Assessing the value of the NHIS for studying changes in state coverage policies: the case of New York.
Assessing the value of the NHIS for studying changes in state coverage policies: the case of New York.
复制标题
评估 NHIS 对于研究州保险覆盖政策变化的价值：纽约案例。
DOI：
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发表时间：
2007
影响因子：
3.4
通讯作者：
S. Zuckerman
中科院分区：
文献类型：
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作者：
S. Long;J. Graves;S. Zuckerman
研究目标
(1)评估2000年纽约卫生保健改革法案对符合条件的成年人的保险覆盖范围的影响;（2）探讨使用国家健康访谈调查（NHIS）而不是当前人口调查（CPS）来评估州卫生改革举措的可行性。
研究设计
我们利用发生在纽约的自然实验，比较健康保险覆盖的成年人之前和之后的国家实施其覆盖范围的倡议，使用差异中的差异框架。我们估计的影响，纽约的倡议对保险覆盖面使用NHIS，比较结果的基础上CPS，最广泛使用的数据源的研究国家覆盖政策的变化估计。虽然NHIS的样本量较小，但NHIS通过提供更好的健康保险状况衡量标准，解决了CPS在此类评估中的一个关键限制。考虑到纽约（包括2001年9月11日的恐怖袭击）扩张努力的时间复杂性，我们允许随着时间的推移，国家政策变化的影响不同。特别是，我们考虑到救灾医疗补助（DRM），这是一个临时计划实施后，立即9月11日，和国家的改革努力的原始组成部分之间的差异家庭健康加（FHP），直接医疗补助覆盖面的扩大，和健康纽约（HNY），努力使私人保险更负担得起。
数据源
2000-2004年公共卫生服务部; 1999-2004年国家健康调查。
主要调查结果
我们发现纽约的父母没有保险的情况显著减少的证据，特别是在DRM之后的时期。对于无子女的成年人，对他们来说，覆盖范围的扩大更为有限，该计划的效果不太乐观，因为我们没有发现任何证据表明无保险的显着下降。
结论
纽约通过扩大公共和私人保险范围，成功地减少了父母的无保险情况，这为扩大保险范围的新战略带来了希望。NHIS是评估许多州卫生改革举措的强大数据来源，提供了更好的保险状况衡量标准，并支持比CPS更全面的州创新研究。
RESEARCH OBJECTIVE
(1) To assess the effects of New York's Health Care Reform Act of 2000 on the insurance coverage of eligible adults and (2) to explore the feasibility of using the National Health Interview Survey (NHIS) as opposed to the Current Population Survey (CPS) to conduct evaluations of state health reform initiatives.
STUDY DESIGN
We take advantage of the natural experiment that occurred in New York to compare health insurance coverage for adults before and after the state implemented its coverage initiative using a difference-in-differences framework. We estimate the effects of New York's initiative on insurance coverage using the NHIS, comparing the results to estimates based on the CPS, the most widely used data source for studies of state coverage policy changes. Although the sample sizes are smaller in the NHIS, the NHIS addresses a key limitation of the CPS for such evaluations by providing a better measure of health insurance status. Given the complexity of the timing of the expansion efforts in New York (which encompassed the September 11, 2001 terrorist attacks), we allow for difference in the effects of the state's policy changes over time. In particular, we allow for differences between the period of Disaster Relief Medicaid (DRM), which was a temporary program implemented immediately after September 11th, and the original components of the state's reform efforts-Family Health Plus (FHP), an expansion of direct Medicaid coverage, and Healthy New York (HNY), an effort to make private coverage more affordable.
DATA SOURCES
2000-2004 CPS; 1999-2004 NHIS.
PRINCIPAL FINDINGS
We find evidence of a significant reduction in uninsurance for parents in New York, particularly in the period following DRM. For childless adults, for whom the coverage expansion was more circumscribed, the program effects are less promising, as we find no evidence of a significant decline in uninsurance.
CONCLUSIONS
The success of New York at reducing uninsurance for parents through expansions of both public and private coverage offers hope for new strategies to expand coverage. The NHIS is a strong data source for evaluations of many state health reform initiatives, providing a better measure of insurance status and supporting a more comprehensive study of state innovations than is possible with the CPS.