Using an Internet-Based Survey to Measure Coverage and Access to Health Care: The Health Reform Monitoring Survey

Major national surveys (e.g., American Community Survey (ACS), National Health Interview Survey (NHIS), and Current Population Survey (CPS)), while critical for longer term evaluations, will provide little information on the Affordable Care Act’s (ACA) effects on coverage, access to care, and affordability based on these sources in 2014. The Health Reform Monitoring Survey (HRMS), a quarterly survey of about 7500 non-elderly adults in the US that draws on questions used in the major national surveys, was initiated in January 2013 as a way to bridge that information gap.  This survey is based on a nationally-representative probability-based internet panel maintained by the GfK Custom Research.

 Although not a substitute for the national surveys, information from the HRMS will be available long before preliminary estimates of the early impacts of the ACA are available from the NHIS in late 2014, and final estimates available from ACS, CPS, and NHIS in mid to late 2015.  However, since internet surveys typically have response rates well below those of the major national surveys, it is critical to establish that estimates from an internet-based survey do not differ systematically from other estimates. By doing this, we can have greater confidence that early findings form the HRMS will be a good indicator of what can be expected from evaluations based larger national surveys.

Early analysis shows that, although the overall HRMS adult uninsurance rate in the first quarter of 2013 was significantly lower than the estimate from the 2011 ACS, HRMS adult uninsurance rates variation across age, race/ethnicity and income categories are consistent with those observed in the ACS.  Comparisons of the HRMS measures of health care access and affordability that overlap with the NHIS suggest greater access and affordability problems among adults in the HRMS than in the NHIS across most of the measures, including lacking a usual source of care, problems finding a doctor, and unmet need for care because the care was not affordable.  While access and affordability levels may differ by survey mode, we find, as in the NHIS, that uninsured adults had greater barriers to care, on average, than adults with coverage. Taken together, these findings lead us to conclude that the HRMS will be a credible source for early monitoring of the effects of the ACA while awaiting the availability of national survey data.