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Pres Omm Hdispar2008 Nov13 Johnson
 

Pres Omm Hdispar2008 Nov13 Johnson

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Pres Omm Hdispar2008 Nov13 Johnson Pres Omm Hdispar2008 Nov13 Johnson Presentation Transcript

  • Healthcare Coverage and Access for Race, Ethnic, and Immigrant (REI) Groups: A Summary of National Survey Data Sources Pamela Jo Johnson, MPH, PhD and Donna L. Spencer, MS State Health Access Data Assistance Center Division of Health Policy & Management University of Minnesota OMMH National Health Disparities Conference, Minneapolis, MN November 13, 2008 Funded by a grant from the Robert Wood Johnson Foundation
  • S tate H ealth A ccess D ata A ssistance C enter
    • SHADAC
      • Provide targeted policy research and technical expertise on the collection and/or use of policy-relevant data on health services, including health insurance coverage and access to healthcare.
    • REI Resource
      • To assist with survey development and/or analysis of existing survey data on coverage and access for disparities populations defined by R ace, E thnicity and I mmigrant group.
  • Data Sources for Healthcare Disparities
    • Policy, funding decisions, program implementation are often at state and local levels
      • Local level data are necessary
      • Local level data not always available
    • National survey data can be useful
      • Identify or quantify a problem
      • Serve as a national benchmark
      • Comparable comparison across states
    • Are national survey data useful for state and local level healthcare disparities?
  • Surveys Reviewed
  • Survey Details for Most Recent Year
  • Choosing a National Data Source
    • REI population of interest
      • Is your population identified?
      • Is the sample size sufficient?
    • Coverage and access measures
      • What health insurance measures are available?
      • What access to care measures are available?
    • Geographic specificity
      • What level of geography is relevant for you?
  • R EI Data: Race Groups Note: Red denotes race identifiers only for selected states.
  • R E I Data: Ethnic Groups
  • RE I Data: Immigrant Groups
  • Health Insurance Coverage
    • Health Insurance
      • Estimates of uninsured
        • Point-in-time: uninsured at time of survey
        • Past year: uninsured at any time during past year
        • All year: uninsured all year
      • Insurance types
        • Private
        • Public
          • Medicaid, SCHIP, Medicare, other government program
        • Other types
          • Military, Indian Health Service, Single service
  • Access to Care
    • Access to care
      • Usual source of care
        • Single question
          • Usual doctor or usual place
        • Multiple questions
          • Place for sick care/place for routine care
          • Type of place
      • Barriers to care
        • Delayed care
        • Foregone care
      • Utilization
        • Interval since last doctor visit
        • Numbers of visits
        • Types of visits (doctor office, ER, hospital)
  • Levels of Geography
    • National level only in public use data
      • NHANES, NSFG
    • Census Regions (Northeast, Midwest, South, West)
      • NHIS, MEPS
    • State identifiers in public use data
      • CPS, BRFSS, NSCH, SIPP
    • Other levels of geography in public use data
      • MSA codes: CPS, BRFSS
        • Metro/non-metro: NSFG, NSCH, SIPP
      • County codes: CPS, BRFSS
  • Current Population Survey – Annual Social and Economic Supplement (CPS-ASEC)
    • Race, Ethnicity, and Immigrant data
      • Detailed race (multiple race combinations) and Hispanic sub-groups
      • Immigrants identified from nearly 150 countries or regions
      • Large sample size
    • Insurance Coverage and Access to Care
      • Insurance coverage
        • Detailed insurance data, including types of coverage
        • Only produces all-year uninsurance estimates
      • Not a health/healthcare survey
        • Limited health data, no access to care data
    • Geography
      • State identifiers and MSA identifiers
        • Some counties identified
  • Survey of Income and Program Participation
    • Race, Ethnicity, and Immigrant data
      • Limited race detail (White, Black, Asian, other)
      • No Hispanic sub-groups (Hispanic or not)
      • No immigrant detail (foreign-born or not)
    • Insurance Coverage and Access to Care
      • Insurance coverage
        • Point-in-time, ever during year, all year uninsurance estimates
        • Longitudinal – can examine insurance coverage over time
      • Health services utilization (doctor visits, dental visits, hospital visits)
    • Geography
      • State identifiers and metro/non-metro status are available
        • Can examine data for a single state or group of states. However, not designed to create state-level estimates
  • National Health Interview Survey
    • Race, Ethnicity, and Immigrant data
      • Detailed race and Hispanic sub-groups
      • Immigrant groups identified by 10 broad regions of the world
    • Insurance Coverage and Access to Care
      • Insurance coverage
        • Detailed insurance data, including types of coverage
        • Point-in-time, ever during year, all year uninsurance estimates
      • Access to care
        • Usual source of sick care and of routine care, type of place
        • Barriers to care, delayed care, foregone care, utilization of care
    • Geography
      • Census regions only (Northeast, Midwest, South, West)
      • No state identifiers in public use file
  • National Survey of Children’s Health
    • Race, Ethnicity, and Immigrant data
      • Limited race detail (differs by state)
      • No Hispanic sub-groups and no immigrant detail
    • Insurance Coverage and Access to Care
      • Insurance coverage
        • Point-in-time uninsurance only
        • No detailed insurance types
      • Access to care
        • Access, utilization of care, medical home
    • Geography
      • State identifiers available
        • Limited state estimates for AIAN (n=7), Asian (n=5), and NHOPI (n=1)
        • MSA/non-MSA status
  • National Health and Nutrition Examination Survey
    • Race, Ethnicity, and Immigrant data
      • Limited race (White, Black, other)
      • Limited Hispanic sub-groups (Mexican and other)
      • Limited immigrant groups (Mexico and elsewhere)
    • Insurance Coverage and Access to Care
      • Insurance coverage
        • Types of insurance coverage
        • Point-in-time, ever during past year uninsurance estimates
      • Access to care
        • Usual source of sick care, type of place
        • Utilization (last doctor visit, number of visits, hospital visits)
    • Geography
      • No state or local level geographic identifiers
  • National Survey of Family Growth
    • Race, Ethnicity, and Immigrant data
      • Limited race (White, Black, other)
      • Limited Hispanic sub-groups (Mexican and other)
      • No immigrant detail (Foreign-born or not)
    • Insurance Coverage and Access to Care
      • Insurance coverage
        • Types of insurance coverage
        • Point-in-time, ever during year, all year uninsurance estimates
      • Access to family planning services and reproductive healthcare
    • Geography
      • Metro/non-metro status
      • No state level identifiers
  • Behavioral Risk Factor Surveillance System
    • Race, Ethnicity, and Immigrant data
      • Detailed race identifiers with large sample size
      • No Hispanic sub-groups (Hispanic or not)
      • No immigrant data
    • Insurance Coverage and Access to Care
      • Insurance coverage (are you covered)
        • No detailed insurance types
        • Point-in-time uninsurance only
      • Few access to care questions
        • Usual doctor; past year foregone care; last doctor visit
    • Geography
      • State identifiers available
      • County identifiers also included, but not all counties represented
        • May need to pool years of data for small REI groups or small counties
  • Medical Expenditure Panel Survey – Household Component (MEPS-HC)
    • Race, Ethnicity, and Immigrant data
      • Detailed race and Hispanic sub-groups
      • No immigrant data
      • Smaller samples
    • Insurance Coverage and Access to Care
      • Insurance coverage (detailed types)
        • Point-in-time, ever during year, all year uninsurance estimates
        • Longitudinal – can examine insurance coverage over time
      • Access to care
        • Access, utilization, preventive care
    • Geography
      • Census regions only (Northeast, Midwest, South, West)
      • No state identifiers in public use file
  • Summary
    • A variety of data sources available for healthcare disparities monitoring or research
    • Must weigh trade-offs to choose best data source
      • REI detail
        • Most: CPS, NHIS
        • Least: NHANES, NSFG, BRFSS
      • Coverage and access measures
        • Most: NHIS, MEPS
        • Least: CPS, BRFSS
      • Geographic specificity
        • Most: CPS, BRFSS
        • Least: NHANES, NSFG
  • Next Steps
    • Technical briefs
      • Summary information about REI
      • Summary information about coverage and access
    • Data briefs
      • Summarize strengths/limitations of each data source
    • Web-based data resource
      • Download PDF briefs
      • Links to data
      • Interactive portal to compare REI, coverage and access measures, geography, sample size
        • Across surveys
        • Across time
  • Contact information
    • Pamela Jo Johnson, MPH, PhD
    • State Health Access Data Assistance Center
    • (SHADAC)
    • www.shadac.org
    • [email_address]
    • 612-624-1406