Pres hsrm2011 apr9_graven

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Pres hsrm2011 apr9_graven

  1. 1. Health Care Consumer Sentiment Index: Development, Results and Discussion of Reform<br />Peter Graven<br />SHADAC<br />University of Minnesota<br />Health Survey Research Methods Conference4/9/2011, Peach Tree City, GA<br />
  2. 2. Acknowledgments<br />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<br />Co-authors Sarah Gollust, PhD; Lynn Blewett, PhD. University of Minnesota, Division of Health Policy and Management.<br />2<br />
  3. 3. Overview<br />Overview of measuring health reform<br />Developing the RWJF index<br />Factor analysis, item validation, index validity<br />Demographic Results<br />Health Reform Importance Results<br />Summary/Discussion<br />Future of index, monitoring health reform<br />3<br />
  4. 4. Overview of measuring health reform<br />Measurable dimensions of health reform<br />Health (quantity and quality of life)<br />Insurance (source, premiums, benefits)<br />Access (provider supply, OOP cost barriers, overuse) <br />Experiences<br />Security about health, insurance and access<br />Expectations about access and insurance<br />Political perspectives (support reform, equity)<br />Others discussed previously<br />Care patterns, impacts on providers and employers (Sondik)<br />4<br />
  5. 5. Index Development-Motivation<br />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.<br />Index would provide barometer of health care confidence and help to estimate impacts of changes at national level.<br />Health Care Consumer Public Perceptions Index<br />Recent Health Cost Barrier Index<br />Future Health Cost Concern Index<br />5<br />
  6. 6. Index Development- Survey Background<br />Health Care Security Survey (Begun March, 2009)<br />Sponsored by Robert Wood Johnson Foundation (RWJF) and developed with the State Health Access Data Assistance Center (SHADAC): <br />Authored by Brian Quinn, PhD (RWJF); Lynn Blewett, PhD; Kathleen Call, PhD; and Michael Davern, PhD; Amy Godecker, PhD.<br />Supplement added to Surveys of Consumers<br />University of Michigan Survey Research Center in conjunction with Thomson Reuters<br />~500 monthly respondents, representative of adults 18+ in contiguous US, begun in 1946<br />50 Core questions in three broad areas:<br /> personal finances, business conditions, and buying conditions<br />Items included questions for index as well as questions about health reform importance and effects on the country and themselves<br />6<br />
  7. 7. Index Development- Item Selection<br />9 items chosen from a potential list of 18<br />Model selection from factor analysis<br />Items targeted recent experiences and expectations about the future<br />From the 9 items, two factors were identified that aligned with the recent and future oriented variables.<br />Cronbach’s alpha from the interitem correlations recent, future and overall are mid-ranged at ~0.85<br />Correlation between recent and future indices is 0.45<br />7<br />
  8. 8. Index Development- Construction<br />Points<br />Recent Health Cost Barriers (RHCB)<br />Delayed seeing a doctor when it was necessary due to cost<br />Skipped a recommended medical test, treatment, or follow-up due to cost<br />Did not fill a prescription due to cost<br />Have had difficulty paying for medical bills<br />Future Health Cost Concern (FHCC)<br />Worried about losing health insurance coverage (if insured)<br />Worried about not being able to afford treatment for serious illness<br />Worried about not being able to afford all of the routine health care services you<br />Worried about not being able to afford prescription drugs<br />Worried about going bankrupt from not being able to pay medical bills<br />8<br />2 1 0<br />No DK Yes<br />No DK Yes<br />No DK Yes<br />No DK Yes<br />2 1 0<br />No DK Yes<br />No DK Yes<br />No DK Yes<br />No DK Yes<br />No DK Yes<br />
  9. 9. Index Development- Construction<br />Recent Health Cost Barrier Index (RHCBI)<br />Future Health Cost Concern Index (FHCCI)<br />RWJF Health Care Consumer Public Perceptions Index (RWJFI) <br />9<br />
  10. 10. Index Development- Item validation<br />10<br />
  11. 11. Index Trend<br />Despite fluctuations no discernible trend since inception<br />Recent index shows less variance than future index<br />Some indication health reform debate may be influencing the future index (despite 12 month look-ahead period)<br />11<br />
  12. 12. Index Trend<br />12#<br />
  13. 13. Index Consistency-Rival Index<br />Similar index was created by Thomson-Reuters in 2009<br />Included in PULSE survey of ~3000 households/month<br />Similar questions and methodology used for its construction <br />Table shows number of measures corresponding to RWJF items<br />13<br />
  14. 14. Index Consistency-Recent Index<br />14#<br />Recent Indices<br />
  15. 15. Index Consistency-Future Index<br />15#<br />Future Indices<br />
  16. 16. Demographic Results -4/2009-2/2011<br />16<br />
  17. 17. Reform Support Analysis<br />17<br />Percent of responses by overall health index (April, 2009-May, 2010) <br />* Includes “somewhat important” and “very important”<br />
  18. 18. Discussion<br />Results from an index of individual’s health experience and expectations that can be tracked over time<br />May capture the underlying effects of the health care system not found in polls political in nature.<br />Index reflects many of the demographic patterns one might expect, suggestive of reform support<br />Index appears externally consistent<br />18<br />
  19. 19. Discussion<br />Future of RWJF index<br />Planned suspension after April, 2011<br />Expensive to maintain during implementation<br />Thomson-Reuters index appears to continue<br />Could serve as proxy due to analysis limitations if RWJF index is re-instituted after implementation<br />Reflection on index<br />Could include items related to other concerns<br />control of own care, need for/adequacy of plans to choose from<br />Ability to identify ACA subpopulations and policy effects<br />high risk pool eligibility, dependent coverage provisions, etc.<br />19<br />
  20. 20. Contact Information<br />Peter Graven grave165@umn.edu<br /> State Health Access Data Assistance Center<br /> Health insurance coverage estimates are a click away at www.shadac.org/datacenter<br />20<br />

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