Program Administrative Data Research Articles

Monitoramento rápido de coberturas vacinais pós-campanhas de vacinação no Brasil: 2008, 2011 e 2012

Objective: describe rapid monitoring of vaccination coverage (RMC) following Measles Mumps Rubella (MMR) (2008-2011) and Multivaccination (2012) vaccination campaigns. Methods: descriptive study using National Immunization Program administrative data on vaccine coverage as well as RMC data, in addition to data on the grounds for non-vaccination (2011-2012). Result: MMR vaccine coverage exceeded 95% in the campaigns. RMC data on a single dose of MMR found 92% post-campaign coverage in 2008 and 96% in 2011. In 2011, 41,700 MMR doses were administered post-campaign, raising vaccination coverage to 99.5% in that year. In 2012 post-campaign coverage ranged between 97% (polio and hepatitis B) and 82% (second diphtheria-tetanus-pertussis booster). Lack of time was the main motive for non-vaccination (43.6% in 2011 and 32.7% in 2012). Conclusion: RMC is a useful tool for evaluating vaccination coverage and reaching those not vaccinated, in addition to informing interventions.

Repeated and Combined Participation in Workforce, Education and Social Program Services: Preliminary Evidence from Maryland Administrative Data Sources

One justification for extended retention of program administrative data is a resulting capability to study whether and how often repeated, concurrent and sequential appearances are found in multiple program transaction records. The expected return-on-investment from extended retention of administrative data rises when coverage of multiple programmatic interventions is consolidated in an integrated data system. This report is based on a preliminary exploration of linked historical administrative data files containing recorded instances of individual participation in defined education, workforce and social service programs. Our results to date should be treated as illustrative of decision-relevant insights that future refinements can produce. To explore the incidence of repeated, concurrent and sequential participation in more than one government program we accessed two workforce, threepublic education, and two social services administrative data files. We document that many individuals do engage in multiple workforce, education and social services program activities, and in repeated participation within each of the program types. There are many reasons for sustained interest in reliable measurement of repeated and combined program engagements. Some combinations and sequences are looked upon favorably, while others are viewed with some concern. Care should be exercised to avoid hasty conclusions about the benefits and costs that can be assigned to particular combinations of program engagements. Our next steps will include renewed attention to dynamic person identification and program engagement methodologies, while continuing the design and implementation of our study of up to 27 years of multiple program engagements by 1984 credit-course enrollees in Maryland’s public community colleges.

Social Assistance and Birth Outcomes: Evidence from the Uruguayan Panes

This paper estimates the impact of a large temporary poverty relief program, Uruguay's PANES on birth outcomes. Using program administrative data and longitudinal vital statistics, a significant and precisely estimated reduction in the fraction of low-weight newborns (less than 2,500 g. ) on the order of 10 to 20 percent was found to be a result of treatment. The cash (and in-kind) transfer components of the program were considered to drive the results, suggesting that unrestricted social assistance has the potential to positively affect birth outcomes, most likely through improved nutrition. Assuming that all the effect of the program was through the transfer, an elasticity of low birthweight with respect to welfare transfers on the order of around 0. 30 can be inferred.

Social Assistance and Birth Outcomes: Evidence from the Uruguayan Panes

This paper estimates the impact of a large temporary poverty relief program, Uruguay’s PANES—on birth outcomes. Using program administrative data and longitudinal vital statistics, a significant and precisely estimated reduction in the fraction of low-weight newborns (less than 2,500 g. ) on the order of 10 to 20 percent was found to be a result of treatment. The cash (and in-kind) transfer components of the program were considered to drive the results, suggesting that unrestricted social assistance has the potential to positively affect birth outcomes, most likely through improved nutrition. Assuming that all the effect of the program was through the transfer, an elasticity of low birthweight with respect to welfare transfers on the order of around 0. 30 can be inferred.

Possible Herd Immunity in the Elderly Following the Vaccination of School Children with Live, Attenuated Trivalent Influenza Vaccine: A Person-Level Analysis

Models predict that immunizing as few as 20% of school children, important transmitters of influenza, will reduce influenza-related illness in the elderly. We evaluated the potential herd immunity during three influenza seasons, 2005-2006, 2006-2007 and 2007-2008, which followed the immunization of>40% of school children in Knox County (KC), TN, with live, attenuated influenza vaccine. Individual-level demographic, health status and health service utilization information about KC residents>65 years and those residing in the 8 surrounding counties was obtained from the United States Medicare Program's administrative data. Influenza seasons were identified based on virus isolation. Pneumonia and influenza (P&I) hospitalization rates per 1,000 were compared between the elderly residing in the two areas for the three influenza seasons, and the 3 prior seasons. Differences-in-difference multivariate analysis allowed us to estimate the effect of the school-based immunization program on P&I hospitalization rates simultaneously adjusting for other important individual-level covariates. The age-adjusted rates among the KC residents were significantly lower, 4.62 and 6.02 versus 6.54 and 7.58 than in the residents of the comparison counties during the first two intervention seasons, p=0.001 and 0.037, respectively, but not in the third. However, after adjusting for the traditionally lower rates of P&I hospitalization in the comparison counties, as well as for the other covariates, we were not able to demonstrate a statistically significant effect of the vaccination program in reducing the rates in either group of the elderly. The impact of the covariates was as expected. Those associated with increased P&I hospitalization rates were increasing age, lower income, poorer health status, prior hospitalization (particularly for P&I), and high prior use of physician services. Influenza immunization of an elderly person reduced his/her probability of being hospitalized for P&I. In conclusion, Immunization of>40% of school children did not result in a reduction of P&I hospitalization rates among the elderly. We believe that the failure to show an impact was likely due to the high level of immunization among the elderly (> 60%). Administration of influenza vaccine to children as a way to protect the elderly in situations where vaccine supplies are limited or the elderly are not accustomed to receiving influenza vaccine may still be appropriate.

Health Care Spending and Service Use among High-Cost Medicaid Beneficiaries, 2002–2004

Using program administrative data, this paper examines spending and service use patterns for the national Medicaid population between 2002 and 2004, with a focus on high-cost beneficiaries. We observed a high degree of spending persistence. 57.9% of those who were among the top 10% of Medicaid spenders in 2002 remained in the top 10% of spenders in the two subsequent years. We identified two distinct subgroups of high spenders--those with persistently high costs and those with episodically high costs-each with different services driving their costs.

Understanding The Current Population Survey's Insurance Estimates And The Medicaid ‘Undercount’

The widely cited Census Bureau estimates of the number of uninsured people, based on the Current Population Survey, probably overstate the number of uninsured people. This is because of a Medicaid "undercount": Fewer people report to survey takers that they're covered by Medicaid than program administrative data show are enrolled. Our study finds that the undercount can be explained by the inability of people to recall their insurance status accurately from the previous year. We suggest that other data sources, such as Census's American Community Survey, should be studied to determine whether they would provide better estimates of the uninsured.

Enhancing NHANES value for food assistance policy research through linkages with program administrative data

Enhancing NHANES value for food assistance policy research through linkages with program administrative data

Management Tools for Medicaid and State Childrenʼs Health Insurance Program (SCHIP)

Medicaid and the State Children's Health Insurance Program need analytic tools to manage their programs. Drawing upon extensive discussions with experts in states, this article describes the state of the art in tool use, making several observations: (1) Several states have linked Medicaid/State Children's Health Insurance Program administrative data to other data (eg, birth and death records) to measure access to care. (2) Several states use managed care encounter data to set payment rates. (3) The analysis of pharmacy claims data appears widespread. The article also describes "lessons learned" regarding building capacity and improving data to support the implementation of management tools.

Multigenerational coresidence and welfare policy

As part of the 1996 federal welfare reform, lawmakers required unmarried, minor parents to live with their own parents (or another qualified adult). This paper considers a few key issues related to this requirement: 1) prior to the living arrangements requirement, did income from Aid to Families with Dependent Children (AFDC) lead teenage mothers to move out of their parents' home? 2) did young mothers who stayed at home do better or worse than their peers who moved out? and 3) how solid is the research evidence about these topics? Measurement barriers in census data prior to the mid-1980s and in state program administrative data, in the past and still today, impede identification of all teenage parents who live at home. Yet, even given this undercount, available data indicates that most unmarried, minor mothers lived with their parents, or other adult relatives, prior to the 1996 welfare reform. Although the research base on the topic is small, there is not clear evidence that the small fraction of young mothers who moved out of their parents' home did so because they could access AFDC income. Consistent descriptive evidence does suggest that living in a three-generational household is associated with teenage mothers' greater economic self-sufficiency; at the same time, however, coresiding teenage mothers appear to exhibit poorer parenting skills and the effects on their children and their own parents remain little understood. These findings are discussed in relation to the minor parent residence policy, and recommendations for future research are made including: 1) collection of data that better identifies minor parent families living in senior parents' households; 2) using whole-family perspectives that look beyond the minor mother to the well-being of her parents, children, and other family members; 3) studies that consider the selection of teenage mothers into various living arrangements when studying their consequences, and 4) intensive studies of positive and negative aspects of family functioning and social networks when minor mothers live in various arrangements. © 1999 John Wiley & Sons, Inc.