Dataset Information

SCHIP's impact on dependent coverage in the small-group health insurance market.

ABSTRACT:

Objective

To estimate the impact of State Children's Health Insurance Program (SCHIP) expansions on public and private coverage of dependents at small firms compared with large firms.

Data sources

1996-2007 Annual Demographic Survey of the Current Population Survey (CPS).

Study design

This study estimates a two-stage least squares (2SLS) model for four insurance outcomes that instruments for SCHIP and Medicaid eligibility. Separate models are estimated for small group markets (firms with fewer than 25 employees), small businesses (firms under 500 employees), and large firms (firms 500 employees and above).

Data collection/extraction methods

We extracted data from the 1996-2007 CPS for children in households with at least one worker.

Principal findings

The SCHIP expansions decreased the percentage of uninsured dependents in the small group market by 7.6 percentage points with negligible crowd-out in the small group and no significant effect on private coverage across the 11-year-period.

Conclusions

The SCHIP expansions have increased coverage for households in the small group market with no significant crowd-out of private coverage. In contrast, the estimates for large firms are consistent with the substantial crowd-out observed in the literature.

SUBMITTER: Seiber EE

PROVIDER: S-EPMC2813446 | biostudies-literature | 2010 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

SCHIP's impact on dependent coverage in the small-group health insurance market.

Seiber Eric E EE Florence Curtis S CS

Health services research 20091015 1

<h4>Objective</h4>To estimate the impact of State Children's Health Insurance Program (SCHIP) expansions on public and private coverage of dependents at small firms compared with large firms.<h4>Data sources</h4>1996-2007 Annual Demographic Survey of the Current Population Survey (CPS).<h4>Study design</h4>This study estimates a two-stage least squares (2SLS) model for four insurance outcomes that instruments for SCHIP and Medicaid eligibility. Separate models are estimated for small group marke ...[more]

PMID: 19840135

Similar Datasets

Project description:BACKGROUND: China has one of the world's largest health insurance systems, composed of government-run basic health insurance and commercial health insurance. The basic health insurance has undergone system-wide reform in recent years. Meanwhile, there is also significant development in the commercial health insurance sector. A phone call survey was conducted in three major cities in China in July and August, 2011. The goal was to provide an updated description of the effect of health insurance on the population covered. Of special interest were insurance coverage, gross and out-of-pocket medical cost and coping strategies. RESULTS: Records on 5,097 households were collected. Analysis showed that smaller households, higher income, lower expense, presence of at least one inpatient treatment and living in rural areas were significantly associated with a lower overall coverage rate. In the separate analysis of basic and commercial health insurance, similar factors were found to have significant associations. Higher income, presence of chronic disease, presence of inpatient treatment, higher coverage rates and living in urban areas were significantly associated with higher gross medical cost. A similar set of factors were significantly associated with higher out-of-pocket cost. Households with lower income, inpatient treatment, higher commercial insurance coverage, and living in rural areas were significantly more likely to pursue coping strategies other than salary. CONCLUSIONS: The surveyed cities and surrounding rural areas had socioeconomic status far above China's average. However, there was still a need to further improve coverage. Even for households with coverage, there was considerable out-of-pocket medical cost, particularly for households with inpatient treatments and/or chronic diseases. A small percentage of households were unable to self-finance out-of-pocket medical cost. Such observations suggest possible targets for further improving the health insurance system.

Project description:ObjectiveIn 2001, Thailand implemented the Universal Coverage Scheme (UCS), a public insurance system that aimed to achieve universal access to healthcare, including essential medicines, and to influence primary care centres and hospitals to use resources efficiently, via capitated payment for outpatient services and other payment policies for inpatient care. Our objective was to evaluate the impact of the UCS on utilisation of medicines in Thailand for three non-communicable diseases: cancer, cardiovascular disease and diabetes.DesignInterrupted time-series design, with a non-equivalent comparison group.SettingThailand, 1998-2006.DataQuarterly purchases of medicines from hospital and retail pharmacies collected by IMS Health between 1998 and 2006.InterventionUCS implementation, April-October 2001.Outcome measuresTotal pharmaceutical sales volume and percent market share by licensing status and National Essential Medicine List status.ResultsThe UCS was associated with long-term increases in sales of medicines for conditions that are typically treated in outpatient primary care settings, such as diabetes, high cholesterol and high blood pressure, but not for medicines for diseases that are typically treated in secondary or tertiary care settings, such as heart failure, arrhythmias and cancer. Although the majority of increases in sales were for essential medicines, there were also postpolicy increases in sales of non-essential medicines. Immediately following the reform, there was a significant shift in hospital sector market share by licensing status for most classes of medicines. Government-produced products often replaced branded generic or generic competitors.ConclusionsOur results suggest that expanding health insurance coverage with a medicine benefit to the entire Thai population increased access to medicines in primary care. However, our study also suggests that the UCS may have had potentially undesirable effects. Evaluations of the long-term impacts of universal health coverage on medicine utilisation are urgently needed.

Project description:ObjectiveTo improve understanding of the relationship between lack of insurance and risk of subsequent mortality.Data sourcesAdults who reported being uninsured or privately insured in the National Health Interview Survey from 1986 to 2000 were followed prospectively for mortality from initial interview through 2002. Baseline information was obtained on 672,526 respondents, age 18-64 at the time of the interview. Follow-up information on vital status was obtained for 643,001 (96 percent) of these respondents, with approximately 5.4 million person-years of follow-up.Study designRelationships between insurance status and subsequent mortality are examined using Cox proportional hazard survival analysis.Principal findingsAdjusted for demographic, health status, and health behavior characteristics, the risk of subsequent mortality is no different for uninsured respondents than for those covered by employer-sponsored group insurance at baseline (hazard ratio 1.03, 95 percent confidence interval [CI], 0.95-1.12). Omitting health status as a control variable increases the estimated hazard ratio to 1.10 (95 percent CI, 1.03-1.19). Also omitting smoking status and body mass index increases the hazard ratio to 1.20 (95 percent CI, 1.15-1.24). The estimated association between lack of insurance and mortality is not larger among disadvantaged subgroups; when the analysis is restricted to amenable causes of death; when the follow-up period is shortened (to increase the likelihood of comparing the continuously insured and continuously uninsured); and does not change after people turn 65 and gain Medicare coverage.ConclusionsThe Institute of Medicine's estimate that lack of insurance leads to 18,000 excess deaths each year is almost certainly incorrect. It is not possible to draw firm causal inferences from the results of observational analyses, but there is little evidence to suggest that extending insurance coverage to all adults would have a large effect on the number of deaths in the United States.

Dataset Information

SCHIP's impact on dependent coverage in the small-group health insurance market.

Objective

Data sources

Study design

Data collection/extraction methods

Principal findings

Conclusions

Publications

SCHIP's impact on dependent coverage in the small-group health insurance market.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets