Databases for Estimating Health Insurance Coverage for Children A Workshop Summary (2010) / Chapter Skim
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12 The Massachusetts Experience: Using Survey Data to Evaluate State Health Care Reform--Sharon K. Long
12 The Massachusetts Experience: Using Survey Data to Evaluate State Health Care Reform--Sharon K. Long
Pages 154-164
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From page 154... ...
Following the passage of the legislation, there was substantial concern among key stakeholders in the state about the ability to evaluate the impacts of health care reform with existing state and national data sources. This led the Blue Cross/ Blue Shield of Massachusetts Foundation, along with the Commonwealth Fund and the Robert Wood Johnson Foundation, to support a new survey effort dedicated to the evaluation of health care reform -- the Massachusetts Health Reform Survey (MHRS)
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From page 155... ...
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 bet ter 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)
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From page 156... ...
The margin of error due to sampling in the 2009 MHIS for estimates based on the full sample of Massachusetts residents is +/–1.5 percentage points at the 95 percent confidence interval. Massachusetts Health Reform Survey The MHRS gathers information on nonelderly adults in the state, the primary target population for many of the components of the 2006 health care reform initiative.3 The MHRS relies on an RDD sample, collecting information on a single, randomly selected adult aged 18 to 64 in each sample household.
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. For children, for whom three surveys provided data in Massachusetts in 2006, the uninsurance estimates prior to health care reform ranged from 2.5 percent (MHIS)
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From page 158... ...
Uninsurance Under Health Care Reform Despite the variation in the point estimates of the uninsurance rate in particular years, the general trend in uninsurance in the state is similar 9 An additional factor that creates some differences in the estimates for children and non elderly adults is differences in the age cutoffs used to define the two population groups. The MHIS, the CPS, the BRFSS, and the ACS define nonelderly adults as persons aged 19 to 64, and the other surveys (the MHRS and the NHIS)
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From page 159... ...
population remained steady at FIGURE 12-2 Trends in uninsurance for the total population in Massachusetts from survey data, 2005-2009. NOTES: ACS = American Community Survey, CPS = Current Population Survey, MHIS = Massachusetts Health Insurance Survey, NHIS = National Health Interview Survey.
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From page 160... ...
Nonelderly adults are defined as aged 19 to 64, except in NHIS and MHRS where they are defined as aged 18 to 64. SOURCES: Data from the American Community Survey, Behavioral Risk Factor Surveillance System, the Current Population Survey, the Massachusetts Health Insurance Survey, the Massachusetts Health Reform Survey, and the National Health Interview Survey.
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From page 161... ...
, raising questions about the appropriate interpretation of the insurance measure in the CPS. LESSONS LEARNED The two Massachusetts surveys have provided valuable information as the state has implemented its landmark health care reform initiative, including timely feedback on the impacts of reform on insurance cov erage, health care access and use, health care affordability, support for health care reform and other measures, and information on key population subgroups in the state.
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Children are defined as aged 0 to 18. SOURCES: Data from the American Community Survey, the Current Population Survey, and the Massachusetts Health Insurance Survey.
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From page 163... ...
These include • providing much larger state and local samples, overall and for key population groups (including children) ; • making state identifiers available outside research data center settings; • providing more geocoding of local areas; • adding state-specific program names to health insurance coverage questions; • expanding survey content to include questions on access, use, and costs of care, along with other issues of relevance to national health care reform; and • making data files available more quickly and in user-friendly for mats to facilitate their use by state analysts.
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From page 164... ...
. Massachusetts Division of Health Care Finance and Policy.
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