2008 Massachusetts Health Insurance Survey Methodology Report

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Abstract

The Urban Institute, along with its subcontractor, International Communications Research, conducted the 2008 Massachusetts Health Insurance Survey (HIS) for the Massachusetts Division of Health Care Finance and Policy to obtain information on health insurance coverage and access to and use of health care for the non-institutionalized population in Massachusetts. This report provides information about the methods used to collect and analyze the 2008 HIS data.

Introduction

The Massachusetts Division of Health Care Finance and Policy (DHCFP) contracted with the Urban Institute, and its subcontractor, International Communications Research/ICR, to conduct the 2008 Massachusetts Health Insurance Survey (HIS). The goal of the 2008 HIS is to document health insurance coverage and access to and use of health care for the non-institutionalized population in Massachusetts. This report provides information about the methods used to collect and analyze the 2008 HIS data.

The report is organized in seven sections. The first section (Section I) describes the design of the sample used for the 2008 survey. Section II discusses the design of the survey instrument. The next two sections describe our data collection strategy (Section III) and data processing and preparation (Section IV), respectively. Section V addresses the response rate to the survey. Section VI describes the survey weights and variance estimation. The final section (Section VII) presents estimates of the uninsurance rate in Massachusetts in 2008.

I. Sample Design

The 2008 HIS has a dual sample frame design that combines a random-digit-dial (RDD) telephone sample and an address-based (AB) household sample. The decision to rely on the dual-frame sample for the 2008 HIS reflects the changing telephone environment in the United States. Historically, RDD telephone interviewing has been the method of choice for many survey data collection efforts given the strength of its randomization method (random digit dialing), ease of administering complex questionnaires using computerized interviewing systems, excellent coverage of the overall population (given that less than 2% of Americans live in a household without telephone service), and relatively low cost. Survey coverage refers to the extent to which the sample frame for a survey includes all members of the target population. A survey design with a gap in coverage raises the possibility of bias if the individuals missing from the sample frame (e.g., households without landline telephones) differ from those in the sample frame. Unfortunately, the coverage of the overall population in RDD surveys is changing as more and more households are relying on cell phones and giving up their landline telephones. Cell phone numbers are typically not called in RDD surveys.

Reliable estimates of the number of cell-phone-only households are not available at the state level; however, data from the National Health Interview Survey (NHIS) found that, nationally, 15.8% of households were cell-phone-only households in the July-December 2007 period (Blumberg and Luke 2008). This is up from 12.8% over the same period in the prior year (Blumberg and Luke, 2007), and is expected to continue to increase over time. In fact, NHIS data from 2003 to 2007 show a steady increase in the share of cell-phone-only households in the United States (Blumberg and Luke, 2008).

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