Papers written by Author(s): 'Alice Zawacki'
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Viewing papers 1 through 10 of 17
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Working PaperMethodology on Creating the U.S. Linked Retail Health Clinic (LiRHC) Database
March 2023
Working Paper Number:
CES-23-10
Retail health clinics (RHCs) are a relatively new type of health care setting and understanding the role they play as a source of ambulatory care in the United States is important. To better understand these settings, a joint project by the Census Bureau and National Center for Health Statistics used data science techniques to link together data on RHCs from Convenient Care Association, County Business Patterns Business Register, and National Plan and Provider Enumeration System to create the Linked RHC (LiRHC, pronounced 'lyric') database of locations throughout the United States during the years 2018 to 2020. The matching methodology used to perform this linkage is described, as well as the benchmarking, match statistics, and manual review and quality checks used to assess the resulting matched data. The large majority (81%) of matches received quality scores at or above 75/100, and most matches were linked in the first two (of eight) matching passes, indicating high confidence in the final linked dataset. The LiRHC database contained 2,000 RHCs and found that 97% of these clinics were in metropolitan statistical areas and 950 were in the South region of the United States. Through this collaborative effort, the Census Bureau and National Center for Health Statistics strive to understand how RHCs can potentially impact population health as well as the access and provision of health care services across the nation.View Full Paper PDF
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Working PaperThe Underserved Have Less Access to Employer-Sponsored Telemedicine Coverage
September 2022
Working Paper Number:
CES-22-40
Telemedicine has been proposed as one means of improving health care access for underserved communities, and information about insurance coverage for telemedicine (TMC) is important in understanding its utilization and provision. We use 2018-2019 Medical Expenditure Panel Survey-Insurance Component data on employer-sponsored coverage to examine pre-pandemic TMC relative to employer, worker, and health plan characteristics. We find that the share of employees in private sector establishments offering TMC was lower in the most rural counties, in smaller firms, in establishments without unionized employees, and in establishments where most workers were low wage, part-time and older when compared to other establishments. These findings reflect differences across establishments in insurance offers, as well as differences in TMC conditional on an insurance offer, which suggests that TMC may function as a premium plan feature with limited availability and potential support for improving healthcare access for the underserved.View Full Paper PDF
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Working PaperIntroducing the Medical Expenditure Panel Survey-Insurance Component with Administrative Records (MEPS-ICAR): Description, Data Construction Methodology, and Quality Assessment
August 2022
Working Paper Number:
CES-22-29
This report introduces a new dataset, the Medical Expenditure Panel Survey-Insurance Component with Administrative Records (MEPS-ICAR), consisting of MEPS-IC survey data on establishments and their health insurance benefits packages linked to Decennial Census data and administrative tax records on MEPS-IC establishments' workforces. These data include new measures of the characteristics of MEPS-IC establishments' parent firms, employee turnover, the full distribution of MEPS-IC workers' personal and family incomes, the geographic locations where those workers live, and improved workforce demographic detail. Next, this report details the methods used for producing the MEPS-ICAR. Broadly, the linking process begins by matching establishments' parent firms to their workforces using identifiers appearing in tax records. The linking process concludes by matching establishments to their own workforces by identifying the subset of their parent firm's workforce that best matches the expected size, total payroll, and residential geographic distribution of the establishment's workforce. Finally, this report presents statistics characterizing the match rate and the MEPS-ICAR data itself. Key results include that match rates are consistently high (exceeding 90%) across nearly all data subgroups and that the matched data exhibit a reasonable distribution of employment, payroll, and worker commute distances relative to expectations and external benchmarks. Notably, employment measures derived from tax records, but not used in the match itself, correspond with high fidelity to the employment levels that establishments report in the MEPS-IC. Cumulatively, the construction of the MEPS-ICAR significantly expands the capabilities of the MEPS-IC and presents many opportunities for analysts.View Full Paper PDF
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Working PaperDeveloping Content for the Management and Organizational Practices Survey-Hospitals (MOPS-HP)
September 2021
Working Paper Number:
CES-21-25
Nationally representative U.S. hospital data does not exist on management practices, which have been shown to be related to both clinical and financial performance using past data collected in the World Management Survey (WMS). This paper describes the U.S. Census Bureau's development of content for the Management and Organizational Practices Survey Hospitals (MOPS-HP) that is similar to data collected in the MOPS conducted for the manufacturing sector in 2010 and 2015 and the 2009 WMS. Findings from cognitive testing interviews with 18 chief nursing officers and 13 chief financial officers at 30 different hospitals across 7 states and the District of Columbia led to using industry-tested terminology, to confirming chief nursing officers as MOPS-HP respondents and their ability to provide recall data, and to eliminating questions that tested poorly. Hospital data collected in the MOPS-HP would be the first nationally representative data on management practices with queries on clinical key performance indicators, financial and hospital-wide patient care goals, addressing patient care problems, clinical team interactions and staffing, standardized clinical protocols, and incentives for medical record documentation. The MOPS-HP's purpose is not to collect COVID-19 pandemic information; however, data measuring hospital management practices prior to and during the COVID-19 pandemic are a byproduct of the survey's one-year recall period (2019 and 2020).View Full Paper PDF
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Working PaperAddressing Data Gaps: Four New Lines of Inquiry in the 2017 Economic Census
September 2019
Working Paper Number:
CES-19-28
We describe four new lines of inquiry added to the 2017 Economic Census regarding (i) retail health clinics, (ii) management practices in health care services, (iii) self-service in retail and service industries, and (iv) water use in manufacturing and mining industries. These were proposed by economists from the U.S. Census Bureau's Center for Economic Studies in order to fill data gaps in current Census Bureau products concerning the U.S. economy. The new content addresses such issues as the rise in importance of health care and its complexity, the adoption of automation technologies, and the importance of measuring water, a critical input to many manufacturing and mining industries.View Full Paper PDF
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Working PaperWhy are employer-sponsored health insurance premiums higher in the public sector than in the private sector?
February 2019
Working Paper Number:
CES-19-03
In this article, we examine the factors explaining differences in public and private sector health insurance premiums for enrollees with single coverage. We use data from the 2000 and 2014 Medical Expenditure Panel Survey-Insurance Component, along with decomposition methods, to explore the relative explanatory importance of plan features and benefit generosity, such as deductibles and other forms of cost sharing, basic employee characteristics (e.g., age, gender, and education), and unionization. While there was little difference in public and private sector premiums in 2000, by 2014, public premiums had exceeded private premiums by 14 to 19 percent. We find that differences in plan characteristics played a substantial role in explaining premium differences in 2014, but they were not the only, or even the most important, factor. Differences in worker age, gender, marital status, and educational attainment were also important factors, as was workforce unionization.View Full Paper PDF
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Working PaperCOMPARING METHODS FOR IMPUTING EMPLOYER HEALTH INSURANCE CONTRIBUTIONS IN THE CURRENT POPULATION SURVEY
August 2013
Working Paper Number:
CES-13-41
The degree to which firms contribute to the payment of workers' health insurance premiums is an important consideration in the measurement of income and for understanding the potential impact of the 2010 Affordable Care Act on employment-based health insurance participation. Currently the U.S. Census Bureau imputes employer contributions in the Annual Social and Economic Supplement of the Current Population Survey based on data from the 1977 National Medical Care Expenditure Survey. The goal of this paper is to assess the extent to which this imputation methodology produces estimates reflective of the current distribution of employer contributions. The paper uses recent contributions data from the Medical Expenditure Panel Survey-Insurance Component to estimate a new model to inform the imputation procedure and to compare the resulting distribution of contributions. These new estimates are compared with those produced under current production methods across employee and employer characteristics.View Full Paper PDF
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Working PaperA Guide to the MEPS-IC Government List Sample Microdata
September 2011
Working Paper Number:
CES-11-27
The Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) is conducted to provide nationally representative estimates on employer sponsored health insurance. MEPSIC data are collected from private sector employers, as well as state and local governments. While similar information is gathered from these two sectors, differences in the survey process exist. The goal of this paper is to provide details on the public sector including types of state and local government employers, sample design, general information on the data collected in the MEPS-IC, and additional sources of information.View Full Paper PDF
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Working PaperDeclines in Employer Sponsored Coverage Between 2000 and 2008: Offers, Take-Up, Premium Contributions, and Dependent Options
September 2010
Working Paper Number:
CES-10-23
Even before the current economic downturn, rates of employer-sponsored insurance (ESI) declined substantially, falling six percentage points between 2000 and 2008 for nonelderly Americans. During a previously documented decline in ESI, from 1987 to 1996, the fall was found to be the result of a reduction in enrollment or 'take-up' of offered coverage and not a decline in employer offer/eligibility rates. In this paper, we investigate the components of the more recent decline in ESI coverage by firm size, using data from the MEPS-IC, a large nationally representative survey of employers. We examine changes in offer rates, eligibility rates and take-up rates for coverage, and include a new dimension, the availability of and enrollment in dependent coverage. We investigate how these components changed for employers of different sizes and find that declining coverage rates for small firms were due to declines in both offer and take-up rates while declining rates for large firms were due to declining enrollment in offered coverage. We also find a decrease in the availability of dependent coverage at small employers and a shift towards single coverage across employers of all sizes. Understanding the components of the decline in coverage for small and large firms is important for establishing the baseline for observing the effects of the current economic downturn and the implementation of health insurance reform.View Full Paper PDF
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Working PaperHealth Insurance and Productivity: Evidence from the Manufacturing Sector
September 2009
Working Paper Number:
CES-09-27
This paper examines the relationship between employer-sponsored offers of health insurance and establishments' labor productivity. Our empirical work is based on unique plant level data that links the 1997 and 2002 Medical Expenditure Panel Survey-Insurance Component with the 1992, 1997, and 2002 Census of Manufactures. These linked data provide information on employer-provided insurance and productivity. We find that health insurance offers are positively associated with levels of establishments' labor productivity. These findings hold for all manufacturers as well as those with fewer than 100 employees. Our preliminary results also show a drop in health care costs from the 75th to the 25th percentile would increase the probability of a plant offering insurance by 1.5-2.0 percent in both 1997 and 2002. The results from this paper provide encouraging and new empirical evidence on the benefits employers may reap by offering health insurance to workers.View Full Paper PDF
