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This document discusses using state surveys to evaluate health care reform. It describes the State Survey Reform Workgroup, which was formed to provide guidance on priority data needs for monitoring health reform progress. The workgroup identified key domains like access to coverage, affordability of care, and emergency department use. It has compiled survey items from various state and national surveys into a searchable database to help states monitor reform implementation and impacts. The document concludes that state-specific surveys can provide valuable policy-relevant data to assess coverage, affordability, and access changes under health reform.

Using State Surveys to Evaluate Health Care
Reform
Kathleen Thiede Call

State Health Access Data Assistance Center (SHADAC)
University of Minnesota

Minnesota Health Services Research Conference
March 5, 2013
Minneapolis, MN

Funded by a grant from the Robert Wood Johnson Foundation

Acknowledgements
• RWJF
• Members of workgroup
• Karen Soderberg
• Jessie Kemmick Pintor
• Pearl Akpoelohor Ometan

2

Overview
• Overview of state survey activity
• Description of State Survey Reform Workgroup
• Value and challenges of state surveys

3

State-Specific Household Survey Activity

http://www.shadac.org/content/state-survey-research-activity

4

State Survey Reform Workgroup
• Formed Fall 2010 to provide guidance on
priority data needs for monitoring progress on
health reform efforts
• 44 members across 18 states and 1 territory:
– Alaska, California, Colorado, Connecticut, Florida,
Louisiana, Massachusetts, Minnesota, New Jersey,
Ohio, Oklahoma, Oregon, Pennsylvania, South
Carolina, Utah, Vermont, U.S. Virgin Islands,
Washington, and Wisconsin
• Priority survey March 2011

5

Workgroup Activities
• Conference call, December 2010
– Coverage
• Navigability/Experiences with health insurance
– Affordability
– Access
• Provider supply
• Emergency department use
• Usual source of care/medical home
• Survey of priorities, March 2011
• Compilation of survey items began Fall 2012
6

State Reform Survey Domains
(in order of priority within domain)
Access to Coverage Emergency Department Use
• Navigability • Use of ED for non-emergency care
• Difficulty purchasing insurance • Number of ED visits in past 12
• Problems experienced with coverage months
• Difficulty enrolling in public program • Reason for ED care
Affordability of Care Usual Source of Care
• Out-of-pocket costs • Usual source of care and type
• Forgone care due to costs • Multi-dimensional medical home
• Problems paying medical bills series
• Financial problems caused by health • Care coordination
care costs • Reason no usual source of care
Provider Supply Barriers
• Problems finding a provider

Members of 13 states participated
7

Work in Progress: Compiling Survey Items
• NHIS plus 20+ states with regular survey
activity
• Overarching comments:
– Some consistency in domains of interest; less
uniformity in the specific questions used to measure
a given domain
– States seldom have resources to test new items;
borrow from other sources which may provide
benchmark
• Target release: April 2013
8

Structure of State Reform Survey Database
• Excel format
• Sort, search and filter functions
Exact
Data Metric/
Domain Desired Metric Comments
Sources* Survey
Question
• Access
Item description
• Affordability
For example access domain
• ED use
includes:
• ESI access
• usual source of care NHIS + Survey item +
• Insurance coverage/
• delayed care/unmet need State specific response Item universe
navigability
• barriers to care surveys options
• Medical home/
• ability to get appointment
Coordination of
• confidence in getting needed
Care
care
• Utilization

9

Concluding Comments
• State-specific surveys provide data in all three
priority areas: coverage, affordability, access
• State-specific survey advantage
– Wide range of policy relevant questions
– Flexibility to alter survey content
– Quick turnaround availability
• State-specific survey have and will continue to
play a role in monitoring health reform

10

Key Contact

Kathleen Call
callx001@umn.edu
612.624.4802

Sign up to receive our newsletter and updates at
www.shadac.org
@shadac

This document discusses the use of state surveys to evaluate health care reform. It provides an overview of the State Reform Survey Workgroup, which was formed in 2010 to guide data needs for monitoring health reform progress. The Workgroup identified key domains to measure - coverage, affordability, access to care - and developed a matrix of survey items used across states. State surveys provide flexibility but also challenges in testing new questions and achieving consistent measurement across populations. Overall, state surveys can play an important role in monitoring health reform implementation.

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