Pres fcsm2012 jan10_turner

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Pres fcsm2012 jan10_turner

  1. 1. Implementation ofImprovements to theAllocation Routine for HealthInsurance Coverage in theCPS ASECFederal Committee on Statistical MethodologyResearch ConferenceJanuary 10, 2012Joanna Turner and Michel BoudreauxState Health Access Data Assistance Center((SHADAC) )University of Minnesota, School of Public HealthSupported by a grant from The Robert Wood Johnson Foundation
  2. 2. Acknowledgements • Thanks to the Health and Disability Statistics Branch, U.S. Census Bureau for their support of this work – Funded under contract #000000033114 • http://www.census.gov/hhes/www/hlthins/hlt hins.htmlwww.shadac.org 2
  3. 3. Outline • Context • Background • Improvements to the allocation routine • Historical trends from 1988 to 2011www.shadac.org 3
  4. 4. Importance of Estimates • Surveillance – Trends and correlates in coverage: Private coverage decreasing as public coverage increases • Policy Analysis – 1990: Medicaid expansions – 1997: Children’s Health Insurance Coverage (CHIP) – 2010 US Health R f 2010: H lth Reform, Aff d bl C Affordable Care A t (ACA) Actwww.shadac.org 4
  5. 5. Data Needs • Accurate estimates for a given year • Consistent estimates over time • Ability to study estimates by characteristics (i.e. age) and for individual stateswww.shadac.org 5
  6. 6. Current Population Survey Annual Social and Economic Supplement (CPS ASEC) dE i S l t • CPS provides over 20 years of health insurance coverage estimates • CPS is a monthly labor force survey • ASEC fielded in February to April – Additional questions on work, income, migration, and health insurance coveragewww.shadac.org 6
  7. 7. Current Population Survey Annual Social and Economic Supplement (CPS ASEC) (2) dE i S l t • Health insurance coverage questions ask about coverage in the previous calendar year – For example, the 2011 ASEC asks about coverage during 2010 • All years in this presentation refer to the f survey year, the year of the ASECwww.shadac.org 7
  8. 8. Improvements to Health Insurance • Census Bureau dedicated to improving the quality of the health insurance estimates – 2000: Verification question – 2001: Separate CHIP question added – 2002: Sample expansion – 2005-2006: Correction to the assignment of private coverage (1997-2004: approximation) – 2010: Assign Medicaid to uninsured foster children – 2010: Addition of premium costs and medical out-of- pocket information – 2011: Improvements to missing data allocationwww.shadac.org 8
  9. 9. Background of Allocation • Approximately 10% of monthly CPS sample does not respond to ASEC – All data for these cases are imputed – Full Supplement Imputations (FSI) • Additionally, 2-3% of respondents are missing data on health insurance itemswww.shadac.org 9
  10. 10. Allocation Method • Hot deck randomly draws values for missing cases (recipients) from similar non-missing records (donors) • Donors are organized into matrices g consisting of variables that define “similar” – For example age, marital status, work status • Assumes missing is random within cells – Maintains correlations within complete datawww.shadac.org 10
  11. 11. Background of Inconsistencies • Davern et al. (2007) discovered inconsistencies in the hot deck specification – Instrument allows any household member to be a private plan dependent – Allocation routine assigned dependent coverage only to nuclear family members of a policy holder – Did not consider other coverage the respondent may have hadwww.shadac.org 11
  12. 12. Improvements to the Allocation Routine R ti • Switch order with public coverage allocated first, followed by private coverage • Include public coverage in the private p g p coverage matrix • Remove nuclear family restriction y • Also, discovered and corrected a cod g so, d sco e ed a d co ected coding error that undercounted imputed direct purchase coverage for childrenwww.shadac.org 12
  13. 13. Results – 2009 Research File Uninsured Estimates by Age and Imputation Routine Old Routine New Routine Percent Count Percent Count All Ages g 15.4 46,340 , 14.9 44,832 , 0 to 18 10.3 8,076 9.9 7,820 19 to 64 20.3 37,617 19.7 36,386 65+ 1.7 646 1.7 627 Source: 2009 CPS ASEC Research File; analysis conducted by SHADACwww.shadac.org 13
  14. 14. Detailed Results • Available in “Modifications to the Imputation Modifications Routine for Health Insurance in the CPS ASEC: Description and Evaluation,” Boudreaux and Turner, 2011, at http://www.census.gov/hhes/www/hlthins/dat a/revhlth/SHADAC.pdf / hlth/SHADAC dfwww.shadac.org 14
  15. 15. Implementation • Improvements and coding correction implemented with the 2011 ASEC • Improvements and coding correction applied to the 2000-2010 ASEC’s – Supplants previous revised serieswww.shadac.org 15
  16. 16. Historical Modifications • Census Bureau dedicated to improving the quality of the health insurance estimates – 2000: Verification question – 2001: Separate CHIP question added – 2002: Sample expansion – 2005-2006: Correction to the assignment of private coverage (1997-2004: approximation) – 2010: Assign Medicaid to uninsured foster children – 2010: Addition of premium costs and medical out-of- pocket information – 2011: Improvements to missing data allocationwww.shadac.org 16
  17. 17. Comparisons Over Time by Data Series • Revised – New allocation routine and all prior modifications • Original – Old allocation routine with 1997-2004 approximation • SHADAC-Enhanced – Developed by SHADAC to harmonize the data over time – Removes full supplement imputations and re-weights – Revised to include the new allocation routinewww.shadac.org 17
  18. 18. Uninsured Time Series by Data Series All Ages 17 16 1 15Percent14 13 12 1990 1995 2000 2005 2010 Year Revised Original Enhanced Source: 1988-2011 CPS ASEC’s; analysis conducted by SHADAC 18
  19. 19. Private Coverage Time Series by Data Series All Ages 76 74 72Percent 70 68 66 6 64 1990 1995 2000 2005 2010 Year Revised Original Enhanced Source: 1988-2011 CPS ASEC’s; analysis conducted by SHADAC 19
  20. 20. Public Coverage Time Series by Data Series All A Ages 31 30 29 28 rcent 27 2Per 26 25 24 23 1990 1995 2000 2005 2010 Year Revised Original Enhanced Source: 1988-2011 CPS ASEC’s; analysis conducted by SHADAC 20
  21. 21. Conclusions • The new allocation routine improves the quality of the CPS ASEC health insurance coverage estimates • The data revisions create a consistent time series for 2000+ which is important for surveillance and policy analysis • SHADAC-Enhanced recommended for pre- 2000 analysis for a consistent time series l i f i t t ti iwww.shadac.org 21
  22. 22. Joanna Turner State Health Access Data Assistance Center University of Minnesota, Minneapolis, MN 612-624-4802 turn0053@umn.eduSign up to receive our newsletter and updates at www.shadac.orgSign up to receive our newsletter and updates at www shadac org facebook.com/shadac4states @SHADAC 22

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