View Research by Author - Shruti Rajan

Citation URL: http://www.urban.org/ShrutiRajan

Until recently, most surveys of insurance coverage have classified people as uninsured if they have not been assigned some coverage in response to one of a series of questions about specific types of insurance. This “residual” approach to measuring uninsurance rates has not required respondents to either verify their insurance status or confirm that they are uninsured. Using the 1997 National Survey of America’s Families, this paper examines the impact of a question confirming whether or not individuals for whom no insurance coverage is reported are, in fact, uninsured. The results of our analysis suggest that a confirmation question as part of a telephone-based survey works to lower estimates of the uninsured. Staring in March 2000 and following the findings of this study, the Current Population Survey introduced a confirmation question in its health insurance sequence. (Inquiry 2000 Fall; 37(3):317-327)

Health disparities among racial and ethnic groups have a long history and continue to exist in the United States. The U.S. government has established as a goal for the year 2010 the elimination of racial/ethnic health differences in six areas. This article examines disparities in one of those areas: access to high-quality health care. Several measures of access and use of health care services are studied both nationally and in 13 diverse states. We find that both the magnitude of disparity and the reasons behind it depend significantly on the state, the ethnic group, and the type of measure being studied. Such information can be valuable for state and national policy makers in targeting resources and in designing effective strategies for the elimination of racial and ethnic disparities. (Medical Care Research and Review 2000; 57(Supplement 1): 55-84).

This paper presents preliminary findings from the 1997 National Survey of America's Families (NSAF), a household survey providing information on over 100,000 children and non-elderly adults representing the noninstitutionalized civilian population under age 65. Focusing on health insurance coverage and several measures of access to care the authors find that children are faring better than adults in terms of health insurance coverage, primarily due to recent Medicaid expansions, the CHIP program and other state-subsidized insurance efforts. The authors also find large variations in rates of uninsurance across states with such variations generally reflecting differences in private-sector coverage. Finally, the authors show that insurance coverage differences across states and between adults and children are correlated with differences in access to care and health status.

This paper provides an overview of the health policy component of the National Survey of America’s Families (NSAF), fielded as part of the Urban Institute’s Assessing the New Federalism project. The paper is intended to provide policymakers, researchers, and potential users of public use files with an overview of NSAF’s purpose, sampling approach and questionnaire content, with a focus on issues that will be of primary interest to health care researchers. Additionally, we describe planned research using the survey and dates for public release of the NSAF data. (Inquiry 1999 Fall;36(3):353-362)

This paper explores the effects of small group and individual insurance market reforms on health insurance coverage using data from the 1989 through 1995 Current Population Survey. Instead of examining the effects of each of the various types of reforms, we reflect how reforms were generally implemented and measure the effects of packages of reforms. We find that small group reforms did little to affect coverage, but that individual market reforms reduced private coverage and increased uninsurance rates. However, our findings suggest that small group reforms may have prevented the erosion of private coverage during the early 1990s. (Inquiry 1999 Spring; 36(1):44-56)

One way of assessing how well the health care system is serving children is by determining how confident parents are that they can get medical care for their children when they need it. If the persistent number of children lacking health insurance or the growing concern about the rights of patients in managed care has undermined parents' confidence, the system may not be meeting children's needs.

People who lack a regular source of health care may not receive services when they need them, leading to missed diagnoses, untreated conditions, and adverse health outcomes. Maintaining regular contact with a health services provider can be difficult for low-income people, who are less likely to have health insurance coverage. People without insurance often rely on hospital emergency rooms, which can raise overall costs and lessen continuity of care. To determine the percentage of children and nonelderly adults with no usual source of health care, adults were asked whether they and their children had a regular place or provider of care and where they received care.

Using the state as the unit of analysis, this study gauges the effects of various state policy interventions on rates of uninsurance, private coverage, and Medicaid coverage for the nonelderly population. The study controls for economic structures, population demographics, and characteristics of the health-service market. Then, using Wisconsin counties as units of analysis within a common regulatory environment, the relative importance of economic and demographic characteristics of the health-service market are tested to see if any of these factors can explain overall rates of health insurance coverage.

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