Partial-Year Insurance Coverage and the Health Care Utilization of Children

University of Wisconsin-Madison, USA.
Medical Care Research and Review (Impact Factor: 2.62). 12/2008; 66(1):49-67. DOI: 10.1177/1077558708324341
Source: PubMed


A large literature examines the effects of health insurance on the health care utilization of children; however, most existing studies conceptualize coverage as a point-in-time measure rather than as a dynamic phenomenon. The major contribution of this article is its provision of estimates on the relationship between the duration of coverage over the course of a calendar year and health care utilization among children. Using child-level fixed-effects regression, we find that an incremental uninsured month is associated with a 0.7 percentage point decline in the probability of receiving a visit over the course of a year and a 3% decrease in the number of visits received. Children with intrayear coverage losses are more likely than those with continuous coverage to lose their usual source of care, which serves as a potential mechanism through which short gaps in coverage may lead to longer-term decrements in utilization.

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    • "The tabulations indicate that the probability of having at least one visit increases monotonically with the length of coverage. The gradient is quite similar to what Leininger (2009) "
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    ABSTRACT: Even as the number of children with health insurance has increased, coverage transitions-movement into and out of coverage and between public and private insurance-have become more common. Using data from 1996 to 2005, we examine whether insurance instability has implications for access to primary care. Because unobserved factors related to parental behavior and child health may affect both the stability of coverage and utilization, we estimate the relationship between insurance and the probability that a child has at least one physician visit per year using a model that includes child fixed effects to account for unobserved heterogeneity. Although we find that unobserved heterogeneity is an important factor influencing cross-sectional correlations, conditioning on child fixed effects we find a statistically and economically significant relationship between insurance coverage stability and access to care. Children who have part-year public or private insurance are more likely to have at least one doctor's visit than children who are uninsured for a full year, but less likely than children with full-year coverage. We find comparable effects for public and private insurance. Although cross-sectional analyses suggest that transitions directly between public and private insurance are associated with lower rates of utilization, the evidence of such an effect is much weaker when we condition on child fixed effects.
    Preview · Article · Feb 2014 · International Journal of Health Care Finance and Economics
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    • "We then focus on the most recent period, 2001 to 2005, and examine family characteristics and changes to family life that may be associated with a loss of health coverage by children. Prior research tells us that the demographic characteristics correlated with breaks in insurance are similar to those associated with long-term uninsured spells, including being Hispanic and from a low-income family (Federico et al., 2007; Klein, Glied, & Ferry, 2005; Leininger, 2009; Satchell & Pati, 2005; Short & Graefe, 2003). Yet few studies attempt to identify specific determinants of changes in insurance status, or even differentiate between static (e.g., race) and dynamic (e.g., income) factors associated with insurance instability. "
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    ABSTRACT: Many children with health insurance will experience gaps in coverage over time, potentially reducing their access to and use of preventive health care services. This article uses the Survey of Income and Program Participation to examine how the stability of children's health insurance changed between 1990 and 2005 and to identify dynamic aspects of family life associated with transitions in coverage. Children's health insurance instability has increased since the early 1990s, due to greater movement between insured and uninsured states and between private and public insurance coverage. Changes in the employment and marital status of the family head are highly associated with an increased risk of a child losing and gaining public and private coverage, largely in hypothesized directions. The exception is that marital dissolution and job loss are associated with an increased probability of a child losing public insurance, despite there being no clear policy explanation for such a relationship.
    Full-text · Article · Oct 2011 · Medical Care Research and Review
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    • "Several studies utilize regression techniques to estimate the covariate-adjusted association between the length of a year spent uninsured with a variety of access to care outcomes, including having a usual source of care provider, delaying needed medical and dental care, and experiencing an unmet need (Aiken, Freed, and Davis, 2004; Cassedy, Fairbrother, and Newacheck, 2008; DeVoe et al., 2008; Halterman et al., 2008; Olson, Tang, and Newacheck, 2005). An additional study (Leininger, 2009) uses a child-level fixed effects methodology in which each child serves as her own control, providing an especially strong test of the relationship between lack of coverage over the year and access to care outcomes among children . These studies employ a wide variety of pediatric samples, including nationally representative pediatric populations culled from large population-based surveys such as the National Health Interview Survey, the Medical Expenditure Survey and the National Survey of Child Health, in addition to samples drawn from low-income pediatric populations and samples drawn from children with specific disease conditions (e.g., asthma). "
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    ABSTRACT: This article employs a comparison group research design to examine the effects of the Medicaid expansions of the late 1990s on the insurance coverage of poor teenagers. Results suggest that the expansions were associated with a decrease in the likelihood of poor teens experiencing uninsured spells over the course of a calendar year, as measured by spending any part of the prior year uninsured and spending over half of the prior year uninsured. While the expansions were successful in increasing coverage among poor adolescents, they fell far short of facilitating near-universal coverage for this population.
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