A potential new data source for assessing the impacts of health reform: Evaluating the Gallup-Healthways Well-Being Index

Abstract

Background: Existing national health-related surveys take several months or years to become available. The Affordable Care Act will bring rapid changes to the health care system in 2014. We analyzed the Gallup-Healthways' Well-Being Index (WBI) in order to assess its ability to provide real-time estimates of the impact of the ACA on key health-related outcomes. Methods:We compared the Gallup-Healthways WBI to established surveys on demographics, health insurance, access to care, and health. Data sources were the Gallup-Healthways WBI, the Current Population Survey, the American Community Survey, the Medical Expenditure Panel Survey, the National Health Interview Survey, and the Behavioral Risk Factor Surveillance System. Demographic measures included age, race/ethnicity, education, and income. Insurance outcomes were coverage rates by type, state, and year. Access measures included having a usual source of care and experiencing cost-related delays in care. Health measures were self-reported health and history of specific diagnoses.Results: Most differences across surveys were statistically significant (p<0.05) due to large sample sizes, so our analysis focused on the absolute magnitude of differences. The GallupHealthways WBI post-weighted sample was similar in age, race/ethnicity, and education to other surveys, though the Gallup-Healthways WBI sample is slightly older, has fewer minorities, and is more highly educated than in other national surveys. In addition, income was more frequently missing. The Gallup-Healthways WBI produced similar national, state, and time-trend estimates on uninsured rates, but far lower rates of public coverage. Access to care and health status were similar in the Gallup-Healthways WBI and other surveys. Conclusions:The Gallup-Healthways WBI is a valuable complement to existing data sources for health services research. The Gallup-Healthways WBI estimates for uninsured rates and access to care were similar to established national surveys and may allow for rapid estimates of the ACA's impact on the uninsured in 2014. Estimates of insurance type are less comparable, particularly for public coverage, which likely limits the utility of the Gallup-Healthways WBI for analyzing changes in particular types of coverage.

Health Reform and Changes in Health Insurance Coverage in 2014

“…32,33 The income information in the WBI is limited, which means that our estimates of income as a percentage of poverty are imprecise, and previous research has shown that the survey overrepresents the middle of the income distribution. 8 Nonetheless, we found logical patterns of coverage on the basis of these measurements, and results were similar when we excluded observations with missing income data.…”

“…The WBI has been validated for these measures, but it less reliably distinguishes between different types of coverage (e.g., Medicaid vs. private insurance). 8 We used multivariate regression to model the likelihood of each outcome over time. The primary analysis modeled a linear monthly time trend, with sensitivity analyses that either added a quadratic time trend or did not include a time trend.…”

“…To convert income information and household size into a percentage of the federal poverty level, we used the midpoint of each income range and imputed missing values using a multivariate regression model, as in prior research (see the Supplementary Appendix). 8 We then analyzed distinct income groups in states that were expanding Medicaid versus in states that were not: up to 138% of the federal poverty level (eligible for Medicaid in states with Medicaid expansion), 139 to 400% of the poverty level (eligible for tax credits in all states), and more than 400% of the poverty level (not eligible for subsidized coverage). We also compared the effect of state decisions regarding Medicaid expansion using a differences-in-differences analysis for low-income adults in states with Medicaid expansion versus those in states without Medicaid expansion.…”

“…As discussed earlier, the response rate for rapid-turnaround data sources such as the WBI is much lower than that for government-conducted surveys. 8,9 However, Gallup polls and similar data sets are used regularly to offer timely evaluations of population-level phenomena, including health care-related issues 27,28 and elections. [29][30][31] More importantly, the WBI has been validated against government-conducted surveys for this type of analysis of the uninsured rate, although the same study concluded that the WBI does not reliably measure the type of insurance a person has.…”

“…[29][30][31] More importantly, the WBI has been validated against government-conducted surveys for this type of analysis of the uninsured rate, although the same study concluded that the WBI does not reliably measure the type of insurance a person has. 8 In addition, the WBI does not provide information on children's insurance coverage, which may also change under the ACA. 32,33 The income information in the WBI is limited, which means that our estimates of income as a percentage of poverty are imprecise, and previous research has shown that the survey overrepresents the middle of the income distribution.…”