Kathleen Thiede Call, Ph.D.

November 1, 2005

Kathleen Thiede Call, Ph.D. serves as associate professor at the University of Minnesota's Division of Health Services Research Policy and Administration. Her research focuses primarily on access to care and health status among vulnerable populations. She has conducted several statewide surveys of Minnesotans, documenting characteristics of people with different kinds of insurance contracts and barriers to insurance coverage among the young, the low-income and minorities. She has developed a stream of research concerning the complexities of measuring and estimating rates of insurance coverage. She is co-principal investigator on the State Health Access Data Assistance Center (SHADAC), funded by The Robert Wood Johnson Foundation, which assists states in monitoring rates of coverage and using data to improve access.

Dr. Call received her Ph.D. in sociology from the University of Minnesota, where she also completed an NIA-funded post-doctoral fellowship in the Behavioral Neuroscience of Aging. Dr. Call has completed research in a wide range of areas, including biased selection in Medicare risk HMOs and potential barriers to expansion of Medicare risk HMOs in rural markets, burden among caregivers of elderly Medicare beneficiaries, adolescent development and participatory research exploring disparities in accessing preventive care.

In December 2003, HCFO awarded Call a grant to examine the Medicaid undercount and its implications for estimating rates of health insurance coverage. Research indicates that general population surveys of health insurance coverage may undercount the number of individuals enrolled in Medicaid by as much as 15 to 50 percent, depending on the survey source. The assumption is that administrative counts are the gold standard, whereas survey estimates are flawed. Reasons put forward to explain the undercount: Medicaid enrollees are not adequately covered in survey samples, or they do not participate in surveys, or when they do participate they misreport their coverage and instead report they are uninsured. Following from the suspicion that the Medicaid undercount leads to an overcount in the number of insured, some analysts reassign survey respondents who appear to be Medicaid eligible from uninsured to Medicaid as to match the count of enrollees indicated in the program's administrative files. This results in a lower survey count of the uninsured. Call and colleagues previously conducted a study that demonstrated that Minnesota Medicaid enrollees generally knew they were insured and whether their insurance was public or private. However, the same enrollees were uncertain as to which public program they were enrolled. Call and colleagues found no significant bias in estimates of uninsurance. These findings have significant implications for adjustments made to surveys to account for the Medicaid undercount.

Call and colleagues are replicating their Minnesota study in three other states: Florida, California and Pennsylvania; with preliminary findings are consistent with the earlier Minnesota study. Call believes that her research on the discrepancy between survey and administrative records is necessary to enhance the usefulness of survey data and inform policymakers regarding the extent to which these programs are reaching their target populations. "This discrepancy between surveys and administrative data often leads to confusion and mistrust of survey estimates. These two sources of data are collected for very different purposes, serve very important and complementary needs, and both have strengths and weakness that need to be understood. The good news is that the three replication studies consistently indicate little bias in survey estimates of uninsurance resulting from the Medicaid undercount," says Call.

For more information on Kathleen Thiede Call and a list of selected publications, see www.sph.umn.edu/facstaff/ourfaculty/faculty.asp