Pres aapor2011 may13_turner

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  • 1. Logical Edits of Health Insurance Coverage in the ACS and the CPS ASEC
    American Association for Public Opinion Research
    Phoenix, Arizona
    May 13, 2011
    Joanna Turner and Michel Boudreaux
    State Health Access Data Assistance Center (SHADAC)
    University of Minnesota, School of Public Health
    Supported by a grant from The Robert Wood Johnson Foundation
  • 2. Outline
    Motivation
    Overview of editing and description of logical edits
    Impact of the edits
    Preliminary evaluation of the edits using Medicaid administrative records
    2
  • 3. Motivation
    Health insurance coverage is generally underreported in surveys
    Health insurance is a particularly difficult concept for respondents and is prone to more response error than other socioeconomic concepts
    To our knowledge no study has carefully examined the quality of the logical edits
    3
  • 4. U.S. Census Bureau Surveys
    Current Population Survey Annual Social and Economic Supplement (CPS ASEC)
    20+ years of health insurance coverage data
    American Community Survey (ACS)
    Added a question on health insurance coverage in 2008
    Implemented logical edits in 2009
    4
  • 5. Overview of Editing
    Survey data are edited prior to release
    Interview-based verification of coverage
    Coding of write-in/open-ended responses
    Imputation edits assign a value to missing responses based on attributes that the respondent shares with other respondents who completed the question
    5
  • 6. Logical Edits
    • Goal is to correct individual cases for inconsistent information in the survey
    • 7. Deterministically assign public coverage to people who not report it
    These edits are used as a partial correction for under-reporting types of coverage
    Coverage is never taken away with these edits
    Results in fewer uninsured
    6
  • 8. Examples of Logical Edit Concepts: ACS
    Medicare
    People that are 65 years or older and have Medicaid or Social Security/Railroad retirement benefits
    Medicaid
    Foster children
    SSI enrollees in “SSI states” (if parent not working or disability)
    Unmarried child (<19 years) with a parent on Medicaid or public assistance
    Adults receiving public assistance if citizens and parents
    Spouse of adult receiving Medicaid if citizens and parents
    TRICARE/Military Health Care
    People on active duty; the non-privately insured spouse or child (<21 years) of an active duty person
    7
  • 9. Development of Logical Edits
    Agreement among internal, Census Bureau, and external experts
    ACS edits derived from edits used in the CPS ASEC and recommendations from a Technical Advisory Group
    Aim to be conservative and avoid edits involving complex coding specifications that vary by sub-group or need frequent updating
    For example in ACS only the SSI edit is state specific
    8
  • 10. Impact of the Logical Edits on Percentage Uninsured: 2008
    9
    Note: The tabulated ACS population is the civilian non-institutionalized population except for the Military tabulations which include active duty personnel.
    Source: Lynch, V., Boudreaux, M., and Davern, M., 2010, “Applying and Evaluating Logical Coverage Edits to Health Insurance Coverage in the American Community Survey” available at http://www.census.gov/hhes/www/hlthins/publications/coverage_edits_final.pdf.
  • 11. Impact of the Logical Edits by Coverage Type: 2008
    10
    About 1.4 million reclassified as
    insured from uninsured
    About 3.1 million reclassified as
    insured from uninsured
  • 12. SNACC Project
    Multi-phase research project linking survey records to state administrative records from the Medicaid Statistical Information System (MSIS)
    SHADAC (grant from Robert Wood Johnson Foundation)
    National Center for Health Statistics (NCHS)
    Assistant Secretary for Planning and Evaluation (ASPE)
    Administration for Healthcare Research and Quality (AHRQ)
    Centers for Medicare and Medicaid Services (CMS)
    U.S. Census Bureau
    Medicaid Undercount (survey respondents do not report coverage when administrative records indicate coverage) – about 32% in the CPS ASEC
    11
  • 13. Preliminary Evaluation of the Logical Edits using the SNACC Data
    12
    • Sensitivity: A/(A+C)
    • 14. False Negative Rate: C/(A+C)
    • 15. Specificity: D/(B+D)
    • 16. Positive Predictive Value (PPV): A/(A+B)
  • Sensitivity: A/(A+C)
    13
    Proportion of linked records that are classified in the
    CPS ASEC as Medicaid Enrollees
    Source: Author calculations from SNACC report available at http://www.census.gov/did/www/snacc
  • 17. False Negative Rate: C/(A+C)
    14
    Proportion of linked records that are classified in the
    CPS ASEC as not being Medicaid Enrollees
    Source: Author calculations from SNACC report available at http://www.census.gov/did/www/snacc
  • 18. Specificity: D/(B+D)
    15
    Proportion of matchable, but unlinked records*, that are classified
    in the CPS ASEC as not being Medicaid Enrollees
    Source: Author calculations from SNACC report available at http://www.census.gov/did/www/snacc
  • 19. Positive Predictive Value: A/(A+B)
    16
    Proportion of CPS ASEC records classified as having Medicaid
    that are found on MSIS having full benefits
    Source: Author calculations from SNACC report available at http://www.census.gov/did/www/snacc
  • 20. Conclusions
    The logical edits seems to be working as well as the survey questions themselves and should be continued
    Room for improvement in the logical edits
    The Affordable Care Act will have far-reaching impacts on health insurance coverage and the logical edits may need to be revised based on implementation
    17
  • 21. SHADAC Resources
    SHADAC’s Data Center:http://www.shadac.org/datacenter
    SHADAC Brief: “A Summary of the American Community Survey Logical Edits Applied to Health Insurance Coverage” available at: http://www.shadac.org/publications/summary-american-community-survey-logical-edits-applied-health-insurance-coverage
    18
  • 22. 19
    Contact Information
    Joanna Turner
    State Health Access Data Assistance Center
    University of Minnesota, Minneapolis, MN
    www.shadac.org
    turn0053@umn.edu
    612-624-1632
    ©2002-2009 Regents of the University of Minnesota. All rights reserved.The University of Minnesota is an Equal Opportunity Employer