Youth Involvement in an Innovative Coconut Value Chain by Mwalimu Menza
Data for Monitoring the Uninsured at the State Level
1. Data for Monitoring the
Uninsured at the State Level
Kathleen Thiede Call
Maximizing Enrollment for Kids
Washington DC
September 25, 2009
Funded by a grant from the Robert Wood Johnson Foundation
2. www.shadac.org 2
Overview of Presentation
• Listing of data sources available to monitor
uninsurance -- beyond the CPS and ACS
• Strengths and weaknesses of different data
sources
• Advice to data users
3. www.shadac.org
3
Focus: Three Specific Data Sources
1. Small Area Health Insurance Estimates
(SAHIE)
2. National Survey of Children’s Health
3. State Health Insurance Surveys
4. www.shadac.org
4
1. Small Area Health Insurance
Estimates (SAHIE)
• Census model-based estimates for
uninsurance at state and county level
– Using multiple sources of data to get better
estimates for local use
– Some think better, more reliable
– Four releases to date providing estimates for
2000, 2001, 2005 and 2006
(2006 data released August of 2009)
http://www.census.gov/did/www/sahie/
6. www.shadac.org 6
2. National Survey of Children’s
Health (NSCH)
• Conducted by the National Center for Health
Statistics (NCHS) using SLAITS
• Data available for 2003 and 2007
• Estimates are available for regions and all 50
states and DC
• Public use data files, on-line query system and
micro data is available at RDC
7. www.shadac.org 7
NSCH
• Funded by HRSA-Maternal and Child
Health Bureau
• Telephone survey administered in English
and Spanish
• Sampling Frame: Children ages 0-17
years old
• Sample Size: over 100,000 children
– State sample sizes vary, but designed to have
a minimum of 1,700 per state
8. www.shadac.org
8
Content of the NSCH
• Child and family demographics
• Children’s physical and mental health status
• Health insurance status and type of coverage
• Access and use of health care services
• Medical home
• Early childhood-specific information (0-5 years)
• Middle childhood and adolescent-specific
information (6-17 years)
• Family health and activities
• Parental health status
• Parent’s perceptions of neighborhood
characteristics
9. www.shadac.org 9
3. State Surveys in MaxEnroll States
Survey Year(s)
Alabama 2003
Illinois 2001
Louisiana 2003, 2005, 2007
Massachusetts 2000, 2002, 2004, 2006, 2007, 2008
New York 2003, 2004, 2005, 2006, 2007
Utah 2000, 2001, 2003, 2004, 2005, 2007
Virginia 2001, 2004
Wisconsin 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008
http://www.shadac.org/content/state-survey-research-activity
10. www.shadac.org
10
Strengths of State Survey Data
• Typically more sample than national data
• Flexibility in adding policy relevant questions
• Ability to over-sample and drill down to
subpopulations
– Children, geographic units, race/ethnicity
• Analysts have data in hand
– Ability to do analysis in-house
• Quick turn-around
• Policy development: Simulation of policy options
• Program design and development, marketing and outreach
11. www.shadac.org
11
Weaknesses of State Survey Data
• Lack of comparability across states
• Variability in timing of surveys
• Most are telephone surveys – coverage
issues
• Inconsistency in data documentation
• Cost concerns limits number of variables
• Discrepancies with other data sources
(survey and administrative data)
12. www.shadac.org
12
Other Miscellaneous State Data Sources
• State Public Program enrollment files
– Current estimate of program participation of
eligible population
– Likely higher than survey estimates
• State Public Program claims paid files
– Average cost per program participant in
different categories
• Behavior Risk Factor Surveillance System
(BRFSS)
– Health outcomes and behavior (adults,
except Massachusetts and soon Utah)
13. www.shadac.org
13
Some Advice
• Be familiar with multiple data sources and
the estimates they produce
– Exploit strengths of each data source
• While each will differ, the trends and
drivers should be similar and lead to
similar conclusions
• Decision-makers want an exact number or
an estimate of the change over time
– Be careful, informed, and push ahead
14. www.shadac.org
More advice
• Discrepancies to be aware of:
– CPS vs ACS vs State survey estimates of
coverage or uninsurance
• See SHADAC Issue Brief 12:
State Health Insurance Coverage Estimates: Why State
– State survey vs state administrative data
estimates of public program coverage
• See: Call et al., 2008. Medicaid Undercount and
Bias to Estimates of Uninsurance: New Estimates
and Existing Evidence. HSR
14
15. www.shadac.org
15
Survey Resources
Small Area Health Insurance Estimates (SAHIE):
http://www.census.gov/hhes/www/sahie/
National Survey of Children’s Health:
http://www.cdc.gov/nchs/about/major/slaits/nsch.htm
SHADAC State Survey Research Activity
http://www.shadac.org/content/state-survey-research-activity
Behavioral Risk Factor Surveillance System (BRFSS):
http://www.cdc.gov/brfss/
For those of you unfamiliar with SHADAC…
Mission:
Support states in measuring and monitoring access
Targeted policy research on factors to increase coverage and reduce disparities
Use of existing federal data
Assist state data collection efforts
***Encourage data-driven policy
The Census Bureau's Small Area Health Insurance Estimates (SAHIE) program produces estimates of health insurance coverage for states and all counties. In July 2005, SAHIE released the first nation-wide set of county-level estimates on the number of people without health insurance coverage for all ages and those under 18 years old. In August 2009, SAHIE released 2006 estimates of health insurance coverage by age, sex, race, Hispanic origin, and income categories at the state-level and by age, sex, and income categories at the county-level.
Data Inputs Main
Annual Social and Economic Supplement of the Current Population Survey
County Business Patterns
Demographic Population Estimates
Federal Tax Returns
SNAP Benefits Recipients
Medicaid Participation
Children's Health Insurance Program Participation
Census 2000
The estimates are adjusted so that for key estimates, before rounding, the county numbers sum to their respective state totals and similarly the states sum to the national 2007 CPS ASEC (which contains questions about income during calendar year 2006) poverty universe for the numbers insured and uninsured.
We have developed 2006 COUNTY estimates of the number of people with and without health insurance coverage by:
Ages 0-64, 18-64, and 40-64;
Sex;
People of all incomes and people at or below 200 percent or 250 percent of poverty; and
Ages 0-18, all incomes and at or below 200 percent of poverty.
We have developed 2006 STATE estimates of the number of people with and without health insurance coverage by:
Ages 0-64, 18-64, 40-64, and 50-64;
Sex;
All Races; White not Hispanic; Black not Hispanic; and Hispanic (any race);
People of all incomes and people at or below 200 percent and 250 percent of poverty; and
Ages 0-18, all incomes and at or below 200 percent of poverty.
Measures of uncertainty are also provided.
Same level of detail in 2005, but prior years had less information available
SLAITS is an acronym for the State and Local Area Integrated Telephone Survey, and is an approach developed by the National Center for Health Statistics to quickly and consistently collect information on a variety of health topics at the state and local levels.
Research Data Center (RDC) at the National Center for Health Statistics.
Bullet 3
Adjust for non-telephone households, cell phones, response rates
Bullet 4
Some long-standing state surveys have good documentation, for some one-time state surveys difficult to know problems/challenges
Bullet 6
CPS vs ACS vs State survey estimates of coverage or uninsurance
State survey vs state administrative data estimates of public program coverage
Which of the Max Enroll states have child supplement to BRFSS:
Alabama - no
Illinois– no
Louisiana - no
Massachusetts– Yes, beginning in 1999
New York - no
Utah – Beginning in 2009 will ask HI and access questions for 1 randomly selected child; discontinue state survey.
Virginia – no
Wisconsin - no
Use of your State survey data helps to build constituency and support
Policymakers become familiar with seeing data
Familiar with seeing differences between state survey data and CPS and eventually ACS
Become more confident in state estimates using state data
Try to take what you know from the data and research and improve outreach and enrollment
SHADAC hosts section that describes data collection across states and territories:
Household, employer, focus group activities.
Year of data collection.
Access local contact information, reports, instruments and questions guides.
More limited state specific