How do Changes in Families' Health Insurance Affect Children's Healthcare?

家庭健康保险的变化如何影响儿童的医疗保健？

• 批准号: 8461986
• 负责人: Jennifer E DeVoe
• 金额: $ 49.95万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8461986
• 关键词: How; do; Changes; Families; Health

DESCRIPTION (provided by applicant): Patterns of family health insurance coverage are changing, and the consequences of these changes for children are not well understood. Although children's public health insurance has been expanded in many states, little is known about how changes in family / parental insurance coverage affect children's healthcare. We propose to determine how changing patterns of family insurance affect children's health insurance stability and their utilization of healthcare services. We will study how two unique Oregon Health Plan (OHP) policy changes affected children: the loss of public coverage for >50,000 adults in 2003, and the random selection of 10,000 adults to gain OHP coverage in 2008 (Aim 1). We will extend our findings by conducting a national assessment (Aim 2), as we have done successfully with Oregon-based research in the past. We propose to test the following central hypotheses: (1) Children's insurance stability and utilization of recommended healthcare services (such as immunization, well-child visits, receipt of preventive screenings), will differ in association with their parents' insurance coverage status / type, independent of child coverage; (2) Children's insurance stability and utilization patterns will be differentially affected when parents gain or lose coverage; (3) Having a usual source of care will mitigate some of these differences. Our aims and brief methods include: Aim 1: To assess the impact of 2003 and 2008 OHP policy changes on children's health insurance stability and utilization of healthcare services, we propose to use an innovative mixed-methods approach. We will create a linked dataset between OHP administrative data and electronic health record data from a network of over 100 Oregon safety net clinics. We will then conduct quantitative analyses of this linked dataset enriched by concurrent qualitative analyses of in-depth interviews with key informants and low-income families. Aim 2: To test how changing national family health insurance patterns affect children's health insurance stability and their utilization of healthcare services, we will conduct secondary analyses of the Medical Expenditure Panel Survey (MEPS) Household Component. We will build on our expertise in pooling data years and linking children with parents, to better understand family insurance dynamics and longitudinal trends over time. This innovate project uses mixed methods to examine Oregon's natural policy experiments, including the 2008 Medicaid 'lottery.' Oregon's experience will be interpreted within the national context, informing longitudinal analyses of MEPS data. As national health insurance reforms are implemented, understanding the impact of changing patterns of family coverage on children's health will become even more important; thus, this project is timely, relevant, and well-positioned to inform state and national health policy debates.

描述（由申请人提供）：家庭健康保险覆盖的模式正在发生变化，这些变化对儿童的影响尚不清楚。虽然儿童的公共健康保险已经在许多州扩大，但人们对家庭/父母保险范围的变化如何影响儿童的医疗保健知之甚少。我们建议，以确定如何改变家庭保险模式影响儿童的健康保险的稳定性和他们利用医疗服务。我们将研究两个独特的俄勒冈州健康计划（OHP）政策变化如何影响儿童：2003年超过50，000名成年人失去公共保险，2008年随机选择10，000名成年人获得OHP保险（目标1）。我们将通过进行国家评估（目标2）来扩展我们的研究结果，就像我们过去在俄勒冈州的研究中所做的那样。本研究拟检验以下中心假设：（1）儿童保险的稳定性与推荐医疗服务的利用（例如免疫接种、健康儿童就诊、接受预防性筛查），将根据父母的保险范围状态/类型而有所不同，与儿童保险无关;（2）当父母获得或失去保险时，儿童保险的稳定性和利用模式将受到不同的影响;（3）拥有通常的护理来源将减轻其中一些差异。我们的目标和简要的方法包括：目标1：为了评估2003年和2008年OHP政策变化对儿童健康保险的稳定性和医疗服务的利用的影响，我们建议使用一种创新的混合方法的方法。我们将在OHP管理数据和来自100多个俄勒冈州安全网诊所网络的电子健康记录数据之间创建一个链接数据集。然后，我们将对这一关联数据集进行定量分析，并通过对关键知情人和低收入家庭的深入访谈进行同步定性分析。目标二：为了验证全国家庭健康保险模式的变化如何影响儿童健康保险的稳定性和他们对医疗服务的利用，我们将对医疗支出调查（MEPS）家庭组成部分进行二次分析。我们将利用我们在汇集数据年和将儿童与父母联系起来方面的专业知识，更好地了解家庭保险动态和长期纵向趋势。 这个创新项目使用混合方法来检查俄勒冈州的自然政策实验，包括2008年医疗补助的彩票。俄勒冈州的经验将在全国范围内解释，为MEPS数据的纵向分析提供信息。随着国家医疗保险改革的实施，了解家庭覆盖模式的变化对儿童健康的影响将变得更加重要;因此，本项目是及时的，相关的，并充分定位为国家和国家卫生政策辩论提供信息。

项目成果

Predictors of children's health insurance coverage discontinuity in 1998 versus 2009: parental coverage continuity plays a major role.

1998 年与 2009 年儿童健康保险覆盖中断的预测因素：父母覆盖连续性起着重要作用。

• DOI: 10.1007/s10995-014-1590-0
• 发表时间: 2015
• 期刊: Maternal and child health journal
• 影响因子: 2.3
• 作者: DeVoe,JenniferE;Tillotson,CarrieJ;Angier,Heather;Wallace,LorraineS
• 通讯作者: Wallace,LorraineS

Trends in Type of Health Insurance Coverage for US Children and Their Parents, 1998-2011.

1998-2011 年美国儿童及其父母健康保险覆盖类型的趋势。

• DOI: 10.1016/j.acap.2015.06.009
• 发表时间: 2016
• 期刊: Academic pediatrics
• 影响因子: 3.1
• 作者: DeVoe,JenniferE;Tillotson,CarrieJ;Marino,Miguel;O'Malley,Jean;Angier,Heather;Wallace,LorraineS;Gold,Rachel
• 通讯作者: Gold,Rachel

Health information technology: an untapped resource to help keep patients insured.

健康信息技术：帮助患者获得保险的未开发资源。

• DOI: 10.1370/afm.1721
• 发表时间: 2014
• 期刊: Annals of family medicine
• 影响因子: 4.4
• 作者: DeVoe,JenniferE;Angier,Heather;Burdick,Tim;Gold,Rachel
• 通讯作者: Gold,Rachel

Improve Synergy Between Health Information Exchange and Electronic Health Records to Increase Rates of Continuously Insured Patients.

• DOI: 10.13063/2327-9214.1158
• 发表时间: 2015
• 期刊: EGEMS (Washington, DC)
• 作者: Gold R;Burdick T;Angier H;Wallace L;Nelson C;Likumahuwa-Ackman S;Sumic A;DeVoe JE
• 通讯作者: DeVoe JE

Healthcare Utilization After a Children's Health Insurance Program Expansion in Oregon.

• DOI: 10.1007/s10995-016-1971-7
• 发表时间: 2016-05
• 期刊: Maternal and child health journal
• 影响因子: 2.3
• 作者: Bailey SR;Marino M;Hoopes M;Heintzman J;Gold R;Angier H;O'Malley JP;DeVoe JE
• 通讯作者: DeVoe JE