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  • Ge
  • All items used language similar to that from Kaiser Health Tracking Poll and many items similar to language in following surveys:BRFSS Massachusetts 2009 survey Massachusetts 2008 survey KPBS, Center for Studying Health System Change 2007 Commonwealth Fund Biennial Health Insurance Survey2007 EBRI/Commonwealth Fund Consumerism in Health Survey Commonwealth Fund Survey of Public Views of the U.S. Health Care SystemOklahoma 2004 survey
  • Both have no trend over timeMonthly movements have low correlation.
  • Neither shows significant trendMovements are closely aligned. Suggests consistency.Correlation is _
  • -65+ age group has the least concern about health care costs-Hispanic (and to lesser extent blacks) have much greater concerns about the future-correlated with income, education, health status and insurance status-men report better recent experiences and fewer future cost concerns-generally related to use of the system except for 65+
  • Strongly inversely correlated with reform importance, and self’s finance and accessMildly inversely correlated with the country’s access and finance.


  • 1. Health Care Consumer Sentiment Index: Development, Results and Discussion of Reform
    Peter Graven
    University of Minnesota
    Health Survey Research Methods Conference4/9/2011, Peach Tree City, GA
  • 2. Acknowledgments
    Funded by a grant from the Robert Wood Johnson Foundation (RWJF) to the State Health Access Data Assistance Center (SHADAC) at the University of Minnesota, School of Public Health
    Co-authors Sarah Gollust, PhD; Lynn Blewett, PhD. University of Minnesota, Division of Health Policy and Management.
  • 3. Overview
    Overview of measuring health reform
    Developing the RWJF index
    Factor analysis, item validation, index validity
    Demographic Results
    Health Reform Importance Results
    Future of index, monitoring health reform
  • 4. Overview of measuring health reform
    Measurable dimensions of health reform
    Health (quantity and quality of life)
    Insurance (source, premiums, benefits)
    Access (provider supply, OOP cost barriers, overuse)
    Security about health, insurance and access
    Expectations about access and insurance
    Political perspectives (support reform, equity)
    Others discussed previously
    Care patterns, impacts on providers and employers (Sondik)
  • 5. Index Development-Motivation
    Goal was to produce an index that could be tracked over time measuring an individual’s health care experiences in the recent past and their expectations about the future.
    Index would provide barometer of health care confidence and help to estimate impacts of changes at national level.
    Health Care Consumer Public Perceptions Index
    Recent Health Cost Barrier Index
    Future Health Cost Concern Index
  • 6. Index Development- Survey Background
    Health Care Security Survey (Begun March, 2009)
    Sponsored by Robert Wood Johnson Foundation (RWJF) and developed with the State Health Access Data Assistance Center (SHADAC):
    Authored by Brian Quinn, PhD (RWJF); Lynn Blewett, PhD; Kathleen Call, PhD; and Michael Davern, PhD; Amy Godecker, PhD.
    Supplement added to Surveys of Consumers
    University of Michigan Survey Research Center in conjunction with Thomson Reuters
    ~500 monthly respondents, representative of adults 18+ in contiguous US, begun in 1946
    50 Core questions in three broad areas:
    personal finances, business conditions, and buying conditions
    Items included questions for index as well as questions about health reform importance and effects on the country and themselves
  • 7. Index Development- Item Selection
    9 items chosen from a potential list of 18
    Model selection from factor analysis
    Items targeted recent experiences and expectations about the future
    From the 9 items, two factors were identified that aligned with the recent and future oriented variables.
    Cronbach’s alpha from the interitem correlations recent, future and overall are mid-ranged at ~0.85
    Correlation between recent and future indices is 0.45
  • 8. Index Development- Construction
    Recent Health Cost Barriers (RHCB)
    Delayed seeing a doctor when it was necessary due to cost
    Skipped a recommended medical test, treatment, or follow-up due to cost
    Did not fill a prescription due to cost
    Have had difficulty paying for medical bills
    Future Health Cost Concern (FHCC)
    Worried about losing health insurance coverage (if insured)
    Worried about not being able to afford treatment for serious illness
    Worried about not being able to afford all of the routine health care services you
    Worried about not being able to afford prescription drugs
    Worried about going bankrupt from not being able to pay medical bills
    2 1 0
    No DK Yes
    No DK Yes
    No DK Yes
    No DK Yes
    2 1 0
    No DK Yes
    No DK Yes
    No DK Yes
    No DK Yes
    No DK Yes
  • 9. Index Development- Construction
    Recent Health Cost Barrier Index (RHCBI)
    Future Health Cost Concern Index (FHCCI)
    RWJF Health Care Consumer Public Perceptions Index (RWJFI)
  • 10. Index Development- Item validation
  • 11. Index Trend
    Despite fluctuations no discernible trend since inception
    Recent index shows less variance than future index
    Some indication health reform debate may be influencing the future index (despite 12 month look-ahead period)
  • 12. Index Trend
  • 13. Index Consistency-Rival Index
    Similar index was created by Thomson-Reuters in 2009
    Included in PULSE survey of ~3000 households/month
    Similar questions and methodology used for its construction
    Table shows number of measures corresponding to RWJF items
  • 14. Index Consistency-Recent Index
    Recent Indices
  • 15. Index Consistency-Future Index
    Future Indices
  • 16. Demographic Results -4/2009-2/2011
  • 17. Reform Support Analysis
    Percent of responses by overall health index (April, 2009-May, 2010)
    * Includes “somewhat important” and “very important”
  • 18. Discussion
    Results from an index of individual’s health experience and expectations that can be tracked over time
    May capture the underlying effects of the health care system not found in polls political in nature.
    Index reflects many of the demographic patterns one might expect, suggestive of reform support
    Index appears externally consistent
  • 19. Discussion
    Future of RWJF index
    Planned suspension after April, 2011
    Expensive to maintain during implementation
    Thomson-Reuters index appears to continue
    Could serve as proxy due to analysis limitations if RWJF index is re-instituted after implementation
    Reflection on index
    Could include items related to other concerns
    control of own care, need for/adequacy of plans to choose from
    Ability to identify ACA subpopulations and policy effects
    high risk pool eligibility, dependent coverage provisions, etc.
  • 20. Contact Information
    Peter Graven grave165@umn.edu
    State Health Access Data Assistance Center
    Health insurance coverage estimates are a click away at www.shadac.org/datacenter