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State Health AccessState Health Access
Reform EvaluationReform Evaluation
Lynn A. Blewett, Ph.D. State Health Access Data Assistance Center
State Coverage Initiatives (SCI) National Meeting
Nashville, Tennessee February 8, 2007
Funded by a grant from the Robert Wood Johnson Foundation
2
Presentation Objectives
• To get you to think about measurable outcomes during your discussions of health reform
• To be specific about your expectations for reform initiatives – How you will know if the program achieved its
objectives? What data will you need?
• To talk to each other and reach consensus on expectations…..
• Think about state-specific data needs and build those into your legislation
3
States Are in Different Phases of Reform Process
In
Discussion
Legislation Introduced
Legislation Passed/
Implementation
Post –Implementation
Colorado
Minnesota
Illinois (all)
New Jersey
New Mexico
PA (all)
WI (all)
California
Oregon
WI
Massachusetts
PA (kids)
Vermont
WI (kids)
Illinois (kids)
Maine
4
Framework for Reform
Public Sector
Initiatives
Employer-Based
Initiatives
Insurance
Reform
Tax credits
HIFA expansion waivers
SCHIP premium assistance
Small employer
purchasing pools
5
POLICY FORMULATION-Agenda Setting-Assessment of Options-Political Setting
POLICY IMPLEMENTATIONPOLICYAdoption
POLICY MODIFICATION
Program Evaluation, Assess impact of policiesInfluence future policy formulation
INPUTSPreferences of individuals, organizations, interest groups, along with cultural
Demographics, ethical, legal, social and technological inputs
Rulemaking Operation
Source: Longest, 1998Longest, 1988.Policy Making Process in the US
6
Performance Assessment or Program Evaluation?
• Performance Measurement– ongoing assessment
– use of performance standards
– early warning system to management
– vehicle for improving accountability to the public
• Program Evaluation– typically more in-depth examination of program
– broader context of environment and alternatives
– overall assessment of whether the program works
– identification of adjustments that may improve its results
Source: U.S. Government Accountability Office, 1998.
7
Levels of Measurement
• Population-based– Data collected from sample of target
population– Survey data, focus groups
• Program-based– Data collected from program recipients,
clients, or participants– Administrative data
8
Program Evaluation Data
• Quantitative Data– Surveys, secondary data (uninsured rate)– Measures activities carried out– Administrative data: program utilization,
behavior change, or cost per unit of change
• Qualitative Data– Interviews, focus groups, observations,
document review– Use to understand attitudes, beliefs, reactions,
to assess quality, to explain perceptions
9
Performance Assessment
• How do you know if your health reform was successful?
• Key Areas to Assess:– Coverage– Cost and Efficiency– Fairness and Equity– Choice and Autonomy
• Develop goals that are measurable, assessable and realistic.
• Consider short-term and long-term outcomes.
10
On Average Uninsurance Estimates from State Surveys are 22% Lower than CPS
11.2%
15.2%
12.1%
7.4%
14.2%
16.1% 16.4%
11.7%
0%
5%
10%
15%
20%
AL 2003 AR 2001 GA 2003 MA 2004
State Estimate CPS from State Survey Year
Uninsurance Estimates for Select States
11
Increased Sample Size in State SurveysHousehold Sample Sizes for Selected States: 2001 Expanded CPS Annual Demographic Supplement and State Initiated Surveys
States
Households Interviewed in Expanded Sample 2001 CPS
Households Interviewed in Recent State-Initiated Household Survey
Alabama 1,254 7,299 Arkansas 903 2,572 Colorado 1,522 10,000 Connecticut 1,339 3,985 Georgia 1,094 10,088 Hawaii 1,028 6,000 Indiana 1,389 10,126 Kansas 1,268 8,004 Maine 1,268 3,500 Maryland 1,273 5,000 Massachusetts 1,432 2,362 Montana 866 4,000 New Hampshire 1,281 5,177 South Carolina 1,014 1,600 Utah 932 7,250 Vermont 1,173 8,622 Washington 1,350 6,726 Wisconsin 1,481 2,436 * Source: Current Population Survey Demographic Supplement 2001
12
State Health AccessData Assistance Center
• Funded by the Robert Wood Johnson Foundation– University of Minnesota, School of Public Health
• Goals:– Help states monitor rates of health insurance coverage
using state and federal data – Research factors associated with access and coverage – Provide targeted policy analysis and technical
assistance to states
• Bridge between state and federal agencies; between survey data and state health policy
• Technical assistance on use of federal survey data and best practices on state surveys
13
State Health Access Reform Evaluation
• National Program Office of the RWJF – Co-located with SHADAC at University of MN, SPH
• Goals:– Fund and coordinate evaluations of state health reform
– Identify and fill gaps on research to identify what works and why
– Organize and disseminate findings in a manner that is meaningful and user-friendly
– Inform state and national policy on health care access and coverage
• Technical assistance on program evaluation and assessment
15
Concluding Comments
• Staff - Ask key legislative leaders what they will want to know next year?
• Discuss long- and short-term program objectives and identify the monitoring process up front
• Make sure staff understand legislative/policy objectives
• Make sure policy makers understand limitations of data/measurement
• Build performance assessment into legislative initiatives
16
More Concluding Comments
Don’t forget to think about…. • Performance assessment and
– Monitoring along the way– Likely within state government
• Program evaluation– How are we going to know in 2-3 years if the program
achieved its objectives?– Possible outside vendor/contractor
• Think now about what you will want to know later – It’s more difficult to go back and evaluate a program
without good baseline data and information
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Federal DataFederal Data(e.g., CPS)(e.g., CPS)
Better Understanding of the Better Understanding of the Characteristics of the UninsuredCharacteristics of the Uninsured
State DataState Data(e.g., State Surveys)(e.g., State Surveys)
The SHADAC Vision
Increase Coverage and AccessIncrease Coverage and Access
THANK YOU!
18
Contact Information
www.shadac.org
www.statereformevaluation.org
University of MinnesotaSchool of Public Health
Division of Health Policy and Management
2221 University Avenue, Suite 345 Minneapolis Minnesota 55414
(612) 624-4802
Principal Investigator: Lynn A. Blewett, Ph.D. ([email protected])