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Using Survey Data to Inform Health Policy in Minnesota

Using Survey Data to Inform Health Policy in Minnesota. Kathleen Thiede Call, Ph.D. AcademyHealth, Seattle WA June 25, 2006.

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Using Survey Data to Inform Health Policy in Minnesota

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  1. Using Survey Data to Inform Health Policy in Minnesota Kathleen Thiede Call, Ph.D. AcademyHealth, Seattle WA June 25, 2006 Supported by Blue Cross and Blue Shield of Minnesota Foundation, the federal Health Resources and Services Administration, and the Minnesota Department of Human Services

  2. In Collaboration with… Julie Sonier, Director April Todd-Malmlov, Associate Director Health Economics Program Minnesota Department of Health

  3. The Start of Data Collection in Minnesota • Reform movement in late 1980s led to large-scale state-funded survey in 1990 • 1990 Minnesota Health Access Survey (MNHA) telephone survey showed a 6 percent uninsurance rate • Large enough sample size to provide detailed information about uninsured • Funded by the Minnesota Health Care Commission

  4. Impact of Early MNHA Survey • MinnesotaCare Act enacted in 1992 • Comprehensive approach to reform • MN Health Care Commission’s legislative mandate to monitor number of uninsured • No $ attached • Triagulation approach: CPS, BRFSS, 1993 Robert Wood Johnson Foundation (RWJF) • “9 percent movement”

  5. Impact of 1995 MNHA Survey: The Adjustment Period • MNHA 1995 • Showed a stable 6% uninsuance rate • CPS 3-year rolling estimate shows 9% rate • Multiple interpretations— • No change- MinnesotaCare Act not successful • Rate dropped- MinnesotaCare Act successful; work is done • Compromose “6-9 percent movement” • Education “campaign” • Different data produce different estimates but consistent story—rate of uninsurance is low and stable • The importance of advisory committee structure in education campaign

  6. Subsequent MNHA Surveys

  7. Flexibility and Utility of Statewide Survey • Larger sample size • Access to micro data • Ability to adapt survey to address needs of policy makers • Change in sample design • Change in survey • Collect coverage for all household/family members • Collect employment status, employment characteristics for all adults • Add policy relevant segments (e.g., Medicare drug coverage, information about access to employer coverage)

  8. Impact of Later MNHA Surveys • Informed changes in MinnesotaCare eligibility (from children, to families, to adults without children) • Instrumental in passage of Eliminating Health Disparities Initiative • Basis for regular policy and data briefs on MDH-HEP and SHADAC websites used by state, county, city agencies and advocacy groups • Yearly legislative and administrative briefings to frame debates • Fiscal note analyses used for House and Senate Bills • MinnesotaCare Small Employer Option • Advocacy group use: • Children’s Defense Fund Report—legislative proposal • National Academy of Social Insurance—Medicare forum focused on near elderly (55-64)

  9. Other Policy-Relevant Uses of the Data • MNHA enables detailed analysis of coverage dynamics, reasons for changing coverage sources, and impact of policy options • Examples using 2001 and 2004 data: • Changes in coverage were related to changing employment, job characteristics, and access to employer coverage; • Rapid demographic change in Minnesota’s Hispanic/Latino population also played a significant role • With other data sources, usually no ability to do state-level analysis more detailed than a single statewide estimate

  10. Data Savvy State • Minnesota analysts use different data for different purposes. For example: • National data sources • CPS: national and cross state comparisons • NSAF: uninsured children prior to 1999 • BRFSS: use of surveys and coverage • The Minnesota survey • Coverage, access, eligibility • Policy simulations • Fiscal notes

  11. State Surveys vs. Other Data Sources • Generalization of MN experience? • Foreshadow of similar “concerns” with state-specific data witnessed in other states of late • With time, acceptance of state-specific data has grown so that MNHA is the preferred source of data (no more ranges) • Policymakers trust state-specific data and expect it to be available to them • State must be prepared to address questions about differences between various survey estimates and their advantages/disadvantages

  12. SHADAC Contact Information www.shadac.org 2221 University Avenue, Suite 345 Minneapolis, Minnesota 55455 (612) 624-4802

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