Health and health care access questions across federal surveys

Attachment N – Health and Health Care Access Questions Across Federal Surveys During COVID-19

Census Pulse Survey and Current Population Survey

At NCHS’ request, the Census Household Pulse Survey during the Covid-19 Epidemic (referred to here as the “Census Pulse Survey”) is currently collecting two dimensions of healthcare access (health insurance status and whether or not a person did not receive non-coronavirus care in the last 4 weeks due to the coronavirus pandemic) as well as questions about general and mental health. These questions are as follows (bolded questions are also on the RANDS during COVID-19 questionnaire):

Pulse Health Questions (RANDS appears in bold)

• Would you say your health in general is excellent, very good, good, fair, or poor?

• Over the last 7 days, how often have you been bothered by the following problems

  • Feeling nervous, anxious, or on edge?

  • Not being able to stop or control worrying?

  • Having little interest or pleasure in doing things?

  • Feeling down, depressed, or hopeless?

• Are you currently covered by any of the following types of health insurance or health coverage plans?

• At any time in the last 4 weeks, did you DELAY getting medical care because of the coronavirus (COVID-19) pandemic?

• At any time in the last 4 weeks, did you need medical care for something other than coronavirus (COVID-19), but DID NOT GET IT because of the coronavirus (COVID-19) pandemic?

Additionally, at NCHS’ request, the Current Population Survey (CPS) is planning on adding one question on health care access during the Coronavirus pandemic. This question, shown below, is nearly identical to the version currently on the Census Pulse Survey and RANDS during COVID-19, with a slight change in the subject of the question to match what is common across the surveys’ questionnaires:

CPS Health Access Questions (RANDS appears in bold)

• At any time in the last 4 weeks, did you or anyone in your household need medical care for something other than coronavirus (COVID-19), but DID NOT GET IT because of the coronavirus (COVID-19) pandemic?

From both of these surveys, NCHS expects to get basic information about health insurance coverage and lack of non-Coronavirus care. The Census Pulse Survey is only asking a single question about both constructs. The CPS is asking only a single question about lack of non-Coronavirus care. Given the broad focus of the Pulse, and the economic focus of the CPS, NCHS also expects to be able to get information about how health insurance and lack of non-coronavirus care relate to other non-health variables from these surveys —in particular employment and economic status. Furthermore, given Pulse’s design, NCHS hopes to be able to gather information about changes over time and state-level information.

Research and Development Survey (RANDS)

As explained in Supporting Statement A and B (see A2 and B2, specifically, as well as Attachment M) NCHS plans to use RANDS to explore health care access during COVID-19 in detail. While CPS and Pulse are only adding one question on lack of non-coronavirus care and one question on health insurance, RANDS will provide NCHS with a robust set of variables about health care access in ways that no other federal surveys are planning. Not only will RANDS collect information on coronavirus health care access and telemedicine access and use, it will collect detailed information on the lack of non-coronavirus care including the types of care that were not used and the reasons for this lack. Furthermore, RANDS will also collect information on the availability of health care access, which is a concept completely uncovered in other federal surveys. The following items on health care access will be administered as part of RANDS (bolded questions are found on other Federal surveys during COVID-19 with the specific survey or surveys in parentheses after the question. The detailed wording of these questions is found in Attachment B and the purpose for which they are included on RANDS is found in Attachment M):

• Is there a place that you usually go to if you are sick and need health care? (NHIS)

• What kind of place is it? (NHIS)

• At any time in the last 4 weeks, did you need medical care for something other than Coronavirus, but not get it because of the Coronavirus pandemic? (CPS and Census Pulse Survey)

• In the last two months, were you unable to get any of the following types of care for any reason?

• [FILL: “Regarding your NOCARTYP”] Were you unable able to get this because of the Coronavirus pandemic?

• [FILL: “Regarding your NOCARTYP”] Did your medical provider make this decision or did you ?

• What reasons were you given for this decision?

• What reasons did you have for your decision?

• In the last two months, has this provider offered you a telephone or video appointment?

• In the last two months, have you had an appointment with a doctor, nurse, or other health professional by video or by phone? (Planned for NHIS with a different reference period)

• Did this provider offer telephone or video appointments before the Coronavirus pandemic?

• Did you seek medical care for Coronavirus or Covid-19?

• Why did you not seek this medical care?

• Since the Coronavirus pandemic began, have you been able, unable, or have not needed… To get medications?

• Since the Coronavirus pandemic began, have you been able, unable, or have not needed… To get a doctor’s appointment or some other kind of healthcare?

Given the specific health care access variables that no other Federal survey during COVID-19 has, RANDS will be able to specifically characterize health care access not only across demographic subgroups, but also across other health and health care access subgroups in ways that surveys such as the CPS and the Census Pulse Survey will not be able to do. Additionally, because RANDS was designed to replicate the CPS/Census Pulse Survey health care access question (and a number of NHIS questions), NCHS will be able to triangulate the health care access results from RANDS with the more general results of these other surveys.

National Health Interview Survey (NHIS)

It is not entirely certain when the NHIS will return to full administration, nor when its planned Coronavirus-related questions will be added. The earliest expectation is July 2020, though the exact date remains uncertain.

By design, RANDS overlaps with the NHIS across a wider range of constructs and variables, including: autoimmune conditions, access to health care, telemedicine, and COVID-19-related health. While RANDS and NHIS staff worked closely in order to facilitate this overlap as much as possible, some questions do differ because: 1) The timing of the surveys - RANDS is expected to field in May 2020, and the inclusion of the Coronavirus-related questions on the NHIS could be as much as 1.5 years out; 2) Based on preliminary testing, there is enough concern that some of the questions are problematic and require further examination that RANDS will provide via its measurement research goals. Additionally, RANDS will run the Census Pulse/CSP version of the access to non-Coronavirus care question, and not the similar NHIS question that asks about all care (instead of just non-Coronavirus care, see below). As explained in A2, NCHS made the decision to match the CPS/Pulse wording in this case for two reasons—first so that NCHS has a point of health care access triangulation with those surveys (whereas it can use other variables to triangulate RANDS with NHIS), and second because the information collected on CPS and the Census Pulse Survey will be contemporaneous to RANDS, whereas the equivalent information on NHIS will not be available until late 2020 at the earliest. The constructs where RANDS and the NHIS overlap include (bolded questions are common across both surveys or only differ in regards to the reference period):

Autoimmune

RANDS:

• Do you currently have a health condition that a doctor or other health professional told you weakens the immune system, making it easier for you to get sick?

NHIS:

• In the past 12 months, have you taken prescription medication or had any medical treatments that a doctor or other health professional told you would weaken your immune system?

• Do you currently have a health condition that a doctor or other health professional told you weakens the immune system, even without related medications or treatments?

Access to Care

RANDS and NHIS:

• USUALPL: Is there a place that you usually go to if you are sick and need health care? (NHIS)

• USPLKIND: What kind of place is it? (NHIS)

RANDS:

• At any time in the last 4 weeks, did you need medical care for something other than coronavirus, but not get it because of the coronavirus pandemic?

• At any point since the coronavirus pandemic began, have you been able, unable, or have not needed… to get a doctor’s appointment or some other kind of healthcare?

NHIS:

• Was there any time when you DELAYED getting medical care because of the coronavirus pandemic?

• Was there any time when you needed medical care, but DID NOT GET IT because of the coronavirus pandemic?

Telemedicine

RANDS and NHIS:

• In the last two months, have you had an appointment with a doctor, nurse, or other health professional by video or by phone? [Note that NHIS uses as 12 month reference period]

RANDS:

• In the last two months, has this provider offered you an appointment with a doctor, nurse, or other health professional by video or by phone?

• Did this provider offer you an appointment with a doctor, nurse, or other health professional by video or by phone before the Coronavirus pandemic?

NHIS:

• Were any of your appointments done by video or by phone because of reasons related to the coronavirus pandemic?

Covid-19 Health

RANDS and NHIS:

• Has a doctor or other health professional ever told you that you had or likely had Coronavirus or COVID-19?

• Have you ever been tested for Coronavirus or COVID-19?

Regarding access to health care access specifically, RANDS is collecting a series of Coronavirus-related questions during COVID-19, whereas NHIS is largely unable to collect data currently. Thus, while both surveys do include a number of health care access variables, and share some overlapping content, RANDS will be able to collect information and produce results during a time when NHIS will not be able to do so. Furthermore, RANDS will ask about both Coronavirus-specific health care access and about particular areas where respondents were unable to access health care—both of which are not planned for the NHIS.

National Longitudinal Survey of Youth | 1979 (NLSY79)

BLS plans to add three Coronavirus-related questions to the NLSY79, two of which appear on the RANDS: (bolded questions are shared across NLSY79and RANDS):

RANDS/ NLSY79 Questions

• Has a doctor or other healthcare professional told you that you had the coronavirus or COVID-19?

• Do you suspect that you have had the coronavirus or COVID-19?

• Were you unable to get any of the following types of care because of the coronavirus outbreak?

Note that the last question in this list was from an early draft of the RANDS during COVID-19 questionnaire. With the three questions they are adding, BLS should be able to examine not only the incidence of COVID-19 within the 1979 cohort, but also whether or not the Coronavirus pandemic has impacted specific types of health care access.

Medicare Current Beneficiary Survey

MCBS staff reached out to NCHS and requested a draft of the RANDS during COVID-19 questionnaire in March. NCHS is unaware of the final questionnaire that CMS will field, but we expect that they will be able to use any RANDS health care access questions to examine whether and which specific types of health care are limited during the COVID-19 pandemic.