Negotiated Rulemaking, Day 2

Day 1.
Trying to divide into two workgroups this morning to try and focus on clarifying how we will measure health status and accessibility/ability to pay in the MUA measure.

I am in the health status workgroup and we are having an excellent discussion about how to measure health status. We are considering Social Deprivation Indices that use secondary measures that proxy health status and direct measures of health status. Key question is whether to use one approach to measure health status (which is required for an MUA designation) or both.

There is some broad interest in the SDI approach we have used, but one tricky issue is that poverty is a key component, and ability to pay is another portion of the MUA. Other key issues to work through include whether to include racial, ethnic and linguistic isolation type variables in the SDI. Issues here include the hispanic mortality paradox.

1:30 pm: The two workgroups (one addressing how we mesaure health status and the other how we measure access and ability to pay). The workgroup looking at how we measure access and ability to pay have provided a useful framework to categorize different types of access barriers and ways to measure ability to pay.

For the health status workgroup, there are two areas of uncertainty that needs to get worked out:

• does the use of poverty in the Social Deprivation Index that could be used to proxy poor health status create either a real and/or a perceived double counting issue with measures that can be used to measure ability to pay?
• where will race, ethnicity and linguistic isolation variables go? For example, race has been suggested as both a proxy of health status, a proxy of access barriers, and a proxy for ability to pay.

These are big issues and represent that there is a bit of conceptual muddle about different measures that could be seen as ways to measure different concepts: health status, access and ability to pay.

2:30pm: Trying to see if we can work through toward some sort of consensus that the social deprivation index approach to proxying health status exists, and then figuring out how we put such an index together with a direct measure of health status like standarized mortality ratio.

3:40: back in two workgroups trying to get to a proposal for measuring health status, accessibility and ability to pay to allow for some initial attempts to put together a draft MUA index.

4:50pm: the health status workgroup has developed a recommendation for testing out a draft health status portion of the MUA index. The workgroup focusing on access and ability to pay is still working.

5:50pm: both workgroups reached a tentative consensus to go ahead and test out a proposal to measure health status, access and ability to pay for the purpose of developing an MUA. Tomorrow we will try and develop a plan to move toward measuring provider availability.