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Pres Omm Hdispar2008 Nov13 Johnson

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    • 1. 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
    • 2. 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.
    • 3. 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?
    • 4. Surveys Reviewed
    • 5. Survey Details for Most Recent Year
    • 6. 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?
    • 7. R EI Data: Race Groups Note: Red denotes race identifiers only for selected states.
    • 8. R E I Data: Ethnic Groups
    • 9. RE I Data: Immigrant Groups
    • 10. 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
    • 11. 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)
    • 12. 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
    • 13. 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
    • 14. 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
    • 15. 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
    • 16. 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
    • 17. 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
    • 18. 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
    • 19. 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
    • 20. 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
    • 21. 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
    • 22. 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
    • 23. Contact information
      • Pamela Jo Johnson, MPH, PhD
      • State Health Access Data Assistance Center
      • (SHADAC)
      • www.shadac.org
      • [email_address]
      • 612-624-1406