In Collecting Data on the Uninsured, States Find That One Size Doesn't Fit All
During 1999 and 2000, researchers at the University of Minnesota School of Public Health conducted a study to determine what data was available to states for tracking the status of people without health insurance.
Key Findings and Recommendations
The investigators found the following:
- State-specific data drive state health policy, but states with few resources must rely on national data that do not meet their needs.
- States find privately sponsored surveys useful, but not all states are included in these surveys.
- States would like reliable, timely data that allow them to perform state-level analyses.
- States vary in their need for technical assistance.
- The researchers concluded that high-quality state data should:
- Be based on a good survey design.
- Provide state identifiers for all 50 states.
- Have a sample size large enough for valid and reliable state estimates.
- Provide timely and routine release of data.
- Provide easy access to micro-data or public use tapes for additional analysis.
The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $49,954.
After the Grant
In September 2000, the investigators established the State Health Access Data Assistance Center at the University of Minnesota.
As states become increasingly accountable for monitoring the health insurance status of their residents, they urgently need detailed state-specific data on trends in health insurance coverage. Despite this need, relevant information for state health policymaking frequently is lacking. State-specific data are especially important in the debate over whether and how to increase access to health care.
In addition, the Children's Health Insurance Program (a federal-state program designed to expand insurance coverage to children whose parents earn too much to qualify for Medicaid, but not enough to afford private health insurance) requires states to use state-specific data.
This grant from The Robert Wood Johnson Foundation (RWJF) supported a study of the data available to the states to track the status of the uninsured. The goals of the project included the following:
- To describe the data that states currently use to monitor access to health insurance and the limitations of that data.
- To identify the key state policy questions relevant to access and outline the data needed to answer those questions.
- To propose options for innovative and efficient strategies for monitoring the uninsured.
To meet these goals, the investigators at the University of Minnesota School of Public Health conducted a literature review of state and national surveys on the uninsured, reviewed 26 of those surveys critically, and evaluated 11 national surveys to determine their state-specific value. They also identified key policy questions through interviews with policy analysts from 15 states, discussions with experts at conferences, and contacts with state policymakers made through the state-sponsored Health Survey Network Listserv (administered by the National Association of Health Data Organizations, in cooperation with the Utah Department of Health and the Wisconsin Department of Health and Family Services).
The researchers concluded that national surveys are not equipped to provide states with the data needed to monitor the uninsured. Although several states have initiated their own surveys, there is a need for a better-coordinated data strategy at both the state and national levels. Investigators report the following:
- Although state-specific data drive state health policy, states with few resources must rely on national data that do not meet their needs. While states with resources and policy interests can collect their own data, many states lack the financial resources and technical skills to do so. States that collect data need guidance and would like to coordinate and share survey experiences with other states, but have no vehicle to do so.
- Many states are knowledgeable about the national Current Population Survey (CPS) and use it to track the uninsured. The survey is conducted monthly by the US Census Bureau to collect labor force data; every March, it includes questions on health insurance.
Although many states are aware that the CPS methodology limits its usefulness for state-level analyses, many states are unclear about the nature of the flaws. States vary in their knowledge and use of other federal data sets, such as the National Health Interview Survey, conducted by National Center For Health Statistics, and the Medical Expenditure Panel Survey, conducted by the Agency for Healthcare Research and Quality.
- States find the data provided by privately sponsored surveys useful, but not all states are included in these surveys. For example, the National Survey of American Families, conducted by the Urban Institute, a nonprofit public policy organization, covers just 13 states. Similarly, the 1993 RWJF Family and Employer Survey provided data on 10 states.
- States have consistent criteria for the data they need. States would like a reliable, timely source of data that are derived from studies with good methodologies and sufficiently large sample sizes for state-level sub-analyses. They would also like the ability to collect their own data to address specific policy issues.
- States vary in their need for technical assistance. Some states have access to multiple data sources and conduct sophisticated analyses; some do not have sufficient access to good data; and some have access to good data, but lack the technical skills to conduct relevant analyses.
- States are concerned about their increasing responsibility for the uninsured and are asking more detailed questions about that population. Many states are interested in examining disparities in insurance coverage by race, income, and county; length of time people are uninsured; the circumstances of the uninsured; and children who are uninsured. None of the available national data sets allows them to perform these analyses at the state level.
- The investigators proposed the creation of a center that would help the states to be better informed consumers of data; coordinate state data collection strategies to monitor the uninsured; and support states in their analytical, data, and information needs as they relate to health-care access.
- High-quality state-level data should meet five criteria:
- Have a good survey design to produce relevant policy information.
- Provide state identifiers for all 50 states.
- Have a sufficiently large sample for valid and reliable state estimates.
- Provide timely and routine release of data.
- Provide easy access to micro-data or public use tapes for additional state analysis.
The results of this grant were presented to RWJF in a paper entitled "Monitoring the Uninsured: A State Policy Perspective." Fifty copies were disseminated to researchers and to state and federal policy analysts. Presentations were made at the annual meeting of the Association for Health Services Research (AHSR) and at an Alpha Center workshop for state officials, "Obtaining State-Level Data on the Uninsured." See the Bibliography for details. AHSR and the Alpha Center have since merged to form the Academy for Health Services Research and Health Policy.
- Use computer listservs to facilitate discussions and get input from researchers and analysts nationwide.
- Create a network of contacts during the early stages of a project. Early contacts with leaders in the field gave researchers an opportunity to make presentations at two conferences where they were able to have discussions with experts.
- Inform colleagues working on related projects about ongoing work. For example, project investigators discussed ways to link national research to state needs with colleagues from the Alpha Center, a nonprofit health policy center. This helped the researchers to define more clearly the needs being met by existing programs and to identify gaps.
AFTER THE GRANT
In September 2000, the investigators established the State Health Access Data Assistance Center at the University of Minnesota with a three-year $3.9 million grant from RWJF (Grant ID# 038846). The Center will assist states to collect better data, use existing data more effectively, and evaluate initiatives designed to increase access to health insurance coverage.
GRANT DETAILS & CONTACT INFORMATION
Analyzing State Data Needs for Monitoring the Uninsured
University of Minnesota School of Public Health (Minneapolis, MN)
Dates: September 1999 to July 2000
Lynn A. Blewett, Ph.D.
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Books and Reports
Blewett LA, Brown ME, and Call KT. Monitoring the Uninsured: A State Policy Perspective. Minneapolis, Minn.: University of Minnesota, Division of Health Services Research and Policy, School of Public Health, May 2000. Approximately 50 copies disseminated.
Presentations and Testimony
Lynn A. Blewett, "Insurance Market Reform: How to Estimate and Monitor Coverage: A State Policy Perspective," at the Annual Meeting of the Association for Health Services Research, June 25, 2000, Los Angeles, Calif.
Lynn A. Blewett, "Monitoring the Uninsured: A State Policy Perspective," at the Workshop for State Officials on Obtaining State-Level Data on the Uninsured, May 2, 2000, Annapolis, Md.
Report prepared by: Lori De Milto
Reviewed by: Karyn Feiden
Reviewed by: Richard Camer
Program Officer: Nancy Barrand