The Long Term Impact of Medicaid in Childhood on Health and Socio-Economic Status

描述（由申请人提供）：童年早期的经历对一生有着深远的影响。在研究文献中很少注意到在儿童时期拥有健康保险的长期影响，尽管众所周知，它可以增加儿童获得医疗保健的机会，并改善儿童健康和家庭的经济状况。该项目的目标是记录0至5岁健康保险覆盖对19-43岁健康、收入和教育程度的长期影响，并以医疗补助为案例研究。该项目将考虑0-5岁通过医疗补助计划获得医疗保险的时间是否比6-12岁获得医疗保险的时间对以后的生活结果更重要。1965年联邦政府制定的医疗补助计划和1966年至1982年间各州逐步实施的计划将被用作自然实验。这段医疗补助计划的历史是研究保险在整个生命过程中的影响的理想背景，因为它针对的是那些几乎没有保险选择的深度贫困群体。此外，它发生的时间足够长，可以随访到成年期。该项目将填补文献中的一个重要空白，确定儿童健康保险的长期影响，并调查公共卫生政策是否能够改善整个生命过程中的健康和社会经济成果。分析策略将使用各州在1966年至1982年间引入医疗补助的变化来比较不同保险敞口但在其他方面相似的儿童的成人结果。数据将主要来自收入动态小组研究，这是一项从1968年开始对家庭及其后代进行的纵向研究。这些数据包含一套丰富的健康、社会经济和地理变量。该小组基于低收入家庭的大量超额样本，使得对更有可能受到医疗补助引入影响的人群进行研究成为可能。该项目还将调查医疗补助计划的引入是否像20世纪80年代扩大该计划时那样增加了儿童的医生就诊和住院时间。实现这一目标是理解将儿童医疗补助暴露与成人结果联系起来的中介途径的重要的第一步。来自全国健康访谈调查的数据将用于解决这个问题。鉴于即将实施的国家医疗改革预计将导致保险覆盖面的广泛增加，这项研究尤其及时。

DESCRIPTION (provided by applicant): Experiences in early childhood have profound impacts throughout life. The long term impact of having health insurance during childhood has received little attention in the research literature, although it is known to increase children's access to medical care, and to improve childhood health and the financial circumstances of families. The goal of this project is to document the long term effects of health insurance coverage between ages 0 and 5 on health, income, and educational attainment at ages 19-43, using Medicaid as a case study. The project will consider whether the timing of exposure to health insurance through Medicaid at age 0-5 matters more to later life outcomes than exposure between ages 6-12. The federal enactment of Medicaid in 1965 and the gradual implementation of the program by the states between 1966 and 1982 will be used as a natural experiment. This period of Medicaid's history is an ideal setting to study the effects of insurance over the life course because it targeted a group in deep poverty that had few insurance alternatives. Further, it occurred sufficiently long ago to allow for follow-up well into adulthood. The project will fillan important gap in the literature by determining the long term impact of health insurance in childhood and by investigating if a public health policy can improve health and socio-economic outcomes over the life-course. The analytical strategy will use variation in the introduction of Medicaid across states between 1966 and 1982 to compare the adult outcomes for children that had different insurance exposures but were similar in other ways. Data will primarily come from the Panel Study of Income Dynamics-an on-going longitudinal study of families and their descendants that began in 1968. These data contain a rich set of health, socio-economic, and geographic variables. The panel is based on a large over sample of low-income families, making possible the study of population groups that were more likely to be affected by Medicaid's introduction. The project also will investigate if the introduction of Medicaid increase physician visits and hospital stays among children much as the program did when it was expanded in the 1980's. Fulfilling this goal is an important first step in understanding the mediating pathways that link childhood Medicaid exposure and adult outcomes. Data from the National Health Interview Survey will be used to address this question. This research is especially timely given impending implementation of national health reform which is expected to lead a broad increase in insurance coverage. PUBLIC HEALTH RELEVANCE: This project seeks to develop evidence on the long term effect of Medicaid on health, education and income over the life course. I will examine whether the effect of Medicaid varies with the age of exposure and will determine if the introduction of Medicaid in 1966 improved access to care. The work will provide important information to policy makers by filling an important gap in the literature on the long term impacts of health policy and health insurance.