Appendix C
Major Survey Sources, Health And Social Welfare Programs

The content and design of four major surveys may need to be modified to permit them to track eligibility, participation, and outcomes of changes in health and social welfare programs:

Current Population Survey (CPS) March Income Supplement;

Survey of Income and Program Participation (SIPP);

National Health Interview Survey (NHIS); and

Medical Expenditure Panel Survey (MEPS).

This appendix briefly describes key features of the design and content of these surveys that are relevant to program eligibility and participation.

The CPS March Income Supplement

Design

The CPS is a monthly survey of 50,000 households, of which about 47,000 are successfully interviewed. The core questionnaire asks about current employment status and is the basis of the monthly unemployment rate statistics. The sample represents the civilian, noninstitutionalized population in the 50 states and District of Columbia and is designed to be state-representative. There is a rotation group design, in which one-eighth of the households are new to the survey each month. Household addresses are retained in the sample for 4 months, dropped for 8 months, and returned to the sample for another 4 months, so that there is 50 percent overlap in the sample of addresses from year to year. (The survey interviews people who currently live at each sample address; it does not follow individuals who move.)

The March income supplement obtains detailed information for sample members aged 15 and older on income and work experience for the previous calendar year. The sample for March includes an additional 2,500 housing units, interviewed the previous November, that contained at least one person of Hispanic origin. The sample also includes people in the Armed Forces living off post or with their families on post. Some respondents to the core questionnaire do not respond to the March income supplement.



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--> Appendix C Major Survey Sources, Health And Social Welfare Programs The content and design of four major surveys may need to be modified to permit them to track eligibility, participation, and outcomes of changes in health and social welfare programs: Current Population Survey (CPS) March Income Supplement; Survey of Income and Program Participation (SIPP); National Health Interview Survey (NHIS); and Medical Expenditure Panel Survey (MEPS). This appendix briefly describes key features of the design and content of these surveys that are relevant to program eligibility and participation. The CPS March Income Supplement Design The CPS is a monthly survey of 50,000 households, of which about 47,000 are successfully interviewed. The core questionnaire asks about current employment status and is the basis of the monthly unemployment rate statistics. The sample represents the civilian, noninstitutionalized population in the 50 states and District of Columbia and is designed to be state-representative. There is a rotation group design, in which one-eighth of the households are new to the survey each month. Household addresses are retained in the sample for 4 months, dropped for 8 months, and returned to the sample for another 4 months, so that there is 50 percent overlap in the sample of addresses from year to year. (The survey interviews people who currently live at each sample address; it does not follow individuals who move.) The March income supplement obtains detailed information for sample members aged 15 and older on income and work experience for the previous calendar year. The sample for March includes an additional 2,500 housing units, interviewed the previous November, that contained at least one person of Hispanic origin. The sample also includes people in the Armed Forces living off post or with their families on post. Some respondents to the core questionnaire do not respond to the March income supplement.

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--> Content (March 1996 Survey) Demographic Characteristics Age Sex Race Origin or descent Relationship to reference person Marital status Parent (if in household) Veteran status Level of education; school enrollment Place of residence (including country if abroad) 1 year ago Citizenship Current Labor Force Status Work status last week Reason for temporary absence from job last week Hours worked, total and overtime, last week Weeks looking for work When last worked Reasons not looking for work Usual work hours per week Usual hourly wage or usual gross earnings per week [Note: There are no questions on volunteer work or participation in work training programs.] Work Experience Last Year Whether worked last year Whether looked for work; how many weeks working or on layoff Reason did not work; did not look for work Weeks worked Hours usually worked per week Number of weeks worked less than 35 hours per week; reason Income and Program Participation Last Year Earnings Total gross earnings from longest job held Tips, bonuses, overtime pay or commissions from longest job held Net earnings from business or farm for the year and each quarter Earnings from all other jobs Tips, bonuses, etc. from all other jobs

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--> Program cash payments (generally includes basis of payment—whether weekly, monthly, quarterly, etc.; number of payments; who in household received; reasons for receipt) State or federal unemployment compensation Supplemental unemployment benefits Union unemployment or strike benefits Worker's compensation payments Social Security payments last year and month Social Security received for children last year and month Supplemental Security Income SSI received for children Public assistance or welfare payments from state or local welfare office; type of assistance (AFDC, other, both) Veterans' payments by type Survivors' benefits by type (e.g., private or public widows' pensions, estates, trusts, annuities; excluding Social Security or VA) Disability benefits by type (excluding Social Security or VA) Pension or retirement benefits by type (excluding Social Security or VA) Asset income (generally includes who owns, basis of payment, number of payments) Interest income Dividend income Property income (including rent, royalties, income from estates or trusts) Other Income Child support payments Alimony payments Regular financial assistance from friends or relatives Income from hobbies, home businesses, or farms not already covered Income from unemployment compensation, severance pay, welfare, foster child payments, or other money income not already covered Educational assistance from Pell Grants; from other sources In-Kind Program Participation Number of children who ate lunch at school; number who qualified for free or reduced price lunch Whether live in public housing project or have subsidized rent Whether household received food stamps; who covered; monthly amount; number of months Receipt of heating assistance; amount [Note: There are no questions on welfare program participation prior to the previous year.] Health and Health Insurance Coverage Health problem that prevents or limits work Ever retired or left a job for health reasons Self-assessment of health status (poor to excellent)

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--> Health insurance coverage from current or former employer or union; policyholders; who covered; whether current or former employer or union paid all, part, or none of premium Health insurance coverage purchased directly; policyholders; who covered Health insurance coverage from non-household member; who covered Medicare coverage; who covered Medicaid coverage; who covered; number of months covered CHAMPUS or CHAMPVA coverage; who covered Coverage by any other state health insurance plan or any other coverage (plans in 26 states listed as possibilities); who covered [Note: Above questions are for coverage any time during previous year; type of coverage last week also ascertained. There are no questions on reasons for lack of coverage.]

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--> The Survey of Income and Program Participation Design The Survey of Income and Program Participation (SIPP) is a rotating panel survey of samples of household members interviewed at 4-month intervals. Beginning in 1983, the survey followed adult members of initially-sampled households (sample sizes ranged from 12,500 to 23,600 households) for 32 months; a new panel was introduced each February. Data were also obtained for children living with adult sample members and for adults and children who joined the household of an adult sample member. Under a redesign introduced in 1996, the survey is following samples of adults and children in about 37,000 initially-sampled households for 48 months; a new panel will be introduced every 4 years. About 8-9 percent of eligible households did not respond in Wave 1 of SIPP for the most recent three panels (1992, 1993, and 1996), and another 5-6 percent did not respond at Wave 2; by Wave 4, cumulative sample loss was 18-20 percent for these three panels. The SIPP sample is not designed for state representation. The sample for the 1996 panel overrepresents household addresses identified as low income in the 1990 decennial census. The design of SIPP may change if the survey is made the source of official poverty statistics, as recommended by a National Research Council panel. The SIPP core questionnaire covers demographic characteristics; work experience, earnings, program participation, and transfer income by month for the 4 months preceding the interview; and asset income for the 4-month period. In addition, each interview wave includes one or more topical modules, which cover a variety of topics. (Some modules are repeated in each panel; others are modified to respond to current policy needs.) Content Changes Some changes were recently made to the content of the 1996 SIPP panel to respond to legislated changes in social welfare programs. Beginning in Wave 4 (administered in summer 1997), references to AFDC were changed to cash assistance. Also, the variable topical module in Wave 8 (to be administered in fall 1998) will be devoted exclusively to measuring participation and benefits under welfare reform, recognizing the potential for an increase in the amount and type of in-kind benefits. Content (Core, 1996 Panel) Demographic Characteristics Age Sex Race Origin or descent Relationship to reference person For children, whether biological, step, foster, or adopted Marital status Parent (if in household) Veteran status and when served Educational attainment; school enrollment [Note: There are no questions on citizenship.]

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--> Labor Force Participation in Past 4 Months1 Whether had at least one paid job or did any work for money in past 4 months Whether worked for employer, self-employed, both, something else (e.g., odd job) Whether did any unpaid work in family business or farm Reason did not work Which weeks worked; which weeks with a job but not paid and why Any time on layoff in past 4 months; whether had date to return to work Any time looking for work in past 4 months; which weeks If could have started a job (or returned to one), reason why didn't How many employers in past 4 months Start and end dates (if applicable) for each employer for which worked during past 4 months Reason stopped working for an employer Number businesses (including farm or professional practice) had alone or jointly in past 4 months; whether active in business or own as investment only Start and end dates (if applicable) for each business; reason gave up a business Usual hours per week per employer Regular pay rate at end of month 4 (or when left job); how often paid Usual hours involved in each business; whether received regular salary or other income Reason worked less than 35 hours per week Current labor force status (as of date of interview) [Note: There are no questions on volunteer work or participation in work training programs.] Previous Work Experience (Wave 1 Topical Module) Before started current job (if applicable), what year last worked at a paid job or business and when started that job How old when first worked 6 straight months at some job or business Main reason never worked 6 straight months Whether worked at least 6 straight months in each year since first job How many years did not work 6 straight months Whether has generally worked 35 hours or more per week Whether any periods of 6 or more months when did not work because taking care of a child, elderly person, or disabled person; when most recent such period and how long; how many such periods; when first such period Income and Program Participation (for each person)2 Earnings (for each of 4 months) Gross earnings from each employer (how paid) Tips, bonuses, overtime pay, or commissions 1   For the 1996 panel, the reference period for labor force questions was expanded to include the period in the interview month prior to the interview date together with the four preceding months. 2   Recipiency of income and benefits in the 1996 panel is ascertained for the period in the interview month preceding the interview date in addition to the preceding four months.

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--> Any other pay How much received from business Net profit or loss from business Income from freelancing, consulting, moonlighting Program cash payments (for each of 4 months; reason for receipt for some income types—retired, disabled, widowed or surviving child, spouse or dependent child, other reason; composition of the recipient unit for some income types; age when began receiving disability income; reason why and when applied for and reason why stopped receiving AFDC, SSI, and some other income types; recipiency history for AFDC and SSI in Wave 1) Social Security Supplemental Security Income; whether ever applied; whether ever received; when first received and for how long SSI on behalf of children Separate SSI payment from state or local welfare office Unemployment compensation Workers' compensation Veterans' compensation by type Payments from own sickness, accident, or disability insurance policy Employer disability payments Employer or union pension Federal civilian pension State government pension Local government pension U.S. military pension National Guard or Reserve Forces retirement Railroad Retirement Black lung payments Other disability payments Other pension payments Regular retirement income from paid-up insurance policy or annuity Payments from estate or trust AFDC; whether ever applied; whether ever received; when first received and for how long; number of times received General Assistance Other welfare Child support as bonus or pass-through from AFDC Asset holdings and asset income (whether owned separately or jointly; value; 4-month income amounts where applicable) U.S. Government savings bonds (E or EE) IRA or Keogh account; whether received lump sum or regular payments in last 4 months 401(k) or thrift plan Interest earning checking account Savings account Money market deposit account

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--> Certificate of deposit (CD) Mutual funds Stocks Municipal or corporate bonds U.S. government securities Mortgages from which payments are received Rental property Royalties Any other financial investments not already mentioned Rental property (gross and net income) Mortgages Royalties Other Income Severance pay when left job during past 4 months; amount Lump sum payments from pension when left job during past 4 months; type; amount; whether and how much rolled over into an IRA or other retirement account Foster child care payments Child support payments Alimony payments Any other income Educational assistance by type In-kind program participation (recipiency history for food stamps in Wave 1) Whether live in public housing project Whether rent subsidized by federal, state, or local government When first applied and moved into public or subsidized housing; whether on waiting list Amount of monthly rent (excluding subsidy); whether pay for utilities Whether authorized to receive food stamps; whether ever applied; when first received and how long; how many times received; amounts in last 4 months; composition of the recipient unit Whether on WIC, the Women, Infants, and Children nutrition program and composition of the recipient unit Energy Assistance; 4-month amount Which children ate lunch and/or breakfast at school; whether free or reduced price Health and Health Care Use Whether health prevents working at a job or business or limits kind of work can do Whether ever retired from a job or business [Note: Wave 2 includes a topical module on work disability history; Wave 4 includes a topical module on disability; Waves 6 and 11 include a topical module on functional limitations and disability for adults and children.] [Note: Waves 3, 6, 9, and 12 include a topical module on medical expenses and utilization of health care for adults and children.]

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--> Health Insurance Coverage (for each person; which months covered) Medicare Medicaid (when coverage started; whether person's children were covered; which children covered and which months) Any other assistance program that pays for medical care (whether person's children were covered) Whether covered under health insurance plan in own name or as family member on another person's plan Type of coverage (current or former employer, union, CHAMPUS, CHAMPVA, military/VA, privately purchased, obtained in some other way) Whether current or former employer union paid all, part, or none of premium Who else covered by plan Whether plan covers anyone not living in household Reason for not being covered If now covered, when ever not covered If not now covered, when covered previously

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--> Schedule of Topical Modules for the 1996 Panel of the Survey of Income and Program Participation Wave and Time Period Topical Modules Last Time Asked and Question Source 1: April 1996-July 1996 Recipiency History 1993 Wave 1     Employment History 1993 Wave 1 2: Aug. 1996-Nov. 1996 Work Disability History 1993 Wave 2     Education and Training History 1993 Wave 2     Marital History 1993 Wave 2     Migration History 1993 Wave 2     Fertility History 1993 Wave 2     Household Relationships 1993 Wave 2 3: Dec. 1996-March 1997 Assets, Liabilities, and Eligibility 1993 Wave 7     Medical Expenses/Utilization of Health Care, Adults and Children 1993 Wave 7/New     Work Related Expenses New     Child Support Paid New 4: April 1997-July 1997 Annual Income and Retirement Accounts 1993 Wave 8     Taxes 1993 Wave 8     Work Schedule 1993 Wave 9     Child Care 1993 Wave 9     Disability Questions New 5: Aug. 1997-Nov. 1997 School Enrollment and Financing 1993 Wave 8     Child Support Agreements 1993 Wave 9     Support for Non-Household Members 1993 Wave 9     Disability:       Functional Limitations and Disability, Adults 1993 Wave 6     Functional Limitations and Disability, Children 1993 Wave 6     Employer Provided Health Benefits New 6: Dec. 1997-March 1998 Children's Well-being 1993 Wave 6     Assets, Liabilities, and Eligibility 1996 Wave 3     Medical Expenses/Utilization of Health Care, Adults and Children 1996 Waves 3 and 6     Work Related Expenses 1996 Wave 3     Child Support Paid 1993 Wave 3

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--> Schedule of Topical Modules for the 1996 Panel of the Survey of Income and Program Participation (continued) Wave and Time Period Topical Modules Last Time Asked and Question Source 7: April 1998-July 1998 Annual Income and Retirement Accounts 1996 Wave 4     Taxes 1996 Wave 4     Retirement and Pension Plan Coverage New     Home Health Care New 8: Aug. 1998-Nov. 1998 Adult Well-being 1993 Wave 9     Welfare Reform New 9: Dec. 1998-March 1999 Assets, Liabilities, and Eligibility 1996 Wave 6     Medical Expenses/Utilization of Health Care, Adults and Children 1996 Wave 6     Work Related Expenses 1996 Wave 6     Child Support Paid 1996 Wave 6 10: April 1999-July 1999 Annual Income and Retirement Accounts 1996 Wave 7     Taxes 1996 Wave 7     Work Schedule 1996 Wave 4     Child Care 1996 Wave 4 11: Aug. 1999-Nov. 1999 Child Support Agreements 1996 Wave 5     Support for Non-Household Members 1996 Wave 5     Disability:       Functional Limitations and Disability, Adults 1996 Wave 5     Functional Limitations and Disability, Children 1996 Wave 5     Variable topical modules to be determineda NA 12: Dec. 1999-March 2000 Assets, Liabilities, and Eligibility 1996 Wave 9     Medical Expenses/Utilization of Health Care, Adults and Children 1996 Wave 9     Work Related Expenses 1996 Wave 9     Child Support Paid 1996 Wave 9     Variable topical modules to be determineda NA NOTE: Information current as of October 31, 1997. a Children's well-being will be included in Wave 11 or 12.

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--> The National Health Interview Survey Design The National Health Interview Survey (NHIS) is a continuing cross-sectional survey that is the principal source of information on the health of the civilian noninstitutionalized population of the United States. The NHIS data are collected through personal interviews that are conducted each week of the year. (Each household is interviewed once, and each week's sample is representative of the universe.) The current annual sample size is about 49,000 households and is designed to oversample black people. The sample is designed to be state-representative. The annual response rate is about 95 percent. The questionnaire consists of two basic parts: (1) a set of basic health and demographic items, and (2) one or more sets of questions on current health topics. The basic or core items are repeated each year and constitute about one-third of the questionnaire. Content (1996 Core) Demographic Characteristics Age Sex Race Ethnic origin Relationship to reference person (including whether biological, adoptive, step, or foster relationship) Marital status; whether ever married Educational attainment Whether attending or ever attended Head Start (for children under 6) Place of birth (state or country) [Note: There are no questions on citizenship.] Labor Force Status Last Week and Year Work status last week Hours worked last week Whether usually work 35 hours or more Reason for not working last week Ever worked previous calendar year Months worked [Note: There are no questions on volunteer work or participation in work training programs.] Income and Program Participation Last Year Earnings from all jobs and businesses last year for each adult (aged 18 or older or married) Whether anyone in family and who received: Wages and salaries Self-employment income including business and farm income

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--> Social Security or Railroad Retirement Pensions from other sources Supplemental Security Income; whether because of disability; ever applied Social Security Disability Insurance; whether because of disability; ever applied Welfare, AFDC, or General Assistance; number of months received Interest income Dividend or property income Child support Any other source Total combined family income from all sources Who authorized to receive food stamps; months authorized (amounts not ascertained) [Note: There are no questions on welfare program participation prior to the previous year.] Health And Health Care Use As reported by family respondent, information about family members on: Health status and limitation of activities Injuries in past 3 months Access to health care (whether family member didn't get care or delayed in seeking care because couldn't afford it) Hospital utilization in past 12 months Health care contacts in 2-week period Whether any family member received care 10 or more times in past 12 months For adults, extensive questions on: Health conditions (long list, some ever reported, some last 12 months, some last 3 months) Emotional feelings in last 30 days (e.g., hopeless, nervous) Health indicators (e.g., days lost from work, days bedridden, health better or worse) Limitation of activities (e.g., walking, bending) and related health conditions Health behaviors (tobacco use, exercise, alcohol use) Access to health care Dental care Health care provider contacts in past 12 months Immunizations (flu shots and pneumonia vaccinations) For children, questions on: Conditions, limitation of activity, health status Mental health Access to health care Dental care Health care provider contacts in last 12 months Immunizations Health Insurance Coverage Whether health insurance offered through workplace Who in family has coverage; type Type of Medicare coverage; whether signed up with an HMO For Medicaid, whether can see any doctor; whether need referrals For private coverage, whether obtained through employer or union; who pays premiums; how much

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--> family spent for premiums including payroll deductions; whether HMO, IPA, PPO, or other type of plan If no coverage, when last was covered; reasons for no longer having coverage Whether ever lacked coverage in previous 12 months; number of months Total family expenditures for medical care (excluding premiums, non-prescription drugs, costs for which expect to be reimbursed)

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--> Medical Expenditure Panel Survey Design The Medical Expenditure Panel Survey (MEPS) is a redesign of the 1987 National Medical Expenditure Survey (NMES). Predecessor surveys to NMES were the 1981 National Medical Care Utilization and Expenditure Survey (NMCUES) and the 1977 National Medical Care Expenditure Survey (NMCES). The 1987 NMES consisted of five rounds of data collection between February 1987 and July 1988 for a sample of 14,000 households, including oversamples of blacks, Hispanics, people aged 65 and older, low-income people, and people with functional limitations. Surveys were also conducted of physicians and health care facilities providing care to members of the household sample during 1987 and of employers and insurance companies responsible for their insurance coverage. The NMES also included an institutional survey of 13,000 residents of nursing and personal care homes, psychiatric hospitals, and facilities for the mentally retarded. MEPS is a continuing panel survey, begun in 1996. It follows samples of households in 5 personal interviews and 1 telephone interview over almost 30 months, with a new panel introduced every year. The 1996 sample is 10,500 households. The sample was drawn from the 1995 National Health Interview Survey sample, making it possible to integrate the NHIS data with MEPS data for MEPS sample households. MEPS also includes surveys of providers, employers, and insurance companies of household sample members, as well as a nursing home survey. The MEPS provider survey includes hospitals, physicians, and home health care providers and obtains information to supplement responses to the MEPS household survey, including information to help estimate medical care expenses of people enrolled in health maintenance organizations and other types of managed care plans. The MEPS health insurance provider survey includes employers, unions, and private insurance companies and obtains detailed information on the health insurance plans of MEPS respondents and other health plans available to, but not chosen by, respondents. The employer component uses the same questionnaire as that used for the National Employer Health Interview Survey, which is a large annual survey of employers about their health insurance plans, beginning in 1997. (NEHIS was first conducted in 1994.) The MEPS national nursing home expenditure survey gathers information from a sample of 800 nursing homes and more than 5,000 residents on the characteristics of the facilities and services offered, expenditures and sources of payment on an individual resident level, and resident characteristics, including functional limitation, cognitive impairment, age, income, and insurance coverage. The survey also collects data on the availability and use of community-based care prior to admission to nursing homes. Content (1996 MEPS Household Survey; Summary Description) Family Demographic Characteristics Age Sex Race/ethnicity Family relationship Marital status Military status Education

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--> Employment Information on jobs held or retired from for household members aged 16 and older, including: Hours worked How long worked at job Wages Whether health insurance offered Whether self-employed Type of business/industry Job title/main duties Periods of unpaid leave (for people currently working) Whether ever worked and reasons for not working (for adults not currently working) Household Income and Assets Value of major common assets Information on annual income from a number of potential sources asked once each year of participation in the survey; sources include: Wages Social Security AFDC SSI Interest income Rental income Royalties Health Status (asked once a year for each family member) Overall physical and mental health status Activity and functional limitations Mental health assessment For children, special health and education services they receive Health Conditions Medical conditions for each family member (provided by household respondent) Pregnancy status for women ages 15 to 45 Health Care Use Hospital stays Emergency room visits Outpatient department visits Medical provider visits Dental care Home health care Prescription medicines Over-the-counter medications

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--> Other medical expenses [Information collected includes when and where the use occurred, what happened during the encounter, the reason for it, and other characteristics, depending on the type of care received.] Charge And Payment (for each medical care use reported by household) Whether a bill/statement received for the care and, if not, why not (e.g., Medicaid, HMO) The charge, if any, for medical care Which sources paid (family, insurance) for the care How much each source paid for the care Whether there was a discrepancy between the charge and the total payments, and why (discount, professional courtesy) Access To Care (asked once a year) Each family member's usual source of health care (or that they do not have one) Reason for not having a usual source of health care Confidence and satisfaction with the quality of care received from a usual source of care Barriers to receiving health care, including experiencing difficulty, delaying, or not receiving health care due to cost, insurance problems, time constraints, or other reasons Health Insurance Coverage Public insurance coverage Medicare Medicaid (including Medicaid waiver programs) CHAMPUS/CHAMPVA Other government programs Private insurance coverage (including policyholder, covered individuals, and covered months) Employer-sponsored coverage Directly purchased insurance (e.g., through a group, association, school, etc.) If not insured, length of uninsured spell If privately or publicly insured, whether covered under a managed care plan Satisfaction with health plan, including satisfaction with choice of providers, difficulty in seeing specialists, plan coverage, plan costs, overall satisfaction