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Cheng TC, Lo CC. Factors Associated with Insured Children's Use of Physician Visits, Dentist Visits, Hospital Care, and Prescribed Medications in the United States: An Application of Behavioral Model of Health-Services Use. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:427. [PMID: 38673338 PMCID: PMC11050310 DOI: 10.3390/ijerph21040427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
This study is the first to examine factors in the utilization of physician services, dentist services, hospital care, and prescribed medications focusing exclusively on insured children in the United States. Data describing 48,660 insured children were extracted from the 2021 National Survey of Children's Health. Children in the present sample were covered by private health insurance, public health insurance, or other health insurance. Logistic regression results showed self-reported health to be negatively associated with physician visits, hospital-care use, and prescription use, but teeth condition to be positively associated with dentist visits. Physician visits were associated negatively with age, Hispanic ethnicity, Asian ethnicity, family income at or below 200% of the federal poverty level, and other health insurance, but positively with parental education and metropolitan residency. Dentist visits were associated positively with girls, age, and parental education, but negatively with Asian ethnicity and public health insurance. Use of hospital care was associated negatively with age and Asian ethnicity, but positively with parental education and public health insurance. Use of prescriptions was associated positively with age, Black ethnicity, parental education, and public health insurance, but negatively with Hispanic ethnicity, Asian ethnicity, and family income at or below 200% of the federal poverty level. Implications included the expansion of public health insurance, promotion of awareness of medicine discount programs, and understanding of racial/ethnic minorities' cultural beliefs in health and treatment.
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Affiliation(s)
- Tyrone C. Cheng
- Little Hall, School of Social Work, University of Alabama, Tuscaloosa, AL 35401, USA
| | - Celia C. Lo
- Defense Personnel and Security Research Center, Peraton, Seaside, CA 93955, USA;
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Daw JR, Yekta S, Jacobson-Davies FE, Patrick SW, Admon LK. Consistency and Adequacy of Public and Commercial Health Insurance for US Children, 2016 to 2021. JAMA HEALTH FORUM 2023; 4:e234179. [PMID: 37991782 PMCID: PMC10665966 DOI: 10.1001/jamahealthforum.2023.4179] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/26/2023] [Indexed: 11/23/2023] Open
Abstract
Importance Before and during the COVID-19 public health emergency (PHE), commercially and publicly insured children may have faced different challenges in obtaining consistent and adequate health insurance. Objective To compare overall rates, COVID-19 PHE-related changes, and child and family characteristics associated with inconsistent and inadequate coverage for publicly and commercially insured children. Design, Settings, and Participants This was a cross-sectional study using nationally representative data from the 2016 to 2021 National Survey of Children's Health of children from age 0 to 17 years living in noninstitutional settings. Exposure Parent- or caregiver-reported current child health insurance type defined as public or commercial. Main Outcomes and Measures Inconsistent insurance, defined as having an insurance gap in the past year; and inadequate insurance, defined by failure to meet 3 criteria: (1) benefits usually/always sufficient to meet child's needs; (2) coverage usually/always allows child to access needed health care practitioners; and (3) no or usually/always reasonable annual out-of-pocket payments for child's health care. Survey-weighted logistic regression was used to compare outcomes by insurance type, by year (2020-2021 vs 2016-2019), and by child characteristics within insurance type. Results Of this nationally representative sample of 203 691 insured children, 34.5% were publicly insured (mean [SD] age, 8.4 [4.1] years; 47.4% female) and 65.5% were commercially insured (mean [SD] age, 8.7 [5.6]; 49.1% female). Most publicly insured children were either non-Hispanic Black (20.9%) or Hispanic (36.4%); living with 2 married parents (38.4%) or a single parent (33.1%); and had a household income less than 200% of the federal poverty level (79%). Most commercially insured children were non-Hispanic White (62.8%), living with 2 married parents (79.0%); and had a household income of 400% of the federal poverty level or higher (49.1%). Compared with commercially insured children, publicly insured children had higher rates of inconsistent coverage (4.2% vs 1.4%; difference, 2.7 percentage points [pp]; 95% CI, 2.3 to 3.2) and lower rates of inadequate coverage (12.2% vs 33.0%; difference, -20.8 pp; 95% CI, -21.6 to -20.0). Compared with the period from 2016 to 2019, inconsistent insurance decreased by 42% for publicly insured children and inadequate insurance decreased by 6% for commercially insured children during the COVID-19 PHE (2020-2021). The child and family characteristics associated with inadequate and inconsistent insurance varied by insurance type. Conclusions and Relevance The findings of this cross-sectional study indicate that insurance gaps are a particular problem for publicly insured children, whereas insurance inadequacy and particularly, out-of-pocket costs are a challenge for commercially insured children. Both challenges improved during the COVID-19 PHE. Improving children's health coverage after the PHE will require policy solutions that target the unique needs of commercially and publicly insured children.
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Affiliation(s)
- Jamie R. Daw
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York
| | - Sarra Yekta
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York
| | | | - Stephen W. Patrick
- Departments of Pediatrics, Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Health Policy, Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lindsay K. Admon
- Institute for Healthcare Policy and Innovation, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
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Dickinson KM, Psoter KJ, Riekert KA, Collaco JM. Association between insurance variability and early lung function in children with cystic fibrosis. J Cyst Fibros 2022; 21:104-110. [PMID: 34175244 PMCID: PMC8695631 DOI: 10.1016/j.jcf.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Lower socioeconomic status (SES) has consistently been associated with poorer outcomes in individuals with cystic fibrosis (CF). Previous studies have compared outcomes for children with and without private insurance coverage, however the potential role of changes in insurance status on early health outcomes in children with CF remains unknown. OBJECTIVES To describe the variability in insurance status in early childhood and to evaluate whether insurance variability was associated with poorer outcomes at age 6. METHODS Retrospective observational study using the Cystic Fibrosis Foundation Patient Registry. Insurance status was defined as: always private (including Tricare), exclusively public, or intermittent private insurance (private insurance and exclusively public insurance in separate years) during the first 6 years of life. Outcomes at age 6 included body mass index (BMI) and FEV1 percent predicted (maxFEV1pp). RESULTS From a 2000-2011 birth cohort (n = 8,109), 42.3% always had private insurance, 30.0% had exclusively public insurance, and 27.6% had intermittent private insurance. BMI percentiles did not differ between groups; however, children with intermittent private insurance and exclusively public insurance had a 3.3% and 6.6% lower maxFEV1pp at age 6, respectively, compared to those with always private insurance. CONCLUSIONS A substantial proportion of young children in a modern CF cohort have public or intermittent private insurance coverage. While public insurance has been associated with poorer health outcomes in CF, variability in health insurance coverage may also be associated with an intermediate risk of disparities in lung function as early as age 6.
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Affiliation(s)
- Kimberly M. Dickinson
- Department of Pediatrics, Division of Pediatric Pulmonology, Johns Hopkins University, Baltimore, MD, USA
| | - Kevin J. Psoter
- Department of Pediatrics, Division of General Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - Kristin A. Riekert
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph M. Collaco
- Department of Pediatrics, Division of Pediatric Pulmonology, Johns Hopkins University, Baltimore, MD, USA
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Cholera R, Anderson D, Raman SR, Hammill BG, DiPrete B, Breskin A, Wiener C, Rathnayaka N, Landi S, Brookhart MA, Whitaker RG, Bettger JP, Wong CA. Medicaid Coverage Disruptions Among Children Enrolled in North Carolina Medicaid From 2016 to 2018. JAMA HEALTH FORUM 2021; 2:e214283. [PMID: 35977295 PMCID: PMC8796937 DOI: 10.1001/jamahealthforum.2021.4283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/23/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Rushina Cholera
- Duke Margolis Center for Health Policy, Durham, North Carolina
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - David Anderson
- Duke Margolis Center for Health Policy, Durham, North Carolina
| | - Sudha R. Raman
- Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Bradley G. Hammill
- Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Bethany DiPrete
- NoviSci, Durham, North Carolina
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | | | | | | | | | - M. Alan Brookhart
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- NoviSci, Durham, North Carolina
| | | | - Janet Prvu Bettger
- Duke Margolis Center for Health Policy, Durham, North Carolina
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Charlene A. Wong
- Duke Margolis Center for Health Policy, Durham, North Carolina
- Department of Pediatrics, Duke University, Durham, North Carolina
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Gai Y, Jones K. Insurance patterns and instability from 2006 to 2016. BMC Health Serv Res 2020; 20:334. [PMID: 32316952 PMCID: PMC7171789 DOI: 10.1186/s12913-020-05226-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 04/14/2020] [Indexed: 11/16/2022] Open
Abstract
Background There is a rich literature on insurance coverage and its impacts on health care. Many recent studies have examined the impacts of the Affordable Care Act (ACA) and found that it had positive effects on health insurance coverage and health care usage. Most of the literature, however, has focused on insurance coverage at a single point in time, while research on insurance instability is underrepresented, even though it could significantly impact health outcomes. The aim of this study is to examine changes and implications of insurance instability among nonelderly adults from 2006 to 2016, covering the Great Recession and post-ACA periods. Methods Using 2006-to-2016 Medical Expenditure Panel Survey data, we identify seven insurance patterns and analyze them by race/ethnicity, age, geography, income, and medical conditions. We then use multivariable linear models to analyze the relationship between insurance instability and health care status, access, and utilization. Logistic, Poisson and nonlinear models test the robustness of our results. Results The post-ACA period 2015–2016 saw the lowest ever-uninsured rate (25.68% or 67.91 million). The largest decrease in insurance instability was among adults aged 19–25, low-income families, Hispanics, the western population, and the healthy population. Like the always-uninsured, those with other insurance gaps experienced a lack of access to care and decreased preventive care and other services. Conclusions Despite the post-ACA instability reduction, over 25% of the U.S. population continued to have insurance gaps over a two-year period. Disparities continued to exist between income groups, race/ethnicities, and regions. Repealing ACA could exacerbate insurance instability and disparities between different groups, which in turn could lead to adverse health outcomes.
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Affiliation(s)
- Yunwei Gai
- Economics Division, Babson College, 231 Forest Street, Babson Park, MA, 02457-0310, USA.
| | - Kent Jones
- Economics Division, Babson College, 231 Forest Street, Babson Park, MA, 02457-0310, USA
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Patterns of Health Insurance Discontinuity and Children’s Access to Health Care. Matern Child Health J 2019; 23:667-677. [DOI: 10.1007/s10995-018-2681-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Pan IW, Lam S, Clarke DF, Shih YCT. Insurance transitions and healthcare utilization for children with refractory epilepsy. Epilepsy Behav 2018; 89:48-54. [PMID: 30384099 DOI: 10.1016/j.yebeh.2018.09.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 09/27/2018] [Accepted: 09/27/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of the study is to investigate the association between insurance transitions and healthcare utilization among children with refractory epilepsy. METHODS We applied published algorithms to identify the study cohort of children with a diagnosis of refractory epilepsy who were treated between 10/1/2013 and 9/30/2014 at 36 children's hospitals in the United States. Insurance transition was defined as having any change in the type of primary payer from the first date of diagnosis to the date of the last visit at the same hospital. Univariate and multilevel multivariable analytical methods were used in the study. RESULTS Among 3488 children hospitalized with refractory epilepsy, rates of insurance transitions at 1, 2, and 5 years of refractory epilepsy diagnosis were 8.1%, 14%, and 29.9%, respectively. Patients whose primary payer at diagnosis was Private or Others were more likely to experience insurance transitions than patients whose primary payer was Medicaid. Younger children were associated with a higher risk of insurance transitions than older children. The high intensity of insurance transitions was associated with a higher number of emergency department and inpatient visits. CONCLUSIONS Insurance transitions interrupted the continuity of medical care for children with refractory epilepsy and were associated with more frequent hospitalizations and emergency department visits, which then translated to higher healthcare costs. Medicaid provided stable insurance coverage and is critically important for these patients and should be the main focus for policies aiming to minimize insurance transitions and optimize healthcare delivery.
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Affiliation(s)
- I-Wen Pan
- Baylor College of Medicine, Department of Neurosurgery, 7200 Cambridge St, Houston, TX 77030, United States of America; Texas Children's Hospital, Department of Neurosurgery, 6701 Fannin St, Houston, TX 77030, United States of America.
| | - Sandi Lam
- Baylor College of Medicine, Department of Neurosurgery, 7200 Cambridge St, Houston, TX 77030, United States of America; Texas Children's Hospital, Department of Neurosurgery, 6701 Fannin St, Houston, TX 77030, United States of America.
| | - Dave Fitzgerald Clarke
- Baylor College of Medicine, Department of Pediatrics, Neurology and Developmental Neuroscience Section, 6701 Fannin St, Houston, TX 77030, United States of America; Texas Children's Hospital, Department of Neurology, Epilepsy Center, 6701 Fannin St, Houston, TX 77030, United States of America.
| | - Ya-Chen Tina Shih
- University of Texas MD Anderson Cancer Center, Department of Health Services Research, 1155 Pressler St., Houston, TX 77030, United States of America.
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Dworsky M. Using All-Payer Claims Databases to Study Insurance and Health Care Utilization Dynamics. J Gen Intern Med 2017; 32:1069-1070. [PMID: 28710595 PMCID: PMC5602770 DOI: 10.1007/s11606-017-4128-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Predicting high-cost pediatric patients: derivation and validation of a population-based model. Med Care 2015; 53:729-35. [PMID: 26172939 DOI: 10.1097/mlr.0000000000000391] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health care administrators often lack feasible methods to prospectively identify new pediatric patients with high health care needs, precluding the ability to proactively target appropriate population health management programs to these children. OBJECTIVE To develop and validate a predictive model identifying high-cost pediatric patients using parent-reported health (PRH) measures that can be easily collected in clinical and administrative settings. DESIGN Retrospective cohort study using 2-year panel data from the 2001 to 2011 rounds of the Medical Expenditure Panel Survey. SUBJECTS A total of 24,163 children aged 5-17 with family incomes below 400% of the federal poverty line were included in this study. MEASURES Predictive performance, including the c-statistic, sensitivity, specificity, and predictive values, of multivariate logistic regression models predicting top-decile health care expenditures over a 1-year period. RESULTS Seven independent domains of PRH measures were tested for predictive capacity relative to basic sociodemographic information: the Children with Special Health Care Needs (CSHCN) Screener; subjectively rated health status; prior year health care utilization; behavioral problems; asthma diagnosis; access to health care; and parental health status and access to care. The CSHCN screener and prior year utilization domains exhibited the highest incremental predictive gains over the baseline model. A model including sociodemographic characteristics, the CSHCN screener, and prior year utilization had a c-statistic of 0.73 (95% confidence interval, 0.70-0.74), surpassing the commonly used threshold to establish sufficient predictive capacity (c-statistic>0.70). CONCLUSIONS The proposed prediction tool, comprising a simple series of PRH measures, accurately stratifies pediatric populations by their risk of incurring high health care costs.
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Orzol SM, Hula L, Harrington M. Program Churning and Transfers Between Medicaid and CHIP. Acad Pediatr 2015; 15:S56-63. [PMID: 25906961 DOI: 10.1016/j.acap.2015.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 02/11/2015] [Accepted: 02/11/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE In the 10 states that are the focus of the Children's Health Insurance Program Reauthorization Act of 2009 evaluation, we analyze in detail the states' recent progress in retaining children in public coverage and public coverage churning. METHODS We used administrative data spanning a five-and-a-half-year period collected from 10 study states-Alabama, California, Florida, Louisiana, Michigan, New York, Ohio, Texas, Utah, and Virginia-to analyze the extent to which children return to the same program a short time after disenrollment and the extent to which transfers between Medicaid and Children's Health Insurance Program (CHIP) lead to public coverage gaps. RESULTS Our analysis yielded 3 key findings. First, many children moved between Medicaid and CHIP; while most transitioned seamlessly, coverage gaps occurred for as many as 40%, depending on the type of transition. Second, churning continued to be a concern for public coverage programs, with approximately 21% of Medicaid disenrollees and 10% of separate CHIP disenrollees returning to the same program within 7 months. Third, we found sizable differences in rates of program churning and nonseamless program transfers across the 10 study states. CONCLUSIONS Notable variation existed across programs and states, which persisted over the period in public program churning. These results suggest the need for continued efforts to simplify renewal processes, particularly in state Medicaid programs, along with the adoption of processes that improve coordination across programs and policies that simplify these transfers.
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Affiliation(s)
| | - Lauren Hula
- Mathematica Policy Research, Ann Arbor, Mich
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Abstract
It might seem strange to ask whether increasing access to medical care can improve children's health. Yet Lindsey Leininger and Helen Levy begin by pointing out that access to care plays a smaller role than we might think, and that many other factors, such as those discussed elsewhere in this issue, strongly influence children's health. Nonetheless, they find that, on the whole, policies to improve access indeed improve children's health, with the caveat that context plays a big role-medical care "matters more at some times, or for some children, than others." Focusing on studies that can plausibly show a causal effect between policies to increase access and better health for children, and starting from an economic framework, they consider both the demand for and the supply of health care. On the demand side, they examine what happens when the government expands public insurance programs (such as Medicaid), or when parents are offered financial incentives to take their children to preventive appointments. On the supply side, they look at what happens when public insurance programs increase the payments that they offer to health-care providers, or when health-care providers are placed directly in schools where children spend their days. They also examine how the Affordable Care Act is likely to affect children's access to medical care. Leininger and Levy reach three main conclusions. First, despite tremendous progress in recent decades, not all children have insurance coverage, and immigrant children are especially vulnerable. Second, insurance coverage alone doesn't guarantee access to care, and insured children may still face barriers to getting the care they need. Finally, as this issue of Future of Children demonstrates, access to care is only one of the factors that policy makers should consider as they seek to make the nation's children healthier.
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Affiliation(s)
| | - Helen Levy
- Institute for Social Research, the Ford School of Public Policy, and the Department of Health Management and Policy of the School of Public Health at the University of Michigan
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