Pres arm2011 jun11_long


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Pres arm2011 jun11_long

  1. 1. Using Federal and State Survey Data to Inform State Health Reform Sharon K. Long University of Minnesota State Health Research Policy Interest Group AcademyHealth Annual Research Meeting Seattle, WA June 11, 2011
  2. 2. Key Federal Surveys <ul><li>General household survey </li></ul><ul><ul><li>ACS : American Community Survey </li></ul></ul><ul><li>Employment/Income surveys </li></ul><ul><ul><li>CPS : Current Population Survey </li></ul></ul><ul><ul><li>SIPP : Survey of Income and Program Participation </li></ul></ul><ul><li>Health surveys </li></ul><ul><ul><li>NHIS : National Health Interview Survey </li></ul></ul><ul><ul><li>MEPS-HC : Medical Expenditure Panel Survey-Household Component </li></ul></ul><ul><ul><li>BRFSS : Behavioral Risk Factor Surveillance System </li></ul></ul>
  3. 3. Feasibility of State-Level Estimates from Federal Surveys * Two-year averages recommended. ACS SIPP CPS NHIS MEPS HC BRFSS State-level estimates possible? <ul><ul><li>All states </li></ul></ul>  *  <ul><ul><li>Some states </li></ul></ul>~20 ~20 ~35 State identifiers available on public use files?     Sample size by state High 353K 9K 20K 13K 5K 20K Median 44K 1K 3K 1K 400 7K Low 6K 160 2K 110 <100 2K
  4. 4. Potential Outcomes of Interest <ul><li>Health insurance coverage </li></ul><ul><li>Affordability and scope of insurance coverage </li></ul><ul><li>Access to care/barriers to care </li></ul><ul><li>Health care use </li></ul><ul><li>Affordability of care </li></ul><ul><li>Quality of care </li></ul>
  5. 5. Availability of Outcome Measures in Federal Surveys ACS CPS SIPP NHIS MEPS HC BRFSS Insurance coverage <ul><ul><li>Point in time </li></ul></ul>     <ul><ul><li>Prior calendar year </li></ul></ul> -    Affordability of coverage/ comprehensiveness of coverage  -  -  Access to care/barriers to care  -  -   - Health care use   +  - Affordability of care  -  -  Quality of care
  6. 6. Timeliness of Data Release for Federal Surveys <ul><li>Data files available now: </li></ul><ul><ul><li>ACS 2009 </li></ul></ul><ul><ul><li>SIPP 2008 </li></ul></ul><ul><ul><li>CPS 2010 (data for 2009) </li></ul></ul><ul><ul><li>NHIS 2010 </li></ul></ul><ul><ul><li>MEPS-HC 2008 </li></ul></ul><ul><ul><li>BRFSS 2010 </li></ul></ul>
  7. 7. Strategies to Increase the Value of Federal Surveys for State Studies <ul><li>Expand state-level estimates </li></ul><ul><ul><li>Increase state sample sizes </li></ul></ul><ul><ul><li>Expand use of small area estimation methods </li></ul></ul><ul><li>Expand survey content </li></ul><ul><li>Improve data availability </li></ul><ul><ul><li>More timely data release </li></ul></ul><ul><ul><li>Make state identifiers available outside of Research Data Center settings </li></ul></ul>
  8. 8. Changes in NHIS and BRFSS to Address Needs Under Health Reform <ul><li>NHIS </li></ul><ul><ul><li>State-level estimates: Added sample size & exploring use of small area estimation methods </li></ul></ul><ul><ul><li>Content: </li></ul></ul><ul><ul><ul><li>Added questions </li></ul></ul></ul><ul><ul><ul><li>Expanding links with administrative data </li></ul></ul></ul><ul><ul><li>Availability: More timely release of data </li></ul></ul><ul><li>BRFSS </li></ul><ul><ul><li>State-level estimates: States can add sample size </li></ul></ul><ul><ul><li>Content: </li></ul></ul><ul><ul><ul><li>Core questions include emerging issues </li></ul></ul></ul><ul><ul><ul><li>States can add their own questions </li></ul></ul></ul>
  9. 9. The Bottom Line on Federal Surveys for State-Level Analyses of Health Reform <ul><li>No single data source is “best” </li></ul><ul><ul><li>CPS, ACS, and BRFSS have accessible 50-state estimates but are limited in scope </li></ul></ul><ul><ul><li>NHIS and MEPS-HC have greater scope but can’t provide estimates for all states and access to state identifiers is restricted </li></ul></ul><ul><ul><li>MEPS-HC on slow track for data release </li></ul></ul><ul><li>No good alternatives available for some states and for some outcome measures </li></ul>
  10. 10. State Survey: One Strategy for Addressing Gaps in Federal Surveys <ul><li>Larger state sample sizes </li></ul><ul><li>Potential to oversample key subgroups </li></ul><ul><li>Information on state-specific insurance and health care programs </li></ul><ul><li>More outcomes: health care access & use, costs, quality, barriers to care, awareness of reform, attitudes toward reform </li></ul><ul><li>More timely access to data to inform policy and program design </li></ul>
  11. 11. State Surveys Addressing Health Insurance Coverage and Other Issues
  12. 12. Federal and State surveys will play an important role under health reform, but… <ul><li>Sample sizes often can’t support analyses of important subgroups, including Medicaid/CHIP enrollees </li></ul><ul><li>Surveys rely on self-reported information, including type of insurance coverage </li></ul><ul><li>Some outcomes are difficult to capture in surveys—such as costs, diagnoses, quality of care </li></ul>
  13. 13. References <ul><li>SHADAC. 2011. “Monitoring the Impacts of Health Reform at the State Level: Using Federal Survey Data.” Brief #24. Minneapolis, MN: University of Minnesota. </li></ul><ul><li>Sonier, J. and E. Lukanen. Forthcoming. “A Framework for Tracking the Impacts of the Affordable Care Act in California.” Minneapolis, MN: University of Minnesota. </li></ul>
  14. 14. Sign up to receive our newsletter and updates at @ shadac State Health Access Data Assistance Center University of Minnesota, Minneapolis, MN 612-624-4802