Demand for health services are examined among Americans ages 65 and older using the Medical Expenditure Panel Survey. Analyses are provided of mode of residence, demand for paid health services in private settings, and the choice of type of nursing home using a common set of explanatory variables. The research shows that age, Medicare coverage, and the use of assistive technology are the strongest predictors of mode of residence. The second analysis shows that total expenditures for paid home health care (HHC) and hospital care do not decrease as expected when the percentage paid by individuals and/or their families increases. Finally, the third analysis suggests that the distribution of nursing home (NH) services is related to ability to pay.
-
Medicare Coverage and Reporting
December 2016
Working Paper Number:
carra-2016-12
Medicare coverage of the older population in the United States is widely recognized as being nearly universal. Recent statistics from the Current Population Survey Annual Social and Economic Supplement (CPS ASEC) indicate that 93 percent of individuals aged 65 and older were covered by Medicare in 2013. Those without Medicare include those who are not eligible for the public health program, though the CPS ASEC estimate may also be impacted by misreporting. Using linked data from the CPS ASEC and Medicare Enrollment Database (i.e., the Medicare administrative data), we estimate the extent to which individuals misreport their Medicare coverage. We focus on those who report having Medicare but are not enrolled (false positives) and those who do not report having Medicare but are enrolled (false negatives). We use regression analyses to evaluate factors associated with both types of misreporting including socioeconomic, demographic, and household characteristics. We then provide estimates of the implied Medicare-covered, insured, and uninsured older population, taking into account misreporting in the CPS ASEC. We find an undercount in the CPS ASEC estimates of the Medicare covered population of 4.5 percent. This misreporting is not random - characteristics associated with misreporting include citizenship status, year of entry, labor force participation, Medicare coverage of others in the household, disability status, and imputation of Medicare responses. When we adjust the CPS ASEC estimates to account for misreporting, Medicare coverage of the population aged 65 and older increases from 93.4 percent to 95.6 percent while the uninsured rate decreases from 1.4 percent to 1.3 percent.
View Full
Paper PDF
-
Reporting of Indian Health Service Coverage in the American Community Survey
May 2018
Working Paper Number:
carra-2018-04
Response error in surveys affects the quality of data which are relied on for numerous research and policy purposes. We use linked survey and administrative records data to examine reporting of a particular item in the American Community Survey (ACS) - health coverage among American Indians and Alaska Natives (AIANs) through the Indian Health Service (IHS). We compare responses to the IHS portion of the 2014 ACS health insurance question to whether or not individuals are in the 2014 IHS Patient Registration data. We evaluate the extent to which individuals misreport their IHS coverage in the ACS as well as the characteristics associated with misreporting. We also assess whether the ACS estimates of AIANs with IHS coverage represent an undercount. Our results will be of interest to researchers who rely on survey responses in general and specifically the ACS health insurance question. Moreover, our analysis contributes to the literature on using administrative records to measure components of survey error.
View Full
Paper PDF
-
Health-Related Research Using Confidential U.S. Census Bureau Data
August 2008
Working Paper Number:
CES-08-21
Economic studies on health-related issues have the potential to benefit all Americans. The approaches for dealing with the growth of health care costs and health insurance coverage are ever changing and information is needed on their efficacy. Research on health-related topics has been conducted for about a decade at the Census Bureau\u2019s Center for Economic Studies and the Research Data Centers. This paper begins by describing the confidential business and demographic Census Bureau data products used in this research. The discussion continues with summaries of nearly 30 papers, including how this work has benefited the Census Bureau and its research findings. Some focus on data linkages and assessing data quality, while others address important questions in the employer, public, and individual insurance markets. This research could not have been accomplished with public-use data. The newly available data from the Agency for Healthcare Research and Quality and National Center for Health Statistics, as well as additional Census Bureau data now available in the Research Data Centers are also discussed.
View Full
Paper PDF
-
Income Packaging and Economic Disconnection: Do Sources of Support Differ from Other Low-Income Women?
December 2013
Working Paper Number:
CES-13-61
Income packaging, or piecing together cash and non-cash resources from a variety of sources, is a common financial survival strategy among low-income women. This strategy is particularly important for economically disconnected women, who lack both employment income and public cash assistance receipt. Using data from the confidential Census Bureau versions of the Survey of Income and Program Participation, this study compares the use of public and private supports between disconnected and connected low-income women, controlling for differences in state welfare rules and county unemployment rates. Findings from bivariate comparisons and multilevel logistic regressions indicate that disconnected women utilize public non-cash supports at similar rates to connected women, but rely more heavily on private sources. Conclusions focus on the policy implications for outreach and program development.
View Full
Paper PDF
-
Response Error & the Medicaid undercount in the CPS
December 2016
Working Paper Number:
carra-2016-11
The Current Population Survey Annual Social and Economic Supplement (CPS ASEC) is an important source for estimates of the uninsured population. Previous research has shown that survey estimates produce an undercount of beneficiaries compared to Medicaid enrollment records. We extend past work by examining the Medicaid undercount in the 2007-2011 CPS ASEC compared to enrollment data from the Medicaid Statistical Information System for calendar years 2006-2010. By linking individuals across datasets, we analyze two types of response error regarding Medicaid enrollment - false negative error and false positive error. We use regression analysis to identify factors associated with these two types of response error in the 2011 CPS ASEC. We find that the Medicaid undercount was between 22 and 31 percent from 2007 to 2011. In 2011, the false negative rate was 40 percent, and 27 percent of Medicaid reports in CPS ASEC were false positives. False negative error is associated with the duration of enrollment in Medicaid, enrollment in Medicare and private insurance, and Medicaid enrollment in the survey year. False positive error is associated with enrollment in Medicare and shared Medicaid coverage in the household. We discuss implications for survey reports of health insurance coverage and for estimating the uninsured population.
View Full
Paper PDF
-
Manufacturing Firms' Decisions Regarding Retiree Health Insurance
June 2003
Working Paper Number:
CES-03-14
This study analyzes the firm's decision to offer and contribute to retiree health insurance. We apply a binomial probit model and an interval regression model to analyze the likelihood of offering and the proportion of costs contributed by the firm. Our findings indicate that while firm characteristics affect the probability that a firm offers retiree health insurance, financial performance and alternative insurance options significantly affect the firm's generosity towards its cost. This study expands on previous research by including potentially important policy-related measures to the more limited set of firm and workforce characteristics that have been typically employed.
View Full
Paper PDF
-
Complex Survey Questions and the Impact of Enumeration Procedures: Census/American Community Survey Disability Questions
April 2009
Working Paper Number:
CES-09-10
This paper explores challenges relating to the identification of the population with disabilities,focusing on Census Bureau efforts using the 2000 Decennial Census Long-Form (Census 2000) and 2000-2005 American Community Survey (ACS). In particular, the analyses explore the impact of survey methods on responses to the work limitation (i.e., employment disability) question in these two Census products. Building on the research of Stern (2003) and Stern and Brault (2005), we look for further evidence of misreporting of an employment disability by specific sub-populations using the participation in the Supplemental Security Income program as an exogenous employment disability status indicator along with a subset of ACS disability questions. We expand upon these earlier studies by examining both false-positive and falsenegative reports of employment disability by implementing logit estimations to examine the role of respondent/enumerator error on the accuracy of the employment disability response. In this manner, we enhance our understanding of Census 2000 and ACS responses to employment disability questions through an exploration of the role of enumeration procedures in two types of misclassifications, as well as by evaluating existing data and estimates to uncover characteristics that might make an individual more likely to misreport an employment disability.
View Full
Paper PDF
-
State and Local Determinants of Employment Outcomes among Individuals with Disabilities
March 2016
Working Paper Number:
CES-16-21
In the United States, employment rates among individuals with disabilities are persistently low but vary substantially. In this study, we examine the relationship between employment outcomes and features of the state and county physical, economic, and policy environment among a national sample of individuals with disabilities. To do so, we merge a set of state- and county-level environmental variables with data from the 2009'2011 American Community Survey accessed in a U.S. Census Research Data Center. We estimate regression models of employment, work hours, and earnings as a function of health conditions, personal characteristics, and these environmental features. We find that certain environmental variables are significantly associated with employment outcomes. Although the estimated importance of environmental variables is small relative to individual health and personal characteristics, our results suggest that these variables may present barriers or facilitators to employment that can explain some geographic variation in employment outcomes across the United States.
View Full
Paper PDF
-
Neighborhood Income and Material Hardship in the United States
January 2022
Working Paper Number:
CES-22-01
U.S. households face a number of economic challenges that affect their well-being. In this analysis we focus on the extent to which neighborhood economic conditions contribute to hardship. Specifically, using data from the 2008 and 2014 Survey of Income and Program Participation panel surveys and logistic regression, we analyze the extent to which neighborhoods income levels affect the likelihood of experiencing seven types of hardships, including trouble paying bills, medical need, food insecurity, housing hardship, ownership of basic consumer durables, neighborhood problems, and fear of crime. We find strong bivariate relationships between neighborhood income and all hardships, but for most hardships these are explained by other household characteristics, such as household income and education. However, neighborhood income retains a strong association with two hardships in particular even when controlling for a variety of other household characteristics: neighborhood conditions (such as the presence of trash and litter) and fear of crime. Our study highlights the importance of examining multiple measures when assessing well-being, and our findings are consistent with the notion that collective socialization and community-level structural features affect the likelihood that households experience deleterious neighborhood conditions and a fear of crime.
View Full
Paper PDF
-
Planning Parenthood: The Affordable Care Act Young Adult Provision and Pathways to Fertility
January 2017
Working Paper Number:
CES-17-65
This paper investigates the effect of the Affordable Care Act young adult provision on fertility and related outcomes. The expected effect of the provision on fertility is not clear ex ante. By expanding insurance coverage to young adults, the provision may affect fertility directly through expanded options for obtaining contraceptives as well as through expanded options for obtaining pregnancy-, birth-, and infant-related care, and these may lead to decreased or increased fertility, respectively. In addition, the provision may also affect fertility indirectly through marriage or labor markets, and the direction and magnitude of these effects is difficult to determine. This paper considers the effect of the provision on fertility as well as the contributing channels by applying difference-in-differences-type methods using the 2008-2010 and 2012-2013 American Community Survey, 2006-2009 and 2012-2013 Centers for Disease Control and Prevention abortion surveillance data, and 2006-2010 and 2011-2013 National Survey of Family Growth. Results suggest that the provision is associated with decreases in the likelihood of having given birth and abortion rates and an increase in the likelihood of using long-term hormonal contraceptives.
View Full
Paper PDF