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6 Implementation Issues
Pages 191-202

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From page 191...
... . This session addresses issues related to data needs associated with the implementation of such a measure: what data are available now, what relevant data will become available under health care reform, data quality and timeliness concerns, and whether the measure of MCER could be released at the same time as the Supplemental Poverty Measure (SPM)
From page 192...
... After that one can think about whether there is some good reason to separate them. Factors Affecting Data Requirements Alternative design choices have a big impact on the data requirements for a medical care economic risk measure.
From page 193...
... MEPS income questions follow the federal tax form and include capital gains and state tax refunds, which are not counted in CPS money income. Respondents who refer to their tax returns would omit portions of earnings and possibly Social Security benefits excluded from taxation.
From page 194...
... Nonresponse to income questions is high; 30 percent of total income is imputed to respondents. A note of caution with the imputation methods is that the medical care risk index is a new measure, and the CPS imputation procedures may not take account of a lot of the components that may be part of this new measure and that may introduce certain kinds of error into the resulting index.
From page 195...
... A new panel started in 2008 will continue until replaced by a reengineered SIPP to be fielded in early 2014. Under the reengineered SIPP, annual interviews will replace the 4-month interviews; event history calendar methods will be used to collect monthly data with 12-month recall; most of SIPP core content will be retained; and key items from annual topical modules -- such as assets and medical and work-related ­ e ­ xpenditures -- will be added to annual interviews.
From page 196...
... Conclusion In conclusion, Czajka reiterated that questions about data source are reduced to what is collected in two surveys: the CPS and MEPS. MEPS collects essentially all data elements needed to construct alternative versions of the medical care risk index, whereas the CPS is missing critical variables for certain variants on these measures.
From page 197...
... Kenneth Finegold suggested that the study panel should consider using the Transfer Income Model, version 3 (TRIM3) as part of the discussion about developing the medical care risk index.
From page 198...
... was just getting the out-of-pocket information to add to the file rather than depending on the Medical Provider Survey, which includes all the different aspects of expenditures, and it is also getting income data, there could be a way of accelerating that sort of a component of MEPS that would then be updated with purer estimates from the medical provider survey. If one is depending just on the out-of-pocket information, perhaps the premium information that is paid out-of-pocket and the income information that is available before the Medical Provider Survey is conducted would be sufficient.
From page 199...
... That is the main story, he said, especially compared with the differences in data collection across the surveys. Caswell commented that, given the conceptual model that was presented and thinking about risk in a prospective way, he thought that modeling health status and particular health conditions would be very important.
From page 200...
... Sarah Meier commented that, with respect to the conceptual model, the risk adjustment models explain only a relatively small amount of the variation in health expenditures. So working with a very complex model that includes ICD-9 diagnosis codes and all sorts of other information, is actually not going to be a big improvement from working with just a scale of poor, good, and very good health status.
From page 201...
... IMPLEMENTATION ISSUES 201 Jennifer Madans (National Center for Health Statistics) stated that a scale of excellent, good, fair, and poor health is good at the extremes, but it is not very good in the middle.


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