From medicaid to uninsured: Drop-out among children in public insurance programs
From medicaid to uninsured: Drop-out among children in public insurance programs
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DOI：
10.1111/j.1475-6773.2005.00342.x
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发表时间：
2005-02-01
影响因子：
3.4
通讯作者：
Sommers, BD
中科院分区：
文献类型：
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作者：
Sommers, BD
目标。估计全国儿童在医疗补助和儿童健康保险计划（CHIP）中的失学率；确定由于购买其他保险或失去资格而导致的退出比例；并研究哪些人口和政策因素更有可能导致退学。数据源。来自当前人口调查（CPS） 3月增刊（1998-2001）的保险状况、收入和人口统计数据；来自全国州长协会的资格数据；以及来自前卫生保健融资管理局（HCFA）、州福利办公室和先前研究的政策数据。研究设计。该研究使用了全国代表性的5551名医疗补助或CHIP儿童样本。关键的结果是一年后仍然注册的儿童的百分比，以及尽管仍然符合条件但未注册的儿童的比例。采用多变量logistic回归探讨人口统计学和政策对退组的预测作用。数据收集和分析。CPS数据是使用人口普查局的联邦电子研究和审查提取工具1.0提取的。使用Stata 7 （Stata Corporation 2001）进行数据分析。主要的发现。在参加医疗补助或CHIP的儿童中，27.7%的儿童在12个月后不再参加。其中，45.4%的人在没有其他保险的情况下辍学，这相当于每年有300万儿童。各州的辍学率差异很大。没有兄弟姐妹参加公共保险的孩子退学的风险更高。父母受教育程度较高的孩子更有可能离开医疗补助计划，选择私人保险或失去医疗补助资格，而黑人儿童和婴儿失去资格的可能性较小。医疗补助提供者报销率的下降与退出密切相关，而医疗补助管理的医疗增加了向私人保险的流失。从医疗补助和CHIP中退出是一个重要的政策问题，这有助于解释数百万符合条件的儿童持续没有保险的原因。与提供者的临床接触似乎在预防辍学方面发挥了关键作用。
Objectives. To estimate a national disenrollment rate among children in Medicaid and the Children's Health Insurance Program (CHIP); to determine what share of disenrollment is due to acquiring other insurance or losing eligibility; and to examine what demographic and policy factors make disenrollment more likely.Data Sources. Insurance status, income, and demographics from the Current Population Survey (CPS) March Supplement (1998-2001); eligibility data from the National Governors Association; and policy data from the former Health Care Financing Administration (HCFA), state welfare offices, and previous research.Study Design. The study used a nationally representative sample of 5,551 children in Medicaid or CHIP. The key outcomes were the percentage of children still enrolled 1 year later, and the share of disenrollees who became uninsured despite remaining eligible. Multivariate logistic regression was used to explore demographics and policies predictive of disenrollment.Data Collection and Analysis. CPS data were extracted using the Census Bureau's Federal Electronic Research and Review Extraction Tool 1.0. Data analysis was performed using Stata 7 (Stata Corporation 2001).Principal Findings. Of the children enrolled in Medicaid or CHIP, 27.7 percent were no longer enrolled 12 months later. Of those, 45.4 percent dropped out despite apparently remaining eligible and having no other insurance-corresponding to 3.0 million children annually. Drop-out varied significantly across states. Children without siblings in public insurance were at a higher risk for drop-out. Children with more educated parents were more likely to leave Medicaid for private insurance or to lose Medicaid eligibility, while black children and infants were less likely to lose their eligibility. Decreased Medicaid provider reimbursement rates were strongly associated with drop-out, while Medicaid managed care increased the exodus to private insurance.Conclusions. Drop-out from Medicaid and CHIP is a significant policy concern and helps explain the persistence of uninsurance among millions of eligible children. Clinical encounters with providers appear to play a key role in preventing drop-out.