Databases for Estimating Health Insurance Coverage for Children A Workshop Summary (2010) / Chapter Skim
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13 Small-Domain Estimation of Health Insurance Coverage--Brett O'Hara and Mark Bauder
13 Small-Domain Estimation of Health Insurance Coverage--Brett O'Hara and Mark Bauder
Pages 165-182
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From page 165... ...
From SAIPE, there was a knowledge base that the SAHIE program has benefited from and used. In 2005, the SAHIE program published health insurance coverage estimates for the first time.
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However, the 3-year average of the CPS ASEC health insurance coverage data could not support model-based estimates of more income categories or additional age groups (Small Area Health Insurance Estimates Team, 2008)
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First, we compare the variances of state estimates of a CPS-based SAHIE model and an ACS-based SAHIE model. Second, the model is modified to obtain ACS model-based estimates for more income categories.
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The Census Bureau was also required to determine whether the ACS or the CPS ASEC gives the best population estimates. In September 2009, the ACS released its first set of health insurance estimates.
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The CPS ASEC provides annual national and state estimates based on a sample of about 100,000 addresses. All health insurance coverage and income questions refer to the previous year.
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The covariates of income-to-poverty ratios are different from those for health insurance coverage. Covariates for income-to-poverty ratios include the estimates from the 2000 census sample data tabulated for the same categories as the survey data as well as other characteristics reported in the census sample data.
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From page 171... ...
• Transformations of the proportions in the income categories and the proportions insured follow linear models, given predictors and parameters, whereas direct estimates of the untransformed propor tions or numbers are unbiased and normal. • The two parts of the SAHIE model are "multivariate." In addition to the survey estimates, other data are treated as random and are modeled by their distributions conditional on the true numbers and proportions.
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From page 172... ...
I I H H I A basic version of the SAHIE model is as follows: • Survey estimates of the proportions in the income group and of the proportions with health insurance, given the true proportions, are normal, unbiased, and have variances that depend on parameters to be estimated. Let p denote either a proportion in an income group or a proportion insured, with corresponding survey estimate p.
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. Model Evaluation There is no "gold standard" relative to which the accuracy of SAHIE model estimates can be checked.
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We use estimates from a preproduction estimation of the model using the CPS ASEC for collection years 2007, 2008, 2009 and from the corresponding ACS model for 2008. We concentrate on one group of interest, uninsured children under age 19 at or below 200 percent of poverty by health insurance coverage.
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From page 175... ...
states, Idaho, Rhode Island, and Wyoming, do the ACS-based estimates have larger standard deviations. Estimating More Income Groups An anticipated advantage of using the ACS rather than the CPS ASEC data is that we will be able to produce reliable model-based estimates for smaller domains.
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From page 176... ...
We also note that ACS Estimate, in Thousands Model Estimate, in Thousands FIGURE 13-2 Plot of the ACS direct estimates versus the ACS model-based estimates, for states, of the number of uninsured children under age 19 with family income between 150 and less than or equal to 200 percent of poverty. SOURCES: Estimates are from the 2008 ACS survey and the 2008 ACS-based SAHIE model.
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Ratio State Population, Aged 0–18, in Thousands FIGURE 13-3 Ratios of standard deviations of model-based estimates to estimates of standard deviations of survey-only estimates. NOTES: Standard deviations of the state estimates of the number uninsured children under age 19 with family income between 150 and less than or equal to 200 percent of poverty.
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From page 178... ...
Figure 13-4 shows the estimated CVs for the model estimates and the ACS estimates, for state estimates of the number of uninsured children under age 19 with family income between 150 and less than or equal to 200 percent of poverty. The states are ordered by increasing population under age 19.
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SOURCE: Estimates are from the 2008 ACS survey and the 2008 ACS-based SAHIE model. ACS direct estimates.
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Many of the small domains discussed in this paper should have a reliable 5-year health insurance coverage estimate at the state level. If a 5-year estimate of health insurance coverage is adequate for policy makers, the SAHIE state estimates should be viewed as a stopgap measure until 2013.
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. new Health Insurance Estimates Improve Measuring Program Participation in the national Breast and Cervical Cancer Early Detection Program.
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From page 182... ...
. [August Small Area Health Insurance Estimates Team.
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