Medical Care Economic Risk Measuring Financial Vulnerability from Spending on Medical Care (2012) / Chapter Skim
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5 Data Sources
5 Data Sources
Pages 89-100
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From page 89... ...
This chapter reviews the data sources that might be used to construct a measure of MCER. Our discussion covers both the medical expenditure risk and financial resources components of a potential measure.
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From page 90... ...
Requirements for the resources component include · Earned income · nearned income, equivalent to the unearned component of Cen U sus money income · ash value of in-kind benefits, such as the Supplemental Nutrition C Assistance Program, school free and reduced-price breakfast and lunch programs, and housing assistance · Taxes paid -- federal, state, and payroll · Work-related expenses, including child care and commuting · Liquid assets 1 Chapter 4 also discusses the calculation of a retrospective measure of MCER using CPS ASEC data. We focus here on the preferred prospective measure, which requires longitudinal data.
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From page 91... ...
None of the three surveys collects all the variables that would be required to develop a prospective measure of MCER as described in Chapter 4. Most notably, none of the three surveys collects a description of the services and treatments covered by each person's health insurance plan, and none of the surveys collects sufficient information with which to assess each sample member's potential liability for out-of-pocket medical costs, although MEPS and the HRS do collect limited information: participation in health maintenance organizations in MEPS and the HRS and whether coverage for a preexisting condition is limited in the HRS.
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From page 92... ...
aData include participation in health maintenance organizations. bData include whether coverage for a preexisting condition is limited.
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From page 93... ...
SIPP collects no data on chronic medical conditions, which is likely to be one of the most important predictors of subsequent medical expenditures, given that none of the surveys collects information on the details of health insurance coverage. SIPP does collect information on in-kind benefits and commuting and child care costs, but its data on taxes paid do not appear to be useful.
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From page 94... ...
, or the predictive model could be applied to another data set that provides measures of the relevant baseline characteristics. The latter approach offers a way to make the measurement of MCER more timely and to extend the measure to a larger and possibly more representative sample.
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From page 95... ...
The CPS ASEC provides a standard for statistical precision because of its role as the official source of monthly unemployment estimates and annual poverty rates and its widespread use for estimating the percentage of the population without health insurance coverage. The CPS ASEC collects interviews from about 80,000 households each year.
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From page 96... ...
Fewer baseline characteristics imply a weaker model unless the baseline characteristics that are omitted have no impact. Because none of the longitudinal surveys provides detailed information on what is actually included in health insurance coverage, such variables will not be included in the predictive model, so the absence of such variables from all five surveys, although a major limitation for modeling, is beside the point.
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From page 97... ...
lData are collected for the consumer unit rather than the family or household. It is not pos sible to reconstruct data for health insurance units when they differ from consumer units.
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From page 98... ...
Minimally, however, it would require only measures of prior year premiums and out-of-pocket expenditures, along with prior year measures of all of the resources that would be needed for a prospective measure, assuming that disposable income as defined for the SPM, plus a portion of liquid assets, would be used as the measure of resources. In essence, a retrospective measure of medical care economic risk of this kind would be similar to a retrospective measure of financial burden, as described in Chapter 2, with the exception of including a portion of liquid assets in the former measure.
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From page 99... ...
If MCER depends too heavily on the measures of chronic medical conditions and functional limitations that are present in the MEPS but not the CPS ASEC, then the CPS ASEC would not be a satisfactory choice. If the development effort should demonstrate that a prospective measure is itself not viable at present or not sufficiently different from a retrospective measure, then the CPS ASEC would be a stronger choice for this alternative measure.
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From page 100... ...
Recommendation 5-2: The panel recommends that the Census Bureau and the Agency for Healthcare Research and Quality assess the merits of adding items to both the Current Population Survey Annual Social and Economic Supplement and the Medical Expenditure Panel Survey to at least partially address the most critical data limitations identified for measuring medical care economic risk.
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