Kenney Genevieve, Holahan John, Nichols Len
The Urban Institute, 2100 M Street, NW, Washington, DC 20037, USA.
Health Serv Res. 2006 Jun;41(3 Pt 1):918-45. doi: 10.1111/j.1475-6773.2006.00544.x.
Examination of the extent to which federal surveys provide the data needed to estimate the coverage/cost impacts of policy alternatives to address the problem of uninsurance.
DATA SOURCES/STUDY SETTING: Assessment of the major federal household surveys that regularly provide information on health insurance and access to care based on an examination of each survey instrument and related survey documentation and the methodological literature.
Identification of the data needed to address key policy questions on insurance coverage, assessment of how well existing surveys meet this need, definition of the critical elements of an ideal survey, and examination of the potential for building on existing surveys.
DATA COLLECTION/EXTRACTION METHODS: Collection and critical assessment of pertinent survey documentation and methodological studies.
While all the federal surveys examined provide valuable information, the information available to guide key policy decisions still has major gaps. Issues include measurement of insurance coverage and critical content gaps, inadequate sample sizes to support precise state and substate estimates, considerable delays between data collection and availability, and concerns about response rates and item nonresponse. Our assessment is that the Current Population Survey (CPS) and the National Health Interview Survey could be most readily modified to address these issues.
The vast resources devoted to health care and the magnitude of the uninsurance problem make it critical that we have a reliable source for tracking health care and coverage at the national and state levels and for major local areas. It is plausible that this could be more cost effectively done by building on existing surveys than by designing and fielding a new one, but further research is needed to make a definitive judgment. At a minimum, the health insurance information collected on the CPS should be revised to address existing measurement problems.
考察联邦调查在多大程度上能提供所需数据，以估计解决未参保问题的政策替代方案对覆盖范围/成本的影响。
数据来源/研究背景：基于对每项调查工具、相关调查文档及方法学文献的审查，评估定期提供医疗保险和就医机会信息的主要联邦住户调查。
确定解决保险覆盖关键政策问题所需的数据，评估现有调查满足这一需求的程度，定义理想调查的关键要素，并考察在现有调查基础上进行改进的潜力。
数据收集/提取方法：收集并批判性评估相关调查文档和方法学研究。
虽然所考察的所有联邦调查都提供了有价值的信息，但用于指导关键政策决策的可用信息仍存在重大差距。问题包括保险覆盖范围的衡量和关键内容缺失、样本量不足无法支持精确的州和州以下层面估计、数据收集与可得性之间存在相当大的延迟，以及对回应率和项目无回答的担忧。我们的评估是，当前人口调查（CPS）和国家健康访谈调查最容易进行修改以解决这些问题。
投入到医疗保健的大量资源以及未参保问题的严重性，使得我们在国家、州和主要地方层面拥有可靠的医疗保健和覆盖范围跟踪来源至关重要。通过在现有调查基础上进行改进，可能比设计并开展一项新调查更具成本效益，但需要进一步研究才能做出明确判断。至少，应修订当前人口调查收集的健康保险信息，以解决现有的衡量问题。
