Pres Omm Hdispar2008 Nov13 Johnson

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  • Pres Omm Hdispar2008 Nov13 Johnson

    1. 1. Healthcare Coverage and Access for Race, Ethnic, and Immigrant (REI) Groups: A Summary of National Survey Data Sources Pamela Jo Johnson, MPH, PhD and Donna L. Spencer, MS State Health Access Data Assistance Center Division of Health Policy & Management University of Minnesota OMMH National Health Disparities Conference, Minneapolis, MN November 13, 2008 Funded by a grant from the Robert Wood Johnson Foundation
    2. 2. S tate H ealth A ccess D ata A ssistance C enter <ul><li>SHADAC </li></ul><ul><ul><li>Provide targeted policy research and technical expertise on the collection and/or use of policy-relevant data on health services, including health insurance coverage and access to healthcare. </li></ul></ul><ul><li>REI Resource </li></ul><ul><ul><li>To assist with survey development and/or analysis of existing survey data on coverage and access for disparities populations defined by R ace, E thnicity and I mmigrant group. </li></ul></ul>
    3. 3. Data Sources for Healthcare Disparities <ul><li>Policy, funding decisions, program implementation are often at state and local levels </li></ul><ul><ul><li>Local level data are necessary </li></ul></ul><ul><ul><li>Local level data not always available </li></ul></ul><ul><li>National survey data can be useful </li></ul><ul><ul><li>Identify or quantify a problem </li></ul></ul><ul><ul><li>Serve as a national benchmark </li></ul></ul><ul><ul><li>Comparable comparison across states </li></ul></ul><ul><li>Are national survey data useful for state and local level healthcare disparities? </li></ul>
    4. 4. Surveys Reviewed
    5. 5. Survey Details for Most Recent Year
    6. 6. Choosing a National Data Source <ul><li>REI population of interest </li></ul><ul><ul><li>Is your population identified? </li></ul></ul><ul><ul><li>Is the sample size sufficient? </li></ul></ul><ul><li>Coverage and access measures </li></ul><ul><ul><li>What health insurance measures are available? </li></ul></ul><ul><ul><li>What access to care measures are available? </li></ul></ul><ul><li>Geographic specificity </li></ul><ul><ul><li>What level of geography is relevant for you? </li></ul></ul>
    7. 7. R EI Data: Race Groups Note: Red denotes race identifiers only for selected states.
    8. 8. R E I Data: Ethnic Groups
    9. 9. RE I Data: Immigrant Groups
    10. 10. Health Insurance Coverage <ul><li>Health Insurance </li></ul><ul><ul><li>Estimates of uninsured </li></ul></ul><ul><ul><ul><li>Point-in-time: uninsured at time of survey </li></ul></ul></ul><ul><ul><ul><li>Past year: uninsured at any time during past year </li></ul></ul></ul><ul><ul><ul><li>All year: uninsured all year </li></ul></ul></ul><ul><ul><li>Insurance types </li></ul></ul><ul><ul><ul><li>Private </li></ul></ul></ul><ul><ul><ul><li>Public </li></ul></ul></ul><ul><ul><ul><ul><li>Medicaid, SCHIP, Medicare, other government program </li></ul></ul></ul></ul><ul><ul><ul><li>Other types </li></ul></ul></ul><ul><ul><ul><ul><li>Military, Indian Health Service, Single service </li></ul></ul></ul></ul>
    11. 11. Access to Care <ul><li>Access to care </li></ul><ul><ul><li>Usual source of care </li></ul></ul><ul><ul><ul><li>Single question </li></ul></ul></ul><ul><ul><ul><ul><li>Usual doctor or usual place </li></ul></ul></ul></ul><ul><ul><ul><li>Multiple questions </li></ul></ul></ul><ul><ul><ul><ul><li>Place for sick care/place for routine care </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Type of place </li></ul></ul></ul></ul><ul><ul><li>Barriers to care </li></ul></ul><ul><ul><ul><li>Delayed care </li></ul></ul></ul><ul><ul><ul><li>Foregone care </li></ul></ul></ul><ul><ul><li>Utilization </li></ul></ul><ul><ul><ul><li>Interval since last doctor visit </li></ul></ul></ul><ul><ul><ul><li>Numbers of visits </li></ul></ul></ul><ul><ul><ul><li>Types of visits (doctor office, ER, hospital) </li></ul></ul></ul>
    12. 12. Levels of Geography <ul><li>National level only in public use data </li></ul><ul><ul><li>NHANES, NSFG </li></ul></ul><ul><li>Census Regions (Northeast, Midwest, South, West) </li></ul><ul><ul><li>NHIS, MEPS </li></ul></ul><ul><li>State identifiers in public use data </li></ul><ul><ul><li>CPS, BRFSS, NSCH, SIPP </li></ul></ul><ul><li>Other levels of geography in public use data </li></ul><ul><ul><li>MSA codes: CPS, BRFSS </li></ul></ul><ul><ul><ul><li>Metro/non-metro: NSFG, NSCH, SIPP </li></ul></ul></ul><ul><ul><li>County codes: CPS, BRFSS </li></ul></ul>
    13. 13. Current Population Survey – Annual Social and Economic Supplement (CPS-ASEC) <ul><li>Race, Ethnicity, and Immigrant data </li></ul><ul><ul><li>Detailed race (multiple race combinations) and Hispanic sub-groups </li></ul></ul><ul><ul><li>Immigrants identified from nearly 150 countries or regions </li></ul></ul><ul><ul><li>Large sample size </li></ul></ul><ul><li>Insurance Coverage and Access to Care </li></ul><ul><ul><li>Insurance coverage </li></ul></ul><ul><ul><ul><li>Detailed insurance data, including types of coverage </li></ul></ul></ul><ul><ul><ul><li>Only produces all-year uninsurance estimates </li></ul></ul></ul><ul><ul><li>Not a health/healthcare survey </li></ul></ul><ul><ul><ul><li>Limited health data, no access to care data </li></ul></ul></ul><ul><li>Geography </li></ul><ul><ul><li>State identifiers and MSA identifiers </li></ul></ul><ul><ul><ul><li>Some counties identified </li></ul></ul></ul>
    14. 14. Survey of Income and Program Participation <ul><li>Race, Ethnicity, and Immigrant data </li></ul><ul><ul><li>Limited race detail (White, Black, Asian, other) </li></ul></ul><ul><ul><li>No Hispanic sub-groups (Hispanic or not) </li></ul></ul><ul><ul><li>No immigrant detail (foreign-born or not) </li></ul></ul><ul><li>Insurance Coverage and Access to Care </li></ul><ul><ul><li>Insurance coverage </li></ul></ul><ul><ul><ul><li>Point-in-time, ever during year, all year uninsurance estimates </li></ul></ul></ul><ul><ul><ul><li>Longitudinal – can examine insurance coverage over time </li></ul></ul></ul><ul><ul><li>Health services utilization (doctor visits, dental visits, hospital visits) </li></ul></ul><ul><li>Geography </li></ul><ul><ul><li>State identifiers and metro/non-metro status are available </li></ul></ul><ul><ul><ul><li>Can examine data for a single state or group of states. However, not designed to create state-level estimates </li></ul></ul></ul>
    15. 15. National Health Interview Survey <ul><li>Race, Ethnicity, and Immigrant data </li></ul><ul><ul><li>Detailed race and Hispanic sub-groups </li></ul></ul><ul><ul><li>Immigrant groups identified by 10 broad regions of the world </li></ul></ul><ul><li>Insurance Coverage and Access to Care </li></ul><ul><ul><li>Insurance coverage </li></ul></ul><ul><ul><ul><li>Detailed insurance data, including types of coverage </li></ul></ul></ul><ul><ul><ul><li>Point-in-time, ever during year, all year uninsurance estimates </li></ul></ul></ul><ul><ul><li>Access to care </li></ul></ul><ul><ul><ul><li>Usual source of sick care and of routine care, type of place </li></ul></ul></ul><ul><ul><ul><li>Barriers to care, delayed care, foregone care, utilization of care </li></ul></ul></ul><ul><li>Geography </li></ul><ul><ul><li>Census regions only (Northeast, Midwest, South, West) </li></ul></ul><ul><ul><li>No state identifiers in public use file </li></ul></ul>
    16. 16. National Survey of Children’s Health <ul><li>Race, Ethnicity, and Immigrant data </li></ul><ul><ul><li>Limited race detail (differs by state) </li></ul></ul><ul><ul><li>No Hispanic sub-groups and no immigrant detail </li></ul></ul><ul><li>Insurance Coverage and Access to Care </li></ul><ul><ul><li>Insurance coverage </li></ul></ul><ul><ul><ul><li>Point-in-time uninsurance only </li></ul></ul></ul><ul><ul><ul><li>No detailed insurance types </li></ul></ul></ul><ul><ul><li>Access to care </li></ul></ul><ul><ul><ul><li>Access, utilization of care, medical home </li></ul></ul></ul><ul><li>Geography </li></ul><ul><ul><li>State identifiers available </li></ul></ul><ul><ul><ul><li>Limited state estimates for AIAN (n=7), Asian (n=5), and NHOPI (n=1) </li></ul></ul></ul><ul><ul><ul><li>MSA/non-MSA status </li></ul></ul></ul>
    17. 17. National Health and Nutrition Examination Survey <ul><li>Race, Ethnicity, and Immigrant data </li></ul><ul><ul><li>Limited race (White, Black, other) </li></ul></ul><ul><ul><li>Limited Hispanic sub-groups (Mexican and other) </li></ul></ul><ul><ul><li>Limited immigrant groups (Mexico and elsewhere) </li></ul></ul><ul><li>Insurance Coverage and Access to Care </li></ul><ul><ul><li>Insurance coverage </li></ul></ul><ul><ul><ul><li>Types of insurance coverage </li></ul></ul></ul><ul><ul><ul><li>Point-in-time, ever during past year uninsurance estimates </li></ul></ul></ul><ul><ul><li>Access to care </li></ul></ul><ul><ul><ul><li>Usual source of sick care, type of place </li></ul></ul></ul><ul><ul><ul><li>Utilization (last doctor visit, number of visits, hospital visits) </li></ul></ul></ul><ul><li>Geography </li></ul><ul><ul><li>No state or local level geographic identifiers </li></ul></ul>
    18. 18. National Survey of Family Growth <ul><li>Race, Ethnicity, and Immigrant data </li></ul><ul><ul><li>Limited race (White, Black, other) </li></ul></ul><ul><ul><li>Limited Hispanic sub-groups (Mexican and other) </li></ul></ul><ul><ul><li>No immigrant detail (Foreign-born or not) </li></ul></ul><ul><li>Insurance Coverage and Access to Care </li></ul><ul><ul><li>Insurance coverage </li></ul></ul><ul><ul><ul><li>Types of insurance coverage </li></ul></ul></ul><ul><ul><ul><li>Point-in-time, ever during year, all year uninsurance estimates </li></ul></ul></ul><ul><ul><li>Access to family planning services and reproductive healthcare </li></ul></ul><ul><li>Geography </li></ul><ul><ul><li>Metro/non-metro status </li></ul></ul><ul><ul><li>No state level identifiers </li></ul></ul>
    19. 19. Behavioral Risk Factor Surveillance System <ul><li>Race, Ethnicity, and Immigrant data </li></ul><ul><ul><li>Detailed race identifiers with large sample size </li></ul></ul><ul><ul><li>No Hispanic sub-groups (Hispanic or not) </li></ul></ul><ul><ul><li>No immigrant data </li></ul></ul><ul><li>Insurance Coverage and Access to Care </li></ul><ul><ul><li>Insurance coverage (are you covered) </li></ul></ul><ul><ul><ul><li>No detailed insurance types </li></ul></ul></ul><ul><ul><ul><li>Point-in-time uninsurance only </li></ul></ul></ul><ul><ul><li>Few access to care questions </li></ul></ul><ul><ul><ul><li>Usual doctor; past year foregone care; last doctor visit </li></ul></ul></ul><ul><li>Geography </li></ul><ul><ul><li>State identifiers available </li></ul></ul><ul><ul><li>County identifiers also included, but not all counties represented </li></ul></ul><ul><ul><ul><li>May need to pool years of data for small REI groups or small counties </li></ul></ul></ul>
    20. 20. Medical Expenditure Panel Survey – Household Component (MEPS-HC) <ul><li>Race, Ethnicity, and Immigrant data </li></ul><ul><ul><li>Detailed race and Hispanic sub-groups </li></ul></ul><ul><ul><li>No immigrant data </li></ul></ul><ul><ul><li>Smaller samples </li></ul></ul><ul><li>Insurance Coverage and Access to Care </li></ul><ul><ul><li>Insurance coverage (detailed types) </li></ul></ul><ul><ul><ul><li>Point-in-time, ever during year, all year uninsurance estimates </li></ul></ul></ul><ul><ul><ul><li>Longitudinal – can examine insurance coverage over time </li></ul></ul></ul><ul><ul><li>Access to care </li></ul></ul><ul><ul><ul><li>Access, utilization, preventive care </li></ul></ul></ul><ul><li>Geography </li></ul><ul><ul><li>Census regions only (Northeast, Midwest, South, West) </li></ul></ul><ul><ul><li>No state identifiers in public use file </li></ul></ul>
    21. 21. Summary <ul><li>A variety of data sources available for healthcare disparities monitoring or research </li></ul><ul><li>Must weigh trade-offs to choose best data source </li></ul><ul><ul><li>REI detail </li></ul></ul><ul><ul><ul><li>Most: CPS, NHIS </li></ul></ul></ul><ul><ul><ul><li>Least: NHANES, NSFG, BRFSS </li></ul></ul></ul><ul><ul><li>Coverage and access measures </li></ul></ul><ul><ul><ul><li>Most: NHIS, MEPS </li></ul></ul></ul><ul><ul><ul><li>Least: CPS, BRFSS </li></ul></ul></ul><ul><ul><li>Geographic specificity </li></ul></ul><ul><ul><ul><li>Most: CPS, BRFSS </li></ul></ul></ul><ul><ul><ul><li>Least: NHANES, NSFG </li></ul></ul></ul>
    22. 22. Next Steps <ul><li>Technical briefs </li></ul><ul><ul><li>Summary information about REI </li></ul></ul><ul><ul><li>Summary information about coverage and access </li></ul></ul><ul><li>Data briefs </li></ul><ul><ul><li>Summarize strengths/limitations of each data source </li></ul></ul><ul><li>Web-based data resource </li></ul><ul><ul><li>Download PDF briefs </li></ul></ul><ul><ul><li>Links to data </li></ul></ul><ul><ul><li>Interactive portal to compare REI, coverage and access measures, geography, sample size </li></ul></ul><ul><ul><ul><li>Across surveys </li></ul></ul></ul><ul><ul><ul><li>Across time </li></ul></ul></ul>
    23. 23. Contact information <ul><li>Pamela Jo Johnson, MPH, PhD </li></ul><ul><li>State Health Access Data Assistance Center </li></ul><ul><li>(SHADAC) </li></ul><ul><li>www.shadac.org </li></ul><ul><li>[email_address] </li></ul><ul><li>612-624-1406 </li></ul>

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