Databases for Estimating Health Insurance Coverage for Children A Workshop Summary (2010) / Chapter Skim
Currently Skimming:
3 Federal Surveys
3 Federal Surveys
Pages 14-31
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 14... ...
Two other surveys are referenced here because they, too, collect insurance coverage information: the Survey of Income and Program Participation (SIPP) and the Medical Expenditure Panel Survey-Household Component (MEPS-HC)
|
From page 15... ...
so C preperiod analysis is limited • ifficult to customize questions or D wording Current Population Survey • High-quality data collection methods • revious year reference period for P • Detailed questions about coverage coverage question increases recall bias • ttempts to correct for misreported A and confusion • ample size and number of primary coverage S • upports robust eligibility simulations S sampling units small in some states • State-level identifiers • ong-time series allows expansive L preperiod analysis • Questions can be customized National Health Interview Survey • High-quality data collection methods • ample size and number of primary S • Detailed questions about coverage sampling units too sparse • ttempts to correct for misreported • o state identifiers in public-use A N coverage microdata file • Time series available • Quality of income data not certain • State-level identifiers available Combined • omparisons help reveal measurement • ublished estimates difficult to C P errors compare • road range of coverage measures and • ot enough explanation of why B N related variables available for study estimates differ SOURCE: Kenney and Lynch (Chapter 8, in this volume) and workshop discussion.
|
From page 16... ...
Kenney and Lynch con sider the NHIS features that may strengthen validity to include • the area sample frame; • a well-trained interview staff that work exclusively on this survey; • a fairly high response rate; • usually an in-person interview; • a knowledgeable respondent (i.e., adults are encouraged to report on coverage for children if they are familiar or to talk about it with the person most familiar with the coverage of household members) ; • a questionnaire that defines concepts and probes respondent mem ory as it collects information; • breadth of content on other health-related data, which potentially helps respondents understand distinctions between coverage types and their type; • asking about coverage source at the time of the survey, which is associated with lower measurement error; • asking about Medicaid and CHIP using state-specific names; • a low level of item nonresponse on insurance sequence; • asking for many details about coverage, which may help define relevant concepts or distinguish different types of coverage (e.g., type of managed care, copayments, deductibles, need for referrals)
|
From page 17... ...
CURRENT POPULATION SURVEy The CPS ASEC has historically played an important role in monitoring coverage. Besides being a relatively large survey that uses high-qual ity data collection methods, it is an income- and employment-focused survey and is considered by the Census Bureau to have the most valid data on those domains, which are integral for eligibility simulations and other coverage-related analyses.
|
From page 18... ...
The CPS ASEC has limitations as well, the most critical of which for purposes of monitoring coverage is the known measurement error with the coverage questions because of confusion, recall bias, and other issues with the retrospective reference period (Pascale et al., 2009)
|
From page 19... ...
AMERICAN COMMUNITy SURVEy ACS, an annual survey designed to provide intercensal estimates of the information previously collected on the decennial census long form, added information on health insurance coverage in 2008. Although the ACS is a new resource for monitoring children's health insurance coverage, it has a number of important strengths relative to the other surveys, the most important of which is its very large sample and its sample frame (which samples every county and census tract)
|
From page 20... ...
Although overall the unadjusted ACS estimates of uninsured children were close to the CPS estimates, they were somewhat higher than the NHIS estimates for the same period, and reports of direct purchase of insurance on the ACS are very high. A major limitation of the survey is that it is conducted primarily by mail (56 percent)
|
From page 21... ...
Another ACS limitation is that there is only one itemized list of coverage types (rather than a detailed series of patterned questioning, defin ing, and probing, as in the NHIS and the CPS) , which could also intro duce more measurement error in the reporting of coverage type.
|
From page 22... ...
MEPS-HC collects data from a sample of families and individuals in selected communities across the United States, drawn from a nationally representative subsample of households that participated in the prior year's NHIS. During the household interviews, MEPS collects detailed information for each person in the household on the following: demographic characteristics, health conditions, health status, use of medical services, charges and source of payments, access to care, satisfaction with care, health insurance coverage, income, and employment.
|
From page 23... ...
The tests, he reported, are promising in terms of the rates reported. SURVEy COVERAGE ESTIMATES Turner stated that, in terms of national estimates of coverage rates, the results from the three major sources are very similar.
|
From page 24... ...
Both the ACS and the CPS ASEC estimate 90.1 percent of children have health insurance coverage, and the NHIS estimates that 91.0 percent of children have health insurance coverage. Looked at another way, however, the three surveys show quite different results on how many children are uninsured at a point in time or throughout the year.
|
From page 25... ...
He observed that the CPS is not a reliable measure of all-year uninsured, mainly because it does not perform consistently. He ascribes this partly to the fact that asking people to remember what insurance coverage they had 16 months ago is a difficult cognitive task, especially for programs like Medicaid or CHIP, in which they may be more likely to move on and off the program than in other types of insurance coverage.
|
From page 26... ...
In response to a question, Johnson reported that the Census Bureau has tested a point-in-time question on the CPS and is evaluating the response, with the thought of replacing the all-year estimate with a point-in-time one. This analysis underscores Davern's observation that the CPS is a very poor measure of all-year uninsurance.
|
From page 27... ...
The CPS, Czajka pointed out, is the official source of annual estimates of income and poverty in the United States, whereas the ACS collects more limited information on personal income and does so through a questionnaire that two-thirds of the sample completes without the assistance of an interviewer and submits by mail. Policy analysts also have reason to be interested in the ACS as a potential data source for a wide variety of analyses of state and local variation in health insurance coverage, and income is likely to play a key role in many such analyses.
|
From page 28... ...
Given these potential uses of the ACS and the current limitations, do the ACS income data measure up to the CPS sufficiently well to warrant their use in producing the mandated annual estimates of low-income children and low-income uninsured children? His paper reviews income measurement and other features that differentiate the CPS, the ACS, and the NHIS, presenting findings from two empirical analyses comparing the surveys.2 Czajka contends that the CPS defines the measurement of annual income and poverty estimates for the United States since it is the official source of such data.
|
From page 29... ...
This means that in a single question the NHIS captures 95 percent as much total income as the CPS, and the ACS, with a simple instrument filled out primarily by respondents rather than a trained interviewer, captures 98 percent as much total income as the CPS. However, Czajka makes the point that distributions are important, and there are important differences when income collected by these three 3 To convert the ACS income to a common reference period -- specifically, the calendar year in which the data were collected -- the Census Bureau applies an inflation adjustment, defined as the ratio of the average monthly price index for the survey year to the average index for the reference period.
|
From page 30... ...
As income is disaggregated, however, some consequential differences emerge owing to collection methods and reference periods. The longer reference period in the ACS means that it tends to lag the CPS in response to changes in the economy, an important issue when assessing the change in health insurance coverage of low-income children in response to the business cycle.
|
From page 31... ...
Turner reported that the 2008 estimates showed an ACS estimate of 14.6 percent uncovered, which was nearly identical to the NHIS 14.8 percent and actually identical to the CPS rate. On the basis of this work, she observed that the ACS estimates of health insurance coverage looked reasonable, and, when the logical edits are implemented for 2009, it is possible that the ACS estimate of uninsured may be nearly identical to the "best" NHIS estimate for overall coverage.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.