 6 months.

Six of the nine students described the reason as being in an "in-between" period: either between schools, jobs, or plans.  Two more mentioned simply not buying a plan, and one mentioned being unable to afford private non-group insurance.

Long-term uninsured period (N=11)

All three students who had been on Medicaid were in this group.  Six students mentioned cost, four students mentioned that their parents did not have coverage, and one student mentioned having a part-time job without health coverage.

Revised graph of insured vs. uninsured

No other questions about demographics or attitude were asked.  This is simply a snapshot of 55 first year HMS students.  Slightly over one third of them have been without insurance at some point, and one fifth of them have experienced being uninsured long-term.


  1. I wish you'd asked whether they'd had any illness or injury during their uninsured period, and if so, how they proceeded.

    The answers might not have been statistically quantifiable, but they'd have been a good deal more instructive than these numbers. Most young adults in the USA go without insurance for periods of time, and most of them never miss it.

  2. Thanks, Susan, that's a good point. Maybe next time for a follow-up!

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