The National Employer Health Insurance Survey (NEHIS) was developed to obtain national and State level estimates of the number of employers offering health insurance, their costs, the coverage and characteristics of their respective health plans. In the NMES III Health Insurance Providers Survey, detailed information related to employer provided health insurance plans is also obtained, including details of plans held by household respondents. As currently designed, there is noticeable overlap in the focus of the two surveys.
The proposed design integrates the analytical capabilities of these distinct surveys. The overall survey design of the NEHIS survey would be modified to improve upon the limitations of the 1994 survey. Revisions would be made to the survey instruments based on results from an evaluation of the quality of the instrument used in the 1994 survey. The revised NEHIS Establishment Questionnaire and the revised NEHIS Plan Questionnaire would serve as the core questionnaires to be administered to all establishments associated with MEP survey respondents that comprise the Consolidated System of Health and Expenditure Surveys. The employers associated with the MEP survey respondents would receive a supplemental streamlined HIPS-type questionnaire to obtain person-based information on employer sponsored health insurance coverage (e.g., household members' specific coverage and premium).
The resulting design would reflect a consolidation of the questionnaire designs, imputation techniques, estimation tasks and data base designs across the surveys. Efforts will be made to develop estimation strategies to allow the two distinct employer samples to be combined to produce national estimates of the number of employers offering health insurance, their costs, the coverage and characteristics of their health plans.
The consolidated NEHIS/HIPS would parallel the sample size cycles of the MEP. A sample of 42,000 employers every five years would coincide with the more extensive MEP, and provide both national and 50-State estimates in that year. In the off-years of the survey (e.g. 1998-2001, 2003-2006), the sample would be reduced in scale to 15,000 employers, but with sufficient sample for national estimation and for major policy relevant employer population subgroups of interest (e.g, classification by size, industry classification).
Consolidated Design Features
The establishment-based consolidated health survey would incorporate the data collection efforts for NMES-HIPS and NEHIS into one effort with the following features:
• a cross-sectional design, in which establishments are interviewed once in any given year ;
• a continuous data collection effort, providing annual data for every year thereby maximizing on efficiency while minimizing costs associated with the start of a data collection effort;
• a sample size of 42,000 establishments every five years (at peak cycles), and 15,000 establishments annually; and
• a single questionnaire and data collection effort which satisfies the analytic capabilities of the individual data collection efforts.
Consolidated Design Efficiencies
The consolidated design reflects the following reductions in burden and associated costs:
• a reduction in the number of employer interviews;
• a reduction in the annual costs of data collection;
• efficiencies with respect to questionnaire design and implementation similar to those outlined for the consolidated household survey; and
• efficiencies with respect to post-data processing (editing, imputation, weighting, production of analytic data files), similar to those outlined in the consolidated household survey.
Expanded and Enhanced Analytic Capabilities
With respect to analytic capabilities, the consolidated effort provides:
• the ability to monitor changes in the coverage and costs of employer-sponsored health insurance at both the national and State level;
• provide measures of employer-sponsored health insurance coverage and costs for the national and State health accounts;
• assess changes in the provision of health insurance by employers;
• analyze person-level and family-level changes over time in the scope of health insurance coverage and options, for the proportion of the sample linked to the consolidated household survey;
• analyze behavior in the context of family choices and employer responses; and
• provide data on employer characteristics at both the establishment level and the firm level.