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

描述(由申请人提供)：家庭健康保险的覆盖模式正在发生变化，这些变化对儿童的影响还没有得到很好的理解。尽管许多州已经扩大了儿童的公共健康保险，但人们对家庭/父母保险覆盖范围的变化如何影响儿童的医疗保健知之甚少。我们建议确定家庭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年失去50,000名成年人的公共保险，以及随机选择10,000名成年人在2008年获得OHP保险(目标1)。我们将通过进行国家评估(目标2)来扩展我们的发现，就像我们过去对俄勒冈州的研究所做的成功一样。我们建议检验以下中心假设：(1)儿童的保险稳定性和对推荐的医疗服务的利用(如免疫接种、儿童健康检查、接受预防性筛查)将因其父母的保险覆盖状况/类型而不同，独立于儿童保险；(2)当父母获得或失去保险时，儿童的保险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缓解其中的一些差异。我们的目标和简要方法包括：目标1：为了评估2003年和2008年OHP政策变化对儿童健康保险稳定性和医疗服务利用的影响，我们建议使用创新的混合方法。我们将在OHP管理数据和来自俄勒冈州100多家安全网诊所网络的电子健康记录数据之间创建一个链接的数据集。然后，我们将对这一相互关联的数据集进行量化分析，同时对关键线人和低收入家庭进行深入访谈的定性分析。目的2：为了检验不断变化的国家家庭医疗保险模式对儿童健康保险稳定性及其医疗服务利用的影响，我们将对医疗支出小组调查(MEPS)的家庭部分进行二次分析。我们将在汇集数据年份和将儿童与父母联系起来方面的专业知识，以更好地了解家庭保险的动态和随着时间的推移的纵向趋势。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年的医疗补助抽奖。俄勒冈州的经验将在国家背景下进行解读，为欧洲议会议员数据的纵向分析提供参考。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，该项目是及时、相关和处于有利地位的，可以为国家和国家卫生政策辩论提供信息。 公共卫生相关性：这一创新项目旨在研究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医疗保健服务的利用。它使用混合的方法来审查俄勒冈州的自然政策实验，包括2008年的医疗补助抽奖。俄勒冈州的经验将在全国范围内进行解释，为医疗支出小组调查数据的纵向分析提供参考。该项目提供了一个前所未有的机会来研究过去的变化，在实施未来的卫生政策改革之前建立当前的基线，然后评估这些变化的实时影响。

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. PUBLIC HEALTH RELEVANCE: This innovate project aims to examine how changing patterns of family health insurance affect children's health insurance stability and utilization of healthcare services. It 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 Medical Expenditure Panel Survey data. This project provides an unprecedented opportunity to study past changes, to establish a current baseline prior to the implementation of future health policy reforms, and then to evaluate the real-time impact of these changes.