estimates than is available in national surveys, including larger samples for important subpopulations in the state and for substate geographic areas; (2) information on insurance coverage that addressed the full scope of coverage options available in the state; (3) information on other key issues of relevance to the states (e.g., access to health care and the affordability of health care); and (4) access to the data in a more timely manner to support analyses, policy development, and program design. The MHRS, the new survey effort sponsored by the foundations, had those goals as well, with an additional focus on expanding the information available to track the impacts of the state’s 2006 health care reform legislation beyond insurance coverage, such as access to and use of care, health care costs and affordability, the quality of insurance coverage, and support for reform (among other outcomes), and providing timely updates on the impacts of reform.

In 2008, a new source of estimates for uninsurance in Massachusetts became available based on the American Community Survey (ACS), which had added a question on health insurance coverage in the 2008 survey. That survey, which provides a much larger sample size for Massachusetts than is available from other surveys (including the two state-specific surveys), addresses one of the factors that has led states to invest in separate state surveys—sample size. However, the ACS does not address the other needs: state-specific insurance coverage options in the survey questions, information on health care outcomes beyond insurance coverage, and more timely data.1

DESIGN OF THE MASSACHUSETTS SURVEYS

Massachusetts Health Insurance Survey

The Massachusetts Division of Health Care Finance and Policy began fielding its health insurance survey in 1998 to provide estimates of the uninsurance rate in the state. The survey was redesigned in 2008 to better position the state to track insurance coverage over time following the passage of the state’s 2006 health care reform legislation.2 Key changes included expanding the survey sample frame to include all residential households (not just those with a land line telephone) and modifying the survey instrument to capture more of the health insurance and health care

1

For more information on the ACS, see: http://www.census.gov/acs/www/ [July 2010].

2

See the Massachusetts Division of Health Care Finance and Policy (2007) for information on the early years of the MHRS, and Long et al. (2009) for information on the survey after the 2008 redesign.



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