Monitoring the Health Care Safety Net

Slide Presentation by Lynn A. Blewett, Ph.D.

On September 24, 2003, Lynn A. Blewett, Ph.D., made a presentation in the Web-Assisted Audioconference entitled Safety Net Data Collection Strategies.

This is the text version of Dr. Blewett's slide presentation. Select to access the PowerPoint® slides (151 KB).

Safety Net Data Collection Strategies

Lynn A. Blewett, Ph.D.
State Health Access Data Assistance Center
School of Public Health, University of Minnesota
blewe001@umn.edu
www.shadac.org

Supported by a grant from The Robert Wood Johnson Foundation

Slide 1

Estimating the Number of Uninsured

• Estimates of demand based on state and local estimates of the number of uninsured.
• Most estimates come from household surveys that ask about health insurance coverage.
• Also used in combination with employer surveys that ask about health insurance coverage.

Slide 2

Estimating the Size of the Uninsured Populations at the Local Level

1. Do your own survey
   • To directly measure health insurance coverage and rates of uninsurance
2. Use existing available data to:
   • Develop proxy measures of uninsurance
   • Develop statistical model-based estimates

Slide 3

Direct Measures: National Data

• Three surveys provide state-level estimates of health insurance coverage.
  • Current Population Survey (CPS): Census
  • Medical Expenditure Panel (Employer) Survey - Insurance Component (MEPS-IC): Agency for Healthcare Research and Quality
  • State and Local Area Integrated Telephone Survey (SLAITS): National Center for Health Statistics

Slide 4

Direct Measures: State Data

• 37 States have developed and fielded their own state household survey to estimate levels of health insurance coverage
  • Many funded by the federal Health Resources Services and Administration State Planning Grant Program
  • Typically have larger sample size and some regional/county estimates of coverage

Slide 5

Other National Surveys of Note

• National Survey of America's Families (NSAF): Urban Institute
  • Uninsurance estimates available for 13 states
  • Public use files available to states for analysis
• Community Tracking Study: Center for Health System Change
  • Uninsurance estimates can be made for the 12 communities in the CTS sample

Slide 6

Proxy Measures

• Use an available measure to serve as a proxy for health insurance coverage
• Example: self-pay variable from hospital administrative records to estimate local levels of uninsurance

Slide 7

Model-Based Approach

• Predicts health insurance coverage using one or more variables correlated with health insurance coverage
• Example: correlation between state unemployment and uninsurance and applying this at local level

Slide 8

National Model-Based Estimates

• Small-Area Estimation
• Census and AHRQ are both working on sophisticated models to provide state and local area estimates
  • CPS: Uninsurance
  • MEPS-IC: Employment offer and take up rates

Slide 9

This slide contains a table showing an Overview of Approaches for Estimating Number of Uninsured At the Local Level. The principal strength of the Direct Estimation-New Survey approach is precision; the principal weakness of this approach is cost. The principal strength of the proxy measure approach is cost; the principal weakness of this approach is bias. The principal strength of the model-based approach is predictive accuracy; the principal weakness is complexity.

Slide 10

Conclusions

• Be knowledgeable and aware of different data sources available for your community
• Use existing resources and data and build on existing state and local survey activities
• Use multiple approaches to maximize information
• Be flexible as new data become available

Slide 11

Contact Information

www.shadac.org
2221 University Avenue, Suite 345
Minneapolis Minnesota 55414
(612) 624-4802

Principal Investigator: Lynn Blewett, Ph.D. blewe001@umn.edu
Co-Principal Investigator: Kathleen Call, Ph.D. callx001@umn.edu
Center Director: Kelli Johnson, M.B.A. johns706@umn.edu
Senior Research Associate: Timothy Beebe, Ph.D. beebe002@umn.edu
Research Associate: Michael Davern, Ph.D. daver004@umn.edu

Current as of February 2004

Internet Citation:

Safety Net Data Collection Strategies. Text Version of a Slide Presentation at a Web-assisted Audioconference. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/safetynetaud/sess2/blewetttxt.htm

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