Using Federal and State Survey Data to Inform State Health Reform

Sharon K. LongUniversity of Minnesota

State Health Research Policy Interest GroupAcademyHealth Annual Research MeetingSeattle, WAJune 11, 2011

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Key Federal Surveys

• General household survey– ACS: American Community Survey

• Employment/Income surveys– CPS: Current Population Survey– SIPP: Survey of Income and Program Participation

• Health surveys– NHIS: National Health Interview Survey– MEPS-HC: Medical Expenditure Panel Survey-

Household Component– BRFSS: Behavioral Risk Factor Surveillance System

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Feasibility of State-Level Estimates from Federal Surveys

ACS SIPP CPS NHIS MEPS HC

BRFSS

State-level estimates possible?

All states *

Some states ~20 ~20 ~35

State identifiers available on public use files?

Sample size by state

High 353K 9K 20K 13K 5K 20K

Median 44K 1K 3K 1K 400 7K

Low 6K 160 2K 110 <100 2K

3* Two-year averages recommended.

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Potential Outcomes of Interest

• Health insurance coverage

• Affordability and scope of insurance coverage

• Access to care/barriers to care

• Health care use

• Affordability of care

• Quality of care

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Availability of Outcome Measures in Federal Surveys

ACS CPS SIPP NHIS MEPS HC

BRFSS

Insurance coverage

Point in time

Prior calendar year -

Affordability of coverage/comprehensiveness of coverage

- -

Access to care/barriers to care - - -

Health care use + -

Affordability of care - -

Quality of care

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Timeliness of Data Release for Federal Surveys

• Data files available now:– ACS 2009– SIPP 2008 – CPS 2010 (data for 2009)– NHIS 2010– MEPS-HC 2008– BRFSS 2010

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Strategies to Increase the Value of Federal Surveys for State Studies

• Expand state-level estimates– Increase state sample sizes– Expand use of small area estimation methods

• Expand survey content

• Improve data availability – More timely data release– Make state identifiers available outside of

Research Data Center settings

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Changes in NHIS and BRFSS to Address Needs Under Health Reform• NHIS

– State-level estimates: Added sample size & exploring use of small area estimation methods

– Content:• Added questions• Expanding links with administrative data

– Availability: More timely release of data

• BRFSS – State-level estimates: States can add sample size– Content:

• Core questions include emerging issues• States can add their own questions

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The Bottom Line on Federal Surveys for State-Level Analyses of Health Reform

• No single data source is “best”– CPS, ACS, and BRFSS have accessible 50-

state estimates but are limited in scope– NHIS and MEPS-HC have greater scope but

can’t provide estimates for all states and access to state identifiers is restricted

– MEPS-HC on slow track for data release

• No good alternatives available for some states and for some outcome measures

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State Survey: One Strategy for Addressing Gaps in Federal Surveys

• Larger state sample sizes

• Potential to oversample key subgroups

• Information on state-specific insurance and health care programs

• More outcomes: health care access & use, costs, quality, barriers to care, awareness of reform, attitudes toward reform

• More timely access to data to inform policy and program design

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State Surveys Addressing Health Insurance Coverage and Other Issues

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Federal and State surveys will play an important role under health reform, but…

• Sample sizes often can’t support analyses of important subgroups, including Medicaid/CHIP enrollees

• Surveys rely on self-reported information, including type of insurance coverage

• Some outcomes are difficult to capture in surveys—such as costs, diagnoses, quality of care

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References

• SHADAC. 2011. “Monitoring the Impacts of Health Reform at the State Level: Using Federal Survey Data.” Brief #24. Minneapolis, MN: University of Minnesota.

• Sonier, J. and E. Lukanen. Forthcoming. “A Framework for Tracking the Impacts of the Affordable Care Act in California.” Minneapolis, MN: University of Minnesota.

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