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Data for Monitoring the Uninsured at the State Level
- 1. Data for Monitoring the Uninsured at the State Level Kathleen Thiede Call Maximizing Enrollment for Kids Washington DC September 25, 2009 Funded by a grant from the Robert Wood Johnson Foundation
- 2. www.shadac.org 2 Overview of Presentation • Listing of data sources available to monitor uninsurance -- beyond the CPS and ACS • Strengths and weaknesses of different data sources • Advice to data users
- 3. www.shadac.org 3 Focus: Three Specific Data Sources 1. Small Area Health Insurance Estimates (SAHIE) 2. National Survey of Children’s Health 3. State Health Insurance Surveys
- 4. www.shadac.org 4 1. Small Area Health Insurance Estimates (SAHIE) • Census model-based estimates for uninsurance at state and county level – Using multiple sources of data to get better estimates for local use – Some think better, more reliable – Four releases to date providing estimates for 2000, 2001, 2005 and 2006 (2006 data released August of 2009) http://www.census.gov/did/www/sahie/
- 5. www.shadac.org 5 Small Area Health Insurance Estimates (SAHIE) - 2000
- 6. www.shadac.org 6 2. National Survey of Children’s Health (NSCH) • Conducted by the National Center for Health Statistics (NCHS) using SLAITS • Data available for 2003 and 2007 • Estimates are available for regions and all 50 states and DC • Public use data files, on-line query system and micro data is available at RDC
- 7. www.shadac.org 7 NSCH • Funded by HRSA-Maternal and Child Health Bureau • Telephone survey administered in English and Spanish • Sampling Frame: Children ages 0-17 years old • Sample Size: over 100,000 children – State sample sizes vary, but designed to have a minimum of 1,700 per state
- 8. www.shadac.org 8 Content of the NSCH • Child and family demographics • Children’s physical and mental health status • Health insurance status and type of coverage • Access and use of health care services • Medical home • Early childhood-specific information (0-5 years) • Middle childhood and adolescent-specific information (6-17 years) • Family health and activities • Parental health status • Parent’s perceptions of neighborhood characteristics
- 9. www.shadac.org 9 3. State Surveys in MaxEnroll States Survey Year(s) Alabama 2003 Illinois 2001 Louisiana 2003, 2005, 2007 Massachusetts 2000, 2002, 2004, 2006, 2007, 2008 New York 2003, 2004, 2005, 2006, 2007 Utah 2000, 2001, 2003, 2004, 2005, 2007 Virginia 2001, 2004 Wisconsin 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008 http://www.shadac.org/content/state-survey-research-activity
- 10. www.shadac.org 10 Strengths of State Survey Data • Typically more sample than national data • Flexibility in adding policy relevant questions • Ability to over-sample and drill down to subpopulations – Children, geographic units, race/ethnicity • Analysts have data in hand – Ability to do analysis in-house • Quick turn-around • Policy development: Simulation of policy options • Program design and development, marketing and outreach
- 11. www.shadac.org 11 Weaknesses of State Survey Data • Lack of comparability across states • Variability in timing of surveys • Most are telephone surveys – coverage issues • Inconsistency in data documentation • Cost concerns limits number of variables • Discrepancies with other data sources (survey and administrative data)
- 12. www.shadac.org 12 Other Miscellaneous State Data Sources • State Public Program enrollment files – Current estimate of program participation of eligible population – Likely higher than survey estimates • State Public Program claims paid files – Average cost per program participant in different categories • Behavior Risk Factor Surveillance System (BRFSS) – Health outcomes and behavior (adults, except Massachusetts and soon Utah)
- 13. www.shadac.org 13 Some Advice • Be familiar with multiple data sources and the estimates they produce – Exploit strengths of each data source • While each will differ, the trends and drivers should be similar and lead to similar conclusions • Decision-makers want an exact number or an estimate of the change over time – Be careful, informed, and push ahead
- 14. www.shadac.org More advice • Discrepancies to be aware of: – CPS vs ACS vs State survey estimates of coverage or uninsurance • See SHADAC Issue Brief 12: State Health Insurance Coverage Estimates: Why State – State survey vs state administrative data estimates of public program coverage • See: Call et al., 2008. Medicaid Undercount and Bias to Estimates of Uninsurance: New Estimates and Existing Evidence. HSR 14
- 15. www.shadac.org 15 Survey Resources Small Area Health Insurance Estimates (SAHIE): http://www.census.gov/hhes/www/sahie/ National Survey of Children’s Health: http://www.cdc.gov/nchs/about/major/slaits/nsch.htm SHADAC State Survey Research Activity http://www.shadac.org/content/state-survey-research-activity Behavioral Risk Factor Surveillance System (BRFSS): http://www.cdc.gov/brfss/
- 16. www.shadac.org 16 Contact information ©2002-2009 Regents of the University of Minnesota. All rights reserved. The University of Minnesota is an Equal Opportunity Employer www.shadac.org University of Minnesota School of Public Health Division of Health Policy and Management 2221 University Avenue, Suite 345 Minneapolis, Minnesota 55414 (612) 624-4802 Principal Investigator: Lynn A. Blewett, Ph.D. (blewe001@umn.edu) Investigator: Kathleen Thiede Call, Ph.D (callx001@umn.edu)
Editor's Notes
- For those of you unfamiliar with SHADAC… Mission: Support states in measuring and monitoring access Targeted policy research on factors to increase coverage and reduce disparities Use of existing federal data Assist state data collection efforts ***Encourage data-driven policy
- The Census Bureau's Small Area Health Insurance Estimates (SAHIE) program produces estimates of health insurance coverage for states and all counties. In July 2005, SAHIE released the first nation-wide set of county-level estimates on the number of people without health insurance coverage for all ages and those under 18 years old. In August 2009, SAHIE released 2006 estimates of health insurance coverage by age, sex, race, Hispanic origin, and income categories at the state-level and by age, sex, and income categories at the county-level. Data Inputs Main Annual Social and Economic Supplement of the Current Population Survey County Business Patterns Demographic Population Estimates Federal Tax Returns SNAP Benefits Recipients Medicaid Participation Children's Health Insurance Program Participation Census 2000 The estimates are adjusted so that for key estimates, before rounding, the county numbers sum to their respective state totals and similarly the states sum to the national 2007 CPS ASEC (which contains questions about income during calendar year 2006) poverty universe for the numbers insured and uninsured. We have developed 2006 COUNTY estimates of the number of people with and without health insurance coverage by: Ages 0-64, 18-64, and 40-64; Sex; People of all incomes and people at or below 200 percent or 250 percent of poverty; and Ages 0-18, all incomes and at or below 200 percent of poverty. We have developed 2006 STATE estimates of the number of people with and without health insurance coverage by: Ages 0-64, 18-64, 40-64, and 50-64; Sex; All Races; White not Hispanic; Black not Hispanic; and Hispanic (any race); People of all incomes and people at or below 200 percent and 250 percent of poverty; and Ages 0-18, all incomes and at or below 200 percent of poverty. Measures of uncertainty are also provided. Same level of detail in 2005, but prior years had less information available
- SLAITS is an acronym for the State and Local Area Integrated Telephone Survey, and is an approach developed by the National Center for Health Statistics to quickly and consistently collect information on a variety of health topics at the state and local levels. Research Data Center (RDC) at the National Center for Health Statistics.
- Bullet 3 Adjust for non-telephone households, cell phones, response rates Bullet 4 Some long-standing state surveys have good documentation, for some one-time state surveys difficult to know problems/challenges Bullet 6 CPS vs ACS vs State survey estimates of coverage or uninsurance State survey vs state administrative data estimates of public program coverage
- Which of the Max Enroll states have child supplement to BRFSS: Alabama - no Illinois– no Louisiana - no Massachusetts– Yes, beginning in 1999 New York - no Utah – Beginning in 2009 will ask HI and access questions for 1 randomly selected child; discontinue state survey. Virginia – no Wisconsin - no
- Use of your State survey data helps to build constituency and support Policymakers become familiar with seeing data Familiar with seeing differences between state survey data and CPS and eventually ACS Become more confident in state estimates using state data Try to take what you know from the data and research and improve outreach and enrollment
- SHADAC hosts section that describes data collection across states and territories: Household, employer, focus group activities. Year of data collection. Access local contact information, reports, instruments and questions guides. More limited state specific