Crowd-in: the effect of private health insurance markets on the demand for Medicaid.
Crowd-in: the effect of private health insurance markets on the demand for Medicaid.
复制标题
拥挤：私人健康保险市场对医疗补助需求的影响。
DOI：
10.1111/j.1475-6773.2006.00563.x
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发表时间：
2006
影响因子：
3.4
通讯作者：
Perreira,KristaM
中科院分区：
文献类型：
--
作者：
Perreira,KristaM
研究目的：调查当地劳动力市场条件和雇主赞助的医疗保险对退出医疗补助计划的影响。数据来源：本项目的数据来自一个独特的管理数据库，其中包含1987年加州医疗补助计划所有病例的2%样本和1987年至1995年期间每年开始的所有新病例的2%样本。研究设计。使用离散持续时间模型估计结果，其中每月退出概率是人口特征，当地劳动力市场变量，雇主赞助保险的概率以及固定年份和县效应的函数。主要发现。劳动力市场机会的改善（即，就业增长，工资增长，以及雇主赞助的医疗保险的可用性增加）促进退出医疗补助计划。雇主赞助保险的可用性增加2.5个百分点，导致完成的法术持续时间不超过2年的概率增加6%。失业率下降2个百分点，或者平均季度收入增长10%，才能在两年内增加退出医疗补助计划的可能性。这些影响是强大的纳入县级固定的影响和时间effects.Conclusions.Medicaid支出和案件量是敏感的地方经济波动和长期趋势的健康保险的可用性。基于雇主的医疗保险覆盖率的持续下降将大大增加对公共保险的需求和州政府的财政压力。
Objective.To investigate the effects of local labor market conditions and the availability of employer‐sponsored health insurance on exits from the Medicaid program.Data Source.Data for this project come from a unique administrative database containing a 2 percent sample of all cases on California's Medicaid program in 1987 and a 2 percent sample of all new cases starting each year between 1987 and 1995.Study Design.The results are estimated using a discrete duration model where the monthly exit probability is a function of demographic characteristics, local labor market variables, the probability of having employer‐sponsored insurance, and fixed year and county effects.Principal Findings.Improvements in labor market opportunities (i.e., employment growth, wage growth, and increases in the availability of employer‐sponsored health insurance) promote exits off the Medicaid program. A 2.5 percentage point increase in the availability of employer‐sponsored insurance leads to a 6 percent increase in the probability that a completed spell lasts no more than 2 years. It would take a 2 percentage point decrease in unemployment rates or a 10 percent increase in average quarterly earnings to yield an equivalent increase in the likelihood of exiting Medicaid within 2 years. These effects are robust to the inclusion of county‐level fixed effects and time effects.Conclusions.Medicaid expenditures and caseloads are sensitive to local economic fluctuations and secular trends in the availability of health insurance. Continued decreases in employer‐based health insurance coverage will greatly increase the demand for public insurance coverage and the financial pressures on state governments.