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Grembowski D, Leibbrand C. A conceptual model of health insurance stability in the United States health care system. Health Serv Manage Res 2022:9514848221146677. [DOI: 10.1177/09514848221146677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In the U.S. health care system, people under age 65 are at risk of losing and regaining health insurance coverage over their lifetimes, which has important consequences for their physical and mental health. Despite the importance of insurance stability, we have an incomplete understanding about the complex factors influencing whether people lose and regain coverage. To advance our understanding of the dynamics of health insurance coverage and guide future research, our purpose is to present a new conceptual model of health insurance stability, where instability is defined as a person’s loss or change of coverage, which can occur more than once in a lifetime. Drawing from theory and evidence in the literature, we posit that personal and plan characteristics, the health system, and the environmental context – economic, social/cultural, political/judicial, and geographic – drive health insurance stability over the life course and are understudied. Studies are needed to identify the populations most at risk of experiencing insurance instability and vulnerability in health outcomes that results from such insecurity, which may suggest reforms and health policies at the individual, health system, or environment levels to reduce those risks.
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Affiliation(s)
- David Grembowski
- Health Systems and Population Health, University of Washington, Seattle, WA, USA
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Fife Donney J, Mitchell SJ, Lewin A. Medicaid Instability and Mental Health of Teen Parent Families. FAMILY & COMMUNITY HEALTH 2020; 43:10-16. [PMID: 31764302 DOI: 10.1097/fch.0000000000000240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study examines the effect of inconsistent Medicaid coverage on parenting stress, maternal depression, and child behavior in a sample of teen mothers and their children. The majority (54%) of mothers experienced inconsistent coverage. After 24 months, mothers experiencing inconsistent coverage had significantly higher parenting stress and depressive symptoms, and their children had more internalizing behaviors than families with consistent Medicaid. These differences existed despite no initial differences and controlling for numerous covariates. Policies and practices that stabilize Medicaid coverage for teen parent families may reduce unnecessary stress, depressive symptoms, and early childhood behavior problems.
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Affiliation(s)
- Julie Fife Donney
- Department of Family Science, School of Public Health, University of Maryland, College Park (Drs Donney and Lewin). Dr Mitchell is an Independent Research Consultant, Nashville, Tennessee
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Herrinton LJ, Ray GT, Curtis JR, Wu JJ, Fireman B, Liu L, Goldfien R. An Observational Study of Cardiovascular Risks Associated with Rheumatoid Arthritis Therapies: A Comparison of Two Analytical Approaches. Perm J 2018; 22:17-101. [PMID: 30010538 DOI: 10.7812/tpp/17-101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Comparative safety studies typically use hierarchical treatment categories that lump monotherapy and combination therapy. The consequence of this approach on study results is not clear. For example, studies of tumor necrosis factor inhibitors usually lump users regardless of whether they are using the drug alone or in combination with other agents. This study explored the importance of lumping vs splitting users of monotherapy and combination therapy. We also explored whether the timing of disenrollment from Health Plan membership was informative as an outcome variable when interpreting unmeasured, time-varying confounding. METHODS This observational cohort study included Kaiser Permanente Northern California 2003 to 2013 members with rheumatoid arthritis who started methotrexate. The study end point was a major cardiovascular event. In Cox proportional hazards analysis, we compared treatment classifications using five lumped categories with treatment classification using nine split categories. We also studied disenrollment as an outcome. RESULTS Among 5885 patients, 238 experienced serious cardiovascular events during an average follow-up of 4.25 years. Analysis of drug treatments using 5 lumped categories was difficult to interpret because treatment effects and drug users were mixed. In contrast, analysis of 9 drug categories that split monotherapies from combination therapy was easier to interpret, although confidence intervals were wider. Analysis of drug treatment in relation to disenrollment provided useful information with which to assess study validity, although the power of the analysis was limited. CONCLUSION In comparative safety studies, we recommend greater transparency in classifying treatment and evaluating disenrollment.
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Affiliation(s)
| | - G Thomas Ray
- Senior Data Consultant for the Division of Research in Oakland, CA.
| | - Jeffrey R Curtis
- William J Koopman Endowed Professor in Clinical Immunology and Rheumatology at the University of Alabama at Birmingham.
| | - Jashin J Wu
- Director of Dermatology Research and Associate Residency Program Director for the Department of Dermatology at the Los Angeles Medical Center in CA.
| | - Bruce Fireman
- Statistician for the Division of Research in Oakland, CA.
| | - Liyan Liu
- Data Scientist for the Division of Research in Oakland, CA.
| | - Robert Goldfien
- Chair of the Chiefs of Rheumatology for The Permanente Medical Group in Richmond, CA.
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The Effect of the Affordable Care Act's Dependent Coverage Provisionon Health Insurance Gaps for Young Adults With SpecialHealthcare Needs. J Adolesc Health 2018; 63:445-450. [PMID: 30108024 DOI: 10.1016/j.jadohealth.2018.05.014] [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: 09/20/2017] [Revised: 05/09/2018] [Accepted: 05/09/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE This study examined the impact of the 2010 Affordable Care Act's dependent coverage provision on gaps in insurance coverage for young adults with special healthcare needs (YASHCN). METHODS We used the 2008 Survey on Income and Program Participation, a longitudinal survey covering 2008-2013. Our sample was comprised of 3,316 YASHCN ages 19-29. We used a difference-in-differenceregression approach to assess the effect of the dependent coverage provision on the probability that a YASHCN experienced a gap in insurance coverage. We compared outcomes for a treatment group, YASHCN ages 19-25, and a control group, YASHCN ages 27-29, before and after the 2010 policy change. The longitudinal data allow us to estimate regressions that control for individual and time fixed effects. RESULTS After controlling for fixed effects and other confounding variables, we found that extending coverage until age 26 for YASHCN was associated with reduced insurance gaps. Specifically, our estimates suggest that the Affordable Care Act dependent coverage provision was associated with reduced insurance gaps among YASHCN by 2.4 percentage points. CONCLUSIONS The Affordable Care Act dependent coverage provision helped mitigate the number ofinsurance gaps experienced by YASHCN. This is of particular importance to YASHCN, as they are a vulnerablepopulation and their continuity of insurance coverage is a critical part of their transition into adulthood.
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Gordon SH, Lee Y, Ndumele CD, Vivier PM, Gutman R, Swaminathan S, Gadbois EA, Shield RR, Kind AJH, Trivedi AN. The Impact of Medicaid Managed Care Plan Type on Continuous Medicaid Enrollment: A Natural Experiment. Health Serv Res 2018; 53:3770-3789. [PMID: 29952062 DOI: 10.1111/1475-6773.13000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the impact of assignment to a Medicaid-focused versus mixed managed care plan on continuity of Medicaid coverage. DATA SOURCES 2011-2016 Medicaid claims from a Northeastern state. STUDY DESIGN Following the exit of a Medicaid managed care insurer, Medicaid administrators prioritized provider networks in reassigning enrollees, but randomly assigned beneficiaries whose providers were equally represented in the two plans. We leveraged the natural experiment created by random plan assignment and conducted an instrumental variable analysis. DATA COLLECTION We analyzed Medicaid claims for 12,083 beneficiaries who were members of the exiting Blue Cross Blue Shield plan prior to January 1, 2011. PRINCIPAL FINDINGS Managed care plan type did not significantly impact continuous enrollment in the Medicaid program. Greater outpatient utilization and the presence of a special need among children were associated with longer enrollment in Medicaid. CONCLUSIONS Managed care plans did not differ in their capacity to keep Medicaid beneficiaries continuously enrolled in coverage, despite differences in plan features.
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Affiliation(s)
- Sarah H Gordon
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI
| | - Yoojin Lee
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI
| | | | - Patrick M Vivier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI.,Hassenfeld Child Health Innovation Institute at Brown University, Providence, RI
| | - Roee Gutman
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI
| | - Shailender Swaminathan
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI.,Public Health Foundation of India, New Delhi, India
| | - Emily A Gadbois
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI
| | - Renee R Shield
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI
| | - Amy Jo Haavisto Kind
- Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, William S. Middleton VA Hospital-GRECC, Madison, WI
| | - Amal N Trivedi
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI.,Providence VA Medical Center, Providence, RI
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Housing Instability and Children's Health Insurance Gaps. Acad Pediatr 2017; 17:732-738. [PMID: 28232258 PMCID: PMC6058677 DOI: 10.1016/j.acap.2017.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/07/2017] [Accepted: 02/14/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the extent to which housing instability is associated with gaps in health insurance coverage of preschool-age children. METHODS Secondary analysis of data from the Early Childhood Longitudinal Study-Birth Cohort, a nationally representative study of children born in the United States in 2001, was conducted to investigate associations between unstable housing-homelessness, multiple moves, or living with others and not paying rent-and children's subsequent health insurance gaps. Logistic regression was used to adjust for potentially confounding factors. RESULTS Ten percent of children were unstably housed at age 2, and 11% had a gap in health insurance between ages 2 and 4. Unstably housed children were more likely to have gaps in insurance compared to stably housed children (16% vs 10%). Controlling for potentially confounding factors, the odds of a child insurance gap were significantly higher in unstably housed families than in stably housed families (adjusted odds ratio 1.27; 95% confidence interval 1.01-1.61). The association was similar in alternative model specifications. CONCLUSIONS In a US nationally representative birth cohort, children who were unstably housed at age 2 were at higher risk, compared to their stably housed counterparts, of experiencing health insurance gaps between ages 2 and 4 years. The findings from this study suggest that policy efforts to delink health insurance renewal processes from mailing addresses, and potentially routine screenings for housing instability as well as referrals to appropriate resources by pediatricians, would help unstably housed children maintain health insurance.
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The Association Between Medicaid Coverage for Children and Parents Persists: 2002-2010. Matern Child Health J 2016; 19:1766-74. [PMID: 25874876 DOI: 10.1007/s10995-015-1690-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To assess the association between a child's and their parent's public health insurance status during a time when children had access to coverage independent of policies that impacted adults' access. Secondary data from the Oregon Health Plan (OHP) [Oregon's Medicaid and Children's Health Insurance Programs] for families with at least one parent and one child with OHP coverage at any time during the study period (2002-2010). We linked children to their parents in the OHP data set and examined longitudinal associations between the coverage patterns for children and their parents, controlling for several demographic and economic confounders. We tested for differences in the strength of associations in monthly coverage status in five time periods throughout the nine-year study period. The odds of a child being insured by the OHP in months in which at least one parent had OHP coverage were significantly higher than among children whose parents were not enrolled at that time. Children with at least one parent who maintained or gained OHP coverage in a given month had a much higher probability of being enrolled in the OHP in that month, compared to children who had no covered parents in the given month or the month prior. Despite implementation of policies that differentially affected eligibility requirements for children and adults, strong associations persisted between coverage continuity for parents and children enrolled in Oregon public health insurance programs.
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DeVoe JE, Tillotson CJ, Marino M, O'Malley J, Angier H, Wallace LS, Gold R. Trends in Type of Health Insurance Coverage for US Children and Their Parents, 1998-2011. Acad Pediatr 2016; 16:192-9. [PMID: 26297668 PMCID: PMC4758913 DOI: 10.1016/j.acap.2015.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 05/22/2015] [Accepted: 06/15/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine trends in health insurance type among US children and their parents. METHODS Using the Medical Expenditure Panel Survey (1998-2011), we linked each child (n = 120,521; weighted n ≈ 70 million) with his or her parent or parents and assessed patterns of full-year health insurance type, stratified by income. We examined longitudinal insurance trends using joinpoint regression and further explored these trends with adjusted regression models. RESULTS When comparing 1998 to 2011, the percentage of low-income families with both child and parent or parents privately insured decreased from 29.2% to 19.1%, with an estimated decline of -0.86 (95% confidence interval, -1.10, -0.63) unadjusted percentage points per year; middle-income families experienced a drop from 74.5% to 66.3%, a yearly unadjusted percentage point decrease of -0.73 (95% confidence interval, -0.98, -0.48). The discordant pattern of publicly insured children with uninsured parents increased from 10.4% to 27.2% among low-income families and from 1.4% to 6.7% among middle-income families. Results from adjusted models were similar to joinpoint regression findings. CONCLUSIONS During the past decade, low- and middle-income US families experienced a decrease in the percentage of child-parent pairs with private health insurance and pairs without insurance. Concurrently, there was a rise in discordant coverage patterns-mainly publicly insured children with uninsured parents.
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Affiliation(s)
- Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland, Ore
| | - Carrie J Tillotson
- Division of Biostatistics, Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Ore
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, Ore; Division of Biostatistics, Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Ore
| | - Jean O'Malley
- Division of Biostatistics, Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Ore
| | - Heather Angier
- Department of Family Medicine, Oregon Health & Science University, Portland, Ore.
| | - Lorraine S Wallace
- Department of Family Medicine, The Ohio State University, Columbus, Ohio
| | - Rachel Gold
- Center for Health Research, Kaiser Permanente Northwest, Portland, Ore
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DeVoe JE, Tillotson CJ, Angier H, Wallace LS. Predictors of children's health insurance coverage discontinuity in 1998 versus 2009: parental coverage continuity plays a major role. Matern Child Health J 2015; 19:889-96. [PMID: 25070735 DOI: 10.1007/s10995-014-1590-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To identify predictors of coverage continuity for United States children and assess how they have changed in the first 12 years since implementation of the Children's Health Insurance Program in 1997. Using data from the nationally-representative Medical Expenditure Panel Survey, we used logistic regression to identify predictors of discontinuity in 1998 and 2009 and compared differences between the 2 years. Having parents without continuous coverage was the greatest predictor of a child's coverage gap in both 1998 and 2009. Compared to children with at least one parent continuously covered, children whose parents did not have continuous coverage had a significantly higher relative risk (RR) of a coverage gap [RR 17.96, 95 % confidence interval (CI) 14.48-22.29 in 1998; RR 12.88, 95 % CI 10.41-15.93 in 2009]. In adjusted models, parental continuous coverage was the only significant predictor of discontinuous coverage for children (with one exception in 2009). The magnitude of the pattern was higher for privately-insured children [adjusted relative risk (aRR) 29.17, 95 % CI 20.99-40.53 in 1998; aRR 25.54, 95 % CI 19.41-33.61 in 2009] than publicly-insured children (aRR 5.72, 95 % CI 4.06-8.06 in 1998; aRR 4.53, 95 % CI 3.40-6.04 in 2009). Parental coverage continuity has a major influence on children's coverage continuity; this association remained even after public health insurance expansions for children. The Affordable Care Act will increase coverage for many adults; however, 'churning' on and off programs due to income fluctuations could result in coverage discontinuities for parents. If parental coverage instability persists, these discontinuities may continue to have a negative impact on children's coverage stability as well.
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Affiliation(s)
- Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode FM, Portland, OR, 97239, USA,
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DeVoe JE, Marino M, Angier H, O’Malley JP, Crawford C, Nelson C, Tillotson CJ, Bailey SR, Gallia C, Gold R. Effect of expanding medicaid for parents on children's health insurance coverage: lessons from the Oregon experiment. JAMA Pediatr 2015; 169:e143145. [PMID: 25561041 PMCID: PMC4918752 DOI: 10.1001/jamapediatrics.2014.3145] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE In the United States, health insurance is not universal. Observational studies show an association between uninsured parents and children. This association persisted even after expansions in child-only public health insurance. Oregon's randomized Medicaid expansion for adults, known as the Oregon Experiment, created a rare opportunity to assess causality between parent and child coverage. OBJECTIVE To estimate the effect on a child's health insurance coverage status when (1) a parent randomly gains access to health insurance and (2) a parent obtains coverage. DESIGN, SETTING, AND PARTICIPANTS Oregon Experiment randomized natural experiment assessing the results of Oregon's 2008 Medicaid expansion. We used generalized estimating equation models to examine the longitudinal effect of a parent randomly selected to apply for Medicaid on their child's Medicaid or Children's Health Insurance Program (CHIP) coverage (intent-to-treat analyses). We used per-protocol analyses to understand the impact on children's coverage when a parent was randomly selected to apply for and obtained Medicaid. Participants included 14409 children aged 2 to 18 years whose parents participated in the Oregon Experiment. EXPOSURES For intent-to-treat analyses, the date a parent was selected to apply for Medicaid was considered the date the child was exposed to the intervention. In per-protocol analyses, exposure was defined as whether a selected parent obtained Medicaid. MAIN OUTCOMES AND MEASURES Children's Medicaid or CHIP coverage, assessed monthly and in 6-month intervals relative to their parent's selection date. RESULTS In the immediate period after selection, children whose parents were selected to apply significantly increased from 3830 (61.4%) to 4152 (66.6%) compared with a nonsignificant change from 5049 (61.8%) to 5044 (61.7%) for children whose parents were not selected to apply. Children whose parents were randomly selected to apply for Medicaid had 18% higher odds of being covered in the first 6 months after parent's selection compared with children whose parents were not selected (adjusted odds ratio [AOR]=1.18; 95% CI, 1.10-1.27). The effect remained significant during months 7 to 12 (AOR=1.11; 95% CI, 1.03-1.19); months 13 to 18 showed a positive but not significant effect (AOR=1.07; 95% CI, 0.99-1.14). Children whose parents were selected and obtained coverage had more than double the odds of having coverage compared with children whose parents were not selected and did not gain coverage (AOR=2.37; 95% CI, 2.14-2.64). CONCLUSIONS AND RELEVANCE Children's odds of having Medicaid or CHIP coverage increased when their parents were randomly selected to apply for Medicaid. Children whose parents were selected and subsequently obtained coverage benefited most. This study demonstrates a causal link between parents' access to Medicaid coverage and their children's coverage.
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Affiliation(s)
- Jennifer E. DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland2OCHIN, Inc, Portland, Oregon
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - Heather Angier
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - Jean P. O’Malley
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland
| | - Courtney Crawford
- Department of Family Medicine, Oregon Health & Science University, Portland
| | | | - Carrie J. Tillotson
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland
| | - Steffani R. Bailey
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - Charles Gallia
- Office of Health Analytics, Oregon Health Authority, Portland
| | - Rachel Gold
- OCHIN, Inc, Portland, Oregon5Kaiser Permanente Center for Health Research, Portland, Oregon
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Buchmueller T, Orzol SM, Shore-Sheppard L. Stability of children’s insurance coverage and implications for access to care: evidence from the Survey of Income and Program Participation. ACTA ACUST UNITED AC 2014; 14:109-26. [DOI: 10.1007/s10754-014-9141-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 01/14/2014] [Indexed: 11/27/2022]
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Berdahl TA, Friedman BS, McCormick MC, Simpson L. Annual report on health care for children and youth in the United States: trends in racial/ethnic, income, and insurance disparities over time, 2002-2009. Acad Pediatr 2013; 13:191-203. [PMID: 23680339 DOI: 10.1016/j.acap.2013.02.003] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine trends in children's health access, utilization, and expenditures over time (2002-2009) by race/ethnicity, income, and insurance status/expected payer. METHODS Data include a nationally representative random sample of children in the United States in 2002-2009 from the Medical Expenditure Panel Survey (MEPS) and a nationwide sample of pediatric hospitalizations in 2005 and 2009 from the Healthcare Cost and Utilization Project (HCUP). RESULTS The percentage of children with private insurance coverage declined from 65.3% in 2002 to 60.6% in 2009. At the same time, the percentage of publicly insured children increased from 27.0% in 2002 to 33.1% in 2009. Fewer children reported being uninsured in 2009 (6.3%) compared to 2002 (7.7%). The most significant progress was for Hispanic children, for whom the percentage of uninsured dropped from 15.0% in 2002 to 10.3% in 2009. The uninsured were consistently the least likely to have access to a usual source of care, and this disparity remained unchanged in 2009. Non-Hispanic whites were most likely to report a usual source of care in both 2002 and 2009. The percentage of children with a doctor visit improved for whites and Hispanics (2009 vs 2002). In contrast, black children saw no improvement during this time period. Between 2002 and 2009, children's average total health care expenditures increased from $1294 to $1914. Average total expenditures nearly doubled between 2002 and 2009 for white children with private health insurance. Among infants, hospitalizations for pneumonia decreased in absolute number (41,000 to 34,000) and as a share of discharges (0.8% to 0.7%). Fluid and electrolyte disorders also decreased over time. Influenza appeared only in 2009 in the list of top 15 diagnoses with 11,000 hospitalization cases. For children aged 1 to 17, asthma hospitalization increased in absolute number (from 119,000 to 134,000) and share of discharges (6.6% to 7.6%). Skin infections appeared in the top 15 categories in 2009, with 57,000 cases (3.3% of total). CONCLUSIONS Despite significant improvement in insurance coverage, disparities by race/ethnicity and income persist in access to and use of care. Hispanic children experienced progress in a number of measures, while black children did not. Because racial/ethnic and socioeconomic disparities are often reported as single cross-sectional studies, our approach is innovative and improves on prior studies by examining population trends during the time period 2002-2009. Our study sheds light on children's disparities during the most recent economic crisis.
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Affiliation(s)
- Terceira A Berdahl
- Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, MD 20850, USA.
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Short PF, Graefe DR, Swartz K, Uberoi N. New estimates of gaps and transitions in health insurance. Med Care Res Rev 2012; 69:721-36. [PMID: 22833452 DOI: 10.1177/1077558712454195] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Changes in individual or family circumstances cause many Americans to experience gaps and transitions in public and private health insurance. Using data from the 2004-2007 Survey of Income and Program Participation, this article updates earlier analyses of insurance gaps and transitions. Eighty-nine million people (one third of nonelderly Americans) were uninsured for at least 1 month during those 4 years. Approximately 23 million lost insurance more than once. The analyses call attention to the continuing instability and insecurity of health insurance, can inform implementation of national reforms, and establish a recent baseline that will be helpful in evaluating the reforms' effects on coverage stability.
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