Analysis of Children's Health Insurance Patterns: Findings from the SIPP. 1. Strengths and Limitations of SIPP

05/12/1999

Several features of the SIPP make these data especially appealing for the analysis of children’s health insurance coverage. The SIPP provides a detailed measure of health insurance coverage for every month of the two to three year duration of a panel. Because of the SIPP rotation group design, the estimates for a given calendar month are based on a median two-and-a-half-month recall, with one quarter being only one month and one quarter being four months. Measures of the duration of new spells of particular types of coverage or lack of coverage can be constructed by aggregating the reports from successive interview waves, so that no matter how long the measured duration of a particular spell, no part of a reported spell relies on respondent recall beyond four months. In addition to providing measures of health insurance coverage, SIPP also provides very detailed measures of demographic and economic characteristics--again on a monthly basis. This affords us the opportunity to construct contemporaneous measures of circumstances that may affect eligibility for and enrollment in particular types of coverage.

Despite the strengths of the SIPP design, however, there are some notable limitations. Monthly reports of a number of characteristics--including Medicaid participation and uninsurance--show evidence of a pronounced “seam effect.” That is, monthly transitions (for example, in reported Medicaid coverage or health insurance coverage generally) are reported as occurring disproportionately between the four-month reference periods of interview waves rather than within these reference periods. Whereas we would expect only one quarter of such transitions to occur between reference periods, we find evidence that 75 to 90 percent of the transitions in certain statuses occur between interview waves--as if respondents were reporting their coverage (or interviewers recording them) in four-month chunks rather than month-by-month. As we demonstrate in another report [no citation yet], this has a profound impact on the reported distribution of spells of Medicaid coverage and uninsurance, and it may affect the point-in-time estimates as well (unless respondents are equally likely to “round up” as “round down” their reported months of coverage in a reference period). Like other surveys, SIPP shows evidence of underreporting of program participation and many sources of income, although there is evidence to suggest that SIPP does better in this regard than surveys with annual reference periods and less detailed measurement of these characteristics.

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