Context or composition: What explains variation in SCHIP disenrollment?
Context or composition: What explains variation in SCHIP disenrollment?
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DOI：
10.1111/j.1475-6773.2004.00262.x
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发表时间：
2004-08-01
影响因子：
3.4
通讯作者：
Gaboda, D
中科院分区：
文献类型：
--
作者：
Phillips, JA;Miller, JE;Gaboda, D
Objective.调查（1）家庭和背景特征对观察到的州儿童健康保险计划（SCHIP）退出率变化的相对贡献，以及（2）背景是否解释了观察到的家庭水平模式。我们使用了24，628个参加新泽西SCHIP计划（NJ KidCare）的家庭的二级数据，以及来自地区资源文件、人口普查和NJ FamilyCare提供者名册的县级数据。有关家庭特征、SCHIP计划以及入组和退出日期的信息取自NJ KidCare管理记录，该记录提供了1998年1月至2000年4月的监测数据。我们估计了一个多层次的离散时间风险模型的SCHIP disenrollment. Findings。参加费用分摊计划的家庭、黑人和只有一个孩子参加的家庭的退出率高于平均水平。在黑人医生比例较高的县，黑人的退学率较低。这些特点占部分县间的变化在辍学率;其余县间的变化在很大程度上是由医生密度或人口密度。政策含义。这可能是值得特别关注的黑人家庭和县与高退学率，以解决其保留率较低的原因。解决医生和客户之间的文化差异和医疗提供者的地理分布可能会减少取消注册。
Objective. To investigate (1) the relative contributions of family and contextual characteristics to observed variation in disenrollment rates from the State Children's Health Insurance Program (SCHIP), and (2) whether context explains observed family-level patterns.Data Sources. We use secondary data on 24,628 families enrolled in New Jersey's SCHIP program (NJ KidCare), and county-level data from the Area Resource File, the Census, and the NJ FamilyCare provider roster.Study Design. Information on family characteristics, SCHIP plan, and dates of enrollment and disenrollment are taken from NJ KidCare administrative records, which provided surveillance data from January 1998 through April 2000.Cata collection/Analysis. We estimate a multilevel discrete-time-hazards model of SCHIP disenrollment.Findings. Families enrolled in plans involving cost-sharing, blacks, and those with only one enrolled child have higher than average rates of disenrollment. Disenrollment rates for blacks are lower in counties with a high share of black physicians. These characteristics account for part of the intercounty variation in disenrollment rates; remaining intercounty variation is largely explained by physician density or population density.Policy Implications. It may be worthwhile to pay special attention to black families and counties with high disenrollment rates to address the reasons for their lower retention. Addressing cultural differences between physician and client and the geographic distribution of medical providers might reduce disenrollment.