Wisconsin State Planning Grant
Research Activities and Grant Projects

Overview

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Background

• On September 21, 2000, Wisconsin was awarded a $1.3 million State Planning Grant (SPG) from the U.S. Department of Health and Human Services, Health Resources Services Administration, to study the state's uninsured population.
• In Wisconsin, these funds have supported new research that will provide the analytical framework to develop program models that could provide access to coverage for the remaining uninsured in our state.
• The Wisconsin Department of Health and Family Services administers the grant.

State Planning Grant Activities

Wisconsin Family Health Survey

The Wisconsin Family Health Survey (FHS) is a random sample telephone survey of Wisconsin households conducted annually to collect information about health status, health problems, health insurance coverage, and use of health care services. The survey was first implemented in 1989.

Three major tasks with regard to the FHS have been conducted under the SPG grant.

• Adding New Questions — The Wisconsin Department of Health and Family Services (DHFS) has contracted with the University of Wisconsin Survey Center to add new questions to the existing FHS to expand information collected primarily about the relationship between employment and health insurance. The new questions ask the respondent about such things as the number of employers and hours worked for each, size of employer, offer of insurance, and the availability of family coverage.
• Analyze Existing FHS Data — The DHFS entered into agreements with two University of Wisconsin research groups to analyze data collected from the FHS to provide a more detailed understanding of the uninsured in Wisconsin. Research has been conducted on the following two topics:
  • A detailed description of the characteristics of the uninsured with attention to specific groups (i.e., working-age adults not eligible for Medicaid because they are not parents of minor children).
  • The relationship between health insurance coverage (or lack thereof) and health care utilization.
• Family Health Survey Redesign — The DHFS has a contract with the University of Wisconsin Survey Center to design a new state health survey, building on the strengths of the current FHS while incorporating new survey research techniques and addressing some of the anticipated information needs of DHFS program and policy areas.

Contracts with National Research Firms

• Agency for Healthcare Research and Quality (AHRQ) — DHFS is working with AHRQ, the research arm of the Department of Health and Human Services, to obtain data and collect new information about employer-based health insurance coverage in Wisconsin.
  
  The State has purchased an increased sample size of the 2000 Medical Expenditure Panel Survey — Insurance Component (MEPS-IC) for Wisconsin. The MEPS-IC is a survey of business establishments that collects data on benefit costs, type of benefits, employer size, type of employer, employee wage information, and take-up rates.
  
  Wisconsin will double its sample for the 2000 MEPS-IC from 800 cases to 1600 cases. The larger sample will significantly improve the reliability of the data. This data will be used to establish a reliable baseline on private insurance coverage of fully and self-insured establishments.
  
  In addition, the DHFS is obtaining MEPS-IC data from 1996 to 1999 to conduct trend analysis that will assist in understanding private coverage from a historical perspective.
  
  
• Institute for Health Policy Solutions (IHPS) — The DHFS is working with IHPS, a national organization with expertise in developing approaches that coordinate public and private sources for coverage of the uninsured, on the research and policy activities described below.
  1. The conduct of focus groups and interviews with small employers and with employees of low-wage workers in order to:
     • Assess small employer attitudes toward health coverage to gain a better understanding of why some small employers decline to offer health insurance for their employees.
     • Gain insights into small employers’ perceptions about their role in the current health insurance system and their likely reactions to alternative structures (i.e., purchasing pool or other buy-in program).
     • Explore workers’ perceptions about obtaining health insurance through their workplace.
  2. A review of Wisconsin’s existing public-private approaches to health insurance coverage, including:
     • Assessing the effectiveness of BadgerCare’s Health Insurance Premium Payment (HIPP) program from a policy and operational perspective.
     • Assisting in the design, development, and implementation of the Private Employer Health Care Coverage Program (PEHCCP) administered by the Department of Employee Trust Funds.
  3. The development of policy options for the efficient coordination of public program funds with private sources to maximize participation of low- and modest-wage workers and families in employer-based health insurance.

State-Local Collaborations/Partnerships

• Dane County Health Council — The Dane County Health Council was created by the County Executive to investigate avenues for achieving increased access to primary care for Dane County’s uninsured residents. The DHFS has worked with Council members to conduct focus groups with Latino, Hmong, and African-American residents of Dane County to explore how language and other barriers impact access to or take-up of health insurance and influence access to care and use of the health care system.
  
  
• Milwaukee County General Assistance Medical Program (GAMP) — The GAMP provides health care services to over 20,000 uninsured individuals in Milwaukee County through a system that is based in primary care. The DHFS has worked with Milwaukee’s GAMP to develop data reports that allow identification and analysis of GAMP participants’ annual costs and service utilization patterns.
  
  
• Wisconsin Primary Health Care Association (WPHCA) and Marshfield Clinic — The DHFS is working with WPHCA and Marshfield Clinic to conduct research that focuses on Wisconsin’s rural and young adult populations. Specifically, we have completed the following:
  1. A survey of farmers to obtain information that helps us better understand their unique circumstances.
  2. A survey of persons who are between the ages of 18 and 24 that are served by the Family Health Center to learn more about their circumstances and decision-making with regard to insurance coverage. This age group is the largest group of uninsured both in Wisconsin and nationally. The presence of this age group is evident in the Marshfield Clinic data as well.
     
     
• Additional Research — Under a pending grant extension, DHFS will further build upon the above activities through the conduct of:
  1. Focus groups with farmers throughout the state in order to better understand their perspectives regarding health insurance.
  2. Focus groups with 18- to 24-year-olds to further explore their decision-making regarding coverage.

Wisconsin Public Health and Health Plan Institute: Conference

The DHFS worked with the Wisconsin Public Health and Health Policy Institute to plan and coordinate the statewide conference, "Who Are the Uninsured in Wisconsin."

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Wisconsin Department of Health Services
Protecting and promoting the health and safety of the people of Wisconsin