About the MNHA Survey data

The Minnesota Health Access (MNHA) Survey is a state landline and cellular telephone survey that collects information related to health insurance and health care access for children and adults.

 

  • The Minnesota Health Access Survey is a state telephone survey that collects information on adults and children related to health insurance and health care access.
  • The survey is conducted in partnership with the Minnesota Department of Health, Health Economics Program and the University of Minnesota, School of Public Health, State Health Access Data Assistance Center (SHADAC).
  • The survey has been conducted in 2001, 2004 and every two years since 2007.
  • The MNHA provides representative health insurance coverage estimates for the state overall, thirteen economic development regions and populations of color in Minnesota.
  • The survey includes the following information:
    • General health status (excellent, very good, good, fair, poor) and CDC Healthy Days Measure.
    • Detailed type(s) of health insurance coverage available or held by survey respondents and sources of coverage available to respondent as dependent coverage.
    • Gaps in health insurance coverage (length of time with or without coverage) and reasons for lack of coverage.
    • Knowledge and perceptions about public coverage.
    • Health insurance coverage for remaining family members.
    • Dental insurance coverage.
    • Employment information for all adults in the household:
      • Employment status (unemployed or employed).
      • Employment type (full-time, part-time, student status, retired).
      • Industry.
      • Number of jobs and total hours worked.
    • Educational level (less than high school, high school, some college, college graduate, professional degree).
    • Other demographic data such as poverty level, race and ethnicity, age, sex, geographic region, country of birth and length of time in the United States.
    • Access to and use of healthcare:
      • Regular place of health care.
      • Number of outpatient doctor visits in the past 12-months.
      • Inpatient stays in the past 12-months.
      • Number of outpatient emergency room care in the past 12-months and reason.
      • Any issues finding a doctor and getting medical appointments when needed.
      • Confidence in the health care system and perceptions of discrimination experienced based on race and ethnicity, type of insurance or lack of insurance and nationality.
      • Affordability concerns that have resulted in delays or not receiving prescription drugs, dental care, routine medical care, mental health and other medical specialties.
      • Problems paying medical bills.
  • The MNHA plays an important role in monitoring policy-relevant trends in health insurance coverage and informing health policy development in Minnesota on topics such as affordability of coverage, redesign of public program coverage and evidence of discrimination faced by enrollees in state public programs.
  • Document health and dental insurance coverage over time.
  • Identify gaps in health insurance coverage and reasons for not having insurance.
  • Identify health and dental insurance disparities by race and ethnicity, sex, age, employment, education, nativity (U.S. versus foreign born) and geographic region.
  • Identify barriers to receiving health care such as lack of insurance, financial difficulty, ability to find doctor or make an appointment, and perceived discrimination.
  • Specific source of dental insurance coverage.
  • Reasons for not having dental insurance.
  • Types of dental care needs that were unmet due to costs.
  • Survey design: Cross-sectional (prevalence) survey.
  • Questionnaire: Modeled after the Coordinated State Coverage Survey developed by SHADAC.
  • Sampling method
    • Since 2009, the sampling frame consists of landline and cellular telephone numbers (dual frame design).
    • The sample is a stratified random sample of households with oversampling of areas such as rural Minnesota and areas with greater probabilities of reaching populations of color and American Indians.
    • Interviewers collect information on the number of household members, relationship of household members, sex and age. Then, one person is selected at random to be the target of the survey. The majority of survey questions ask about this randomly selected target.
  • Household eligibility: A household is eligible to participate in the survey if Minnesota is the primary place of residence.
  • Sample size refers to the number of interviews completed in a given year. The sample size of the survey varies over time and includes responses from between 9,700 and 27,000 households between 2001 and 2015.

MNHA response, cooperation and refusal rates of landline and cellular phones, 2009-2015.

 

Notes: The response rate is the ratio of the number of completed interviews divided by the number of eligible reporting units in a sample. The cooperation rate is the ratio of the number of all interviewed cases divided by the number of all eligible cases contacted. The refusal rate is the ratio of the number of eligible cases that refused to participate in the survey divided by the number of all contacted eligible cases.

^ The total count includes partial interviews with complete data through questions about health insurance coverage (H series).

*Based on AAPOR RR4 response and cooperation rates from 2001-2007. Based on AAPOR RR3 response and cooperation rates from 2009 onward which excludes partials.

**Based on AAPOR refusal rate 2 (REF2), includes estimates of eligible cases among unknown cases. For comparability with prior MNHAS, refusal rate calculations in 2009 and 2011 ignored screening that occurred (e.g., excluding minors both years and over sampling of cell only households in 2011). In 2011, the refusal rate was 27% and 58% for landline and cell frames respectively.

  • Weighting: Two types of weights are applied to account for sample coverage problems (the difference between respondents and non-respondents) and to reduce potential bias associated with differential participation in the survey. These weights produce estimates that are representative of the state population.
    • Base weight takes into consideration that each respondent’s probability of selection varied by sampling stratum, i.e. the number of phone lines connected to the household (or number of cell phones accessible to adults in the case of the cell phone frame) and the number of people living in the household.
    • Post-stratification weight adjusts the base weight to account for key characteristics of the state’s population such as region, age, education, race, nativity (U.S. versus foreign born), home ownership, household count, telephone use and telephone service interruption.

There are three ways to classify uninsurance:

  1. Point-in-time: respondents who said they did not have health insurance at the time of the survey.
  2. Part-year: survey respondents who said they did not have health insurance during some period of time in the past 12-months.
  3. Full-year: survey respondents who said they did not have health insurance for the past 12-months.

All three measures of “uninsurance” were collected in the survey, however the point-in-time classification is the measure used in the View Charts pages.

No. Survey methodologies in the MNHA are different from national surveys that collect health insurance data such as the Current Population Survey and the American Community Survey. In addition, the National Association of Dental Plans collects data and reports yearly on national and state resident enrollment in dental plans, dental benefits and consumer behavior.

Oral health questions Response options

Do you (DOES TARGET) currently have insurance that pays for all or part of your (TARGET's) dental care?

  • Yes
  • No
  • Don’t know
  • Refused

During the past 12 months, was there any time that (you/TARGET) did (INSERT CHOICE) because of cost?  Choice B. Not get dental care that (you/TARGET) needed.

  • Yes
  • No
  • Don’t know
  • Refused
  • No dental insurance coverage: The percent of Minnesotans who reported they did not have insurance to cover all or part of their dental care at the time of the survey.
  • Forgone dental care: The percent of Minnesotans who reported that there was a time in the past 12 months that they did not get needed dental care due to costs.

No dental insurance coverage (percent): The number of Minnesotans who reported they did not have insurance to cover all or part of their dental care at the time of the survey divided by the total number of Minnesotans, multiplied by 100 to get a percent.

Forgone dental care (percent): The number of Minnesotans who did not get needed dental care within the past 12 months due to costs divided by the total number of Minnesotans, multiplied by 100 to get a percent.

Note: data is weighted to population characteristics to create representative population level estimates.

Each data indicator may be analyzed by a number of population characteristics, including:

  • Age: 0 to 17 years, 18 to 25 years, 26 to 34 years, 35 to 44 years, 45 to 64 years and 65 years and older.
  • Race and ethnicity: White, Black, American Indian, Asian, and Hispanic.
  • Education: Less than high school, high school, some college, college graduate, and postgraduate.
  • Household poverty level (federal poverty level): 100% or below, 101 to 200%, 201 to 300%, 301 to 400%, and above 400%.
  • Residence: urban, large rural city or town, small rural town and isolated small rural town as defined by Rural/Urban Commuting-Area taxonomy (RUCA-zip) developed by the University of Washington, Rural Health Research Center.
  • Non-institutionalized (not on active duty in the Armed Forces or living in mental health facilities, long-term care facilities, nursing homes, or prisons) Minnesota residents.
  • Survey data is based on respondent report of health insurance and access to care measures (reporting bias); however, due to lack of a single administrative data source, surveys are the standard way to measure lack of insurance.
  • All surveys have possible selection bias. For the MNHA survey, this may arise from:
    • The survey sample is the civilian non-institutional population, and does not include those in the Armed Forces who are living elsewhere, or those living in mental health facilities, long-term care facilities, nursing homes, or prisons.
    • The survey is only conducted in English and Spanish.
    • The MNHA is a telephone survey; therefore, households who do not have access to a landline or cellular phone do not have an opportunity to respond to the survey. Nonetheless, previous research has indicated minimal bias from this source.

Minnesota Department of Health Oral Health Program (2015). Minnesota Department of Health, Health Economics Program. Collected by the Minnesota Oral Health Program. St. Paul, Minnesota: MN Public Health Data Access portal. [Add URL] Retrieved month, year.

To learn more about the Minnesota Health Access Survey, see the MDH Health Economics Program, or contact the MDH Oral Health Program: health.oral@state.mn.us

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