Medical>medical and dental insurance plan
In the past 30 years, dental insurance has grown from a rare fringe benefit to standard fare in many employee health-care packages. About 156 million Americans have dental coverage, estimates Evelyn Ireland, executive director of the National Association of Dental Plans, a Dallas-based trade organization whose members include providers of managed-care and other dental plans. Of that total, roughly 90 million have traditional indemnity plans; 60 million have managed-care plans; and 6 million operate on a referral system, going to dentists who have agreed to offer special rates, Ireland says. Referral systems, however, are not insurance plans. People who work for large companies are most likely to have dental coverage. About 90 percent of employers with 500 or more employees offer dental benefits. Across the board, about 50 percent of companies offer dental coverage, Ireland says. The self-employed are the least likely to be covered. Despite the growth of dental plans, many companies do not consider dental benefits as crucial as medical coverage. When companies look at what to offer employees, "Dental plans are at the bottom of the pile," says Ray Werntz, president of the Consumer Health Education Council, a Washington, D.C. organization formed by the Employee Benefits Research Institute (EBRI). Since individual dental plans are not particularly profitable for providers, few are offered.
Based on telephone interviews with more than 3,000 adults throughout the United States, the researchers found that almost two-thirds (62 percent) of Hispanic adults aged 19 to 64 (15 million people) were uninsured at some point during the past year, a rate more than triple that of working-age white adults (20 percent).
"The strategies that people have been pursuing simply aren't going to be very effective," said Greg Scandlen, founder of Consumers for Health Care Choices. "An awful lot of Hispanics work for small employers [who don't offer health insurance]. They change jobs a lot. Very often, they're in the underground economy."
The study also found that one-third of working-age black adults (more than 6 million people) were also uninsured or experienced a gap in coverage during the year.
Low-income Hispanics were at even greater risk: 76 percent with incomes below 200 percent of the federal poverty level spent time uninsured, compared with 44 percent of blacks and 46 percent of whites in the same income bracket.
More than one-quarter (27 percent) of uninsured Hispanic adults with health problems said they did not see a doctor in the past year, compared to 17 percent of black and white adults. In addition, only three-quarters of Hispanic adults had had their blood pressure checked in the past year, compared with 94 percent of blacks and 90 percent of whites. Just 51 percent of Hispanics had had a dental exam in the past year, compared with 60 percent of blacks and 65 percent of whites.
Hispanics are also least confident about their ability to "self-manage" chronic diseases or health problems such as diabetes or heart disease. Thirty-one percent of uninsured Hispanic adults with health problems said they were not too or not at all confident about managing their health problems, compared to 16 percent of black adults and 17 percent of white adults with health problems.
More than one-third (36 percent) of black adults said they went to the emergency room for a condition that could have been treated by a regular doctor had one been available, compared to 19 percent of Hispanics and 19 percent of whites.
Blacks had the most problems with medical debt, with 61 percent of uninsured black adults reporting medical bill or debt problems, vs. 56 percent of whites and 35 percent of Hispanics.
"This report brings home the message that if you don't have insurance, the system basically burdens you with medical debt," Andrulis said. "Anybody who's had any kind of debt is going to be discouraged from using [health-care] services. Why do you want to think twice about using health care if you need it? This has profound, long-term consequences that affect behavior."
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