How does Health Insurance Buffer the Consequences of Intimate Partner Violence in Ohio? Kenneth J. Steinman, PhD, MPH Phyllis Pirie, PHD The Ohio State University College of Public Health Erinn M. Hade, MS The Ohio State University Center for Biostatistics July 29, 2011 Ohio Employer and Ohio Family Health Research Conference
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How does Health Insurance Buffer the Consequences of Intimate Partner Violence in Ohio? Kenneth J. Steinman, PhD, MPH Phyllis Pirie, PHD The Ohio State.
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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?