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Monitoring the Health Care Safety Net

Slide Presentation by Lynn A. Blewett, Ph.D.

On September 24, 2003, Lynn A. Blewett, Ph.D., made a presentation in the Web-Assisted Audioconference entitled Safety Net Data Collection Strategies.

This is the text version of Dr. Blewett's slide presentation. Select to access the PowerPoint® slides (151 KB).

Safety Net Data Collection Strategies

Lynn A. Blewett, Ph.D.
State Health Access Data Assistance Center
School of Public Health, University of Minnesota

Supported by a grant from The Robert Wood Johnson Foundation

Slide 1

Estimating the Number of Uninsured

  • Estimates of demand based on state and local estimates of the number of uninsured.
  • Most estimates come from household surveys that ask about health insurance coverage.
  • Also used in combination with employer surveys that ask about health insurance coverage.

Slide 2

Estimating the Size of the Uninsured Populations at the Local Level

  1. Do your own survey
    • To directly measure health insurance coverage and rates of uninsurance
  2. Use existing available data to:
    • Develop proxy measures of uninsurance
    • Develop statistical model-based estimates

Slide 3

Direct Measures: National Data

  • Three surveys provide state-level estimates of health insurance coverage.
    • Current Population Survey (CPS): Census
    • Medical Expenditure Panel (Employer) Survey - Insurance Component (MEPS-IC): Agency for Healthcare Research and Quality
    • State and Local Area Integrated Telephone Survey (SLAITS): National Center for Health Statistics

Slide 4

Direct Measures: State Data

  • 37 States have developed and fielded their own state household survey to estimate levels of health insurance coverage
    • Many funded by the federal Health Resources Services and Administration State Planning Grant Program
    • Typically have larger sample size and some regional/county estimates of coverage

Slide 5

Other National Surveys of Note

  • National Survey of America's Families (NSAF): Urban Institute
    • Uninsurance estimates available for 13 states
    • Public use files available to states for analysis
  • Community Tracking Study: Center for Health System Change
    • Uninsurance estimates can be made for the 12 communities in the CTS sample

Slide 6

Proxy Measures

  • Use an available measure to serve as a proxy for health insurance coverage
  • Example: self-pay variable from hospital administrative records to estimate local levels of uninsurance

Slide 7

Model-Based Approach

  • Predicts health insurance coverage using one or more variables correlated with health insurance coverage
  • Example: correlation between state unemployment and uninsurance and applying this at local level

Slide 8

National Model-Based Estimates

  • Small-Area Estimation
  • Census and AHRQ are both working on sophisticated models to provide state and local area estimates
    • CPS: Uninsurance
    • MEPS-IC: Employment offer and take up rates

Slide 9

This slide contains a table showing an Overview of Approaches for Estimating Number of Uninsured At the Local Level. The principal strength of the Direct Estimation-New Survey approach is precision; the principal weakness of this approach is cost. The principal strength of the proxy measure approach is cost; the principal weakness of this approach is bias. The principal strength of the model-based approach is predictive accuracy; the principal weakness is complexity.

Slide 10


  • Be knowledgeable and aware of different data sources available for your community
  • Use existing resources and data and build on existing state and local survey activities
  • Use multiple approaches to maximize information
  • Be flexible as new data become available

Slide 11

Contact Information
2221 University Avenue, Suite 345
Minneapolis Minnesota 55414
(612) 624-4802

Principal Investigator: Lynn Blewett, Ph.D.
Co-Principal Investigator: Kathleen Call, Ph.D.
Center Director: Kelli Johnson, M.B.A.
Senior Research Associate: Timothy Beebe, Ph.D.
Research Associate: Michael Davern, Ph.D.

Current as of February 2004

Internet Citation:

Safety Net Data Collection Strategies. Text Version of a Slide Presentation at a Web-assisted Audioconference. Agency for Healthcare Research and Quality, Rockville, MD.

Return to Audioconference

The information on this page is archived and provided for reference purposes only.

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