1. Health Care Consumer Sentiment Index: Development, Results and Discussion of Reform Peter Graven SHADAC 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. 2

3. Overview Overview of measuring health reform Developing the RWJF index Factor analysis, item validation, index validity Demographic Results Health Reform Importance Results Summary/Discussion Future of index, monitoring health reform 3

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) Experiences 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) 4

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 5

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 6

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 7

8. Index Development- Construction Points 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 8 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) 9

10. Index Development- Item validation 10

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) 11

12. Index Trend 12#

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 13

14. Index Consistency-Recent Index 14# Recent Indices

15. Index Consistency-Future Index 15# Future Indices

16. Demographic Results -4/2009-2/2011 16

17. Reform Support Analysis 17 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 18

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. 19

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 20