Pres aapor2011 may13_turner


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Pres aapor2011 may13_turner

  1. 1. Logical Edits of Health Insurance Coverage in the ACS and the CPS ASEC<br />American Association for Public Opinion Research<br />Phoenix, Arizona<br />May 13, 2011<br />Joanna Turner and Michel Boudreaux<br />State Health Access Data Assistance Center (SHADAC)<br />University of Minnesota, School of Public Health<br />Supported by a grant from The Robert Wood Johnson Foundation<br />
  2. 2. Outline<br />Motivation<br />Overview of editing and description of logical edits<br />Impact of the edits<br />Preliminary evaluation of the edits using Medicaid administrative records<br />2<br />
  3. 3. Motivation<br />Health insurance coverage is generally underreported in surveys<br />Health insurance is a particularly difficult concept for respondents and is prone to more response error than other socioeconomic concepts<br />To our knowledge no study has carefully examined the quality of the logical edits<br />3<br />
  4. 4. U.S. Census Bureau Surveys<br />Current Population Survey Annual Social and Economic Supplement (CPS ASEC)<br />20+ years of health insurance coverage data<br />American Community Survey (ACS)<br />Added a question on health insurance coverage in 2008<br />Implemented logical edits in 2009<br />4<br />
  5. 5. Overview of Editing<br />Survey data are edited prior to release<br />Interview-based verification of coverage<br />Coding of write-in/open-ended responses<br />Imputation edits assign a value to missing responses based on attributes that the respondent shares with other respondents who completed the question<br />5<br />
  6. 6. Logical Edits<br /><ul><li>Goal is to correct individual cases for inconsistent information in the survey
  7. 7. Deterministically assign public coverage to people who not report it </li></ul>These edits are used as a partial correction for under-reporting types of coverage<br />Coverage is never taken away with these edits<br />Results in fewer uninsured<br />6<br />
  8. 8. Examples of Logical Edit Concepts: ACS<br />Medicare<br />People that are 65 years or older and have Medicaid or Social Security/Railroad retirement benefits<br />Medicaid<br />Foster children <br />SSI enrollees in “SSI states” (if parent not working or disability)<br />Unmarried child (<19 years) with a parent on Medicaid or public assistance<br />Adults receiving public assistance if citizens and parents<br />Spouse of adult receiving Medicaid if citizens and parents<br />TRICARE/Military Health Care<br />People on active duty; the non-privately insured spouse or child (<21 years) of an active duty person<br />7<br />
  9. 9. Development of Logical Edits<br />Agreement among internal, Census Bureau, and external experts<br />ACS edits derived from edits used in the CPS ASEC and recommendations from a Technical Advisory Group<br />Aim to be conservative and avoid edits involving complex coding specifications that vary by sub-group or need frequent updating<br />For example in ACS only the SSI edit is state specific<br />8<br />
  10. 10. Impact of the Logical Edits on Percentage Uninsured: 2008<br />9<br />Note: The tabulated ACS population is the civilian non-institutionalized population except for the Military tabulations which include active duty personnel. <br />Source: Lynch, V., Boudreaux, M., and Davern, M., 2010, “Applying and Evaluating Logical Coverage Edits to Health Insurance Coverage in the American Community Survey” available at<br />
  11. 11. Impact of the Logical Edits by Coverage Type: 2008<br />10<br />About 1.4 million reclassified as <br />insured from uninsured<br />About 3.1 million reclassified as <br />insured from uninsured<br />
  12. 12. SNACC Project<br />Multi-phase research project linking survey records to state administrative records from the Medicaid Statistical Information System (MSIS)<br />SHADAC (grant from Robert Wood Johnson Foundation)<br />National Center for Health Statistics (NCHS)<br />Assistant Secretary for Planning and Evaluation (ASPE)<br />Administration for Healthcare Research and Quality (AHRQ)<br />Centers for Medicare and Medicaid Services (CMS)<br />U.S. Census Bureau<br />Medicaid Undercount (survey respondents do not report coverage when administrative records indicate coverage) – about 32% in the CPS ASEC<br />11<br />
  13. 13. Preliminary Evaluation of the Logical Edits using the SNACC Data<br />12<br /><ul><li> Sensitivity: A/(A+C)
  14. 14. False Negative Rate: C/(A+C)
  15. 15. Specificity: D/(B+D)
  16. 16. Positive Predictive Value (PPV): A/(A+B)</li></li></ul><li>Sensitivity: A/(A+C) <br />13<br />Proportion of linked records that are classified in the <br />CPS ASEC as Medicaid Enrollees<br />Source: Author calculations from SNACC report available at<br />
  17. 17. False Negative Rate: C/(A+C) <br />14<br />Proportion of linked records that are classified in the <br />CPS ASEC as not being Medicaid Enrollees<br />Source: Author calculations from SNACC report available at<br />
  18. 18. Specificity: D/(B+D)<br />15<br />Proportion of matchable, but unlinked records*, that are classified <br />in the CPS ASEC as not being Medicaid Enrollees<br />Source: Author calculations from SNACC report available at<br />
  19. 19. Positive Predictive Value: A/(A+B)<br />16<br />Proportion of CPS ASEC records classified as having Medicaid<br />that are found on MSIS having full benefits<br />Source: Author calculations from SNACC report available at<br />
  20. 20. Conclusions<br />The logical edits seems to be working as well as the survey questions themselves and should be continued<br />Room for improvement in the logical edits<br />The Affordable Care Act will have far-reaching impacts on health insurance coverage and the logical edits may need to be revised based on implementation<br />17<br />
  21. 21. SHADAC Resources<br />SHADAC’s Data Center:<br />SHADAC Brief: “A Summary of the American Community Survey Logical Edits Applied to Health Insurance Coverage” available at:<br />18<br />
  22. 22. 19<br />Contact Information<br />Joanna Turner<br />State Health Access Data Assistance Center <br />University of Minnesota, Minneapolis, MN<br /><br /><br />612-624-1632<br />©2002-2009 Regents of the University of Minnesota. All rights reserved.The University of Minnesota is an Equal Opportunity Employer<br />