Author: Harrington, Mary
Working Paper: The Effect Of A Health Care Visit On Transitions To Medicaid Or Schip Among Uninsured, Low-Income Children (PDF) ; June 2008
Objective.To investigate whether uninsured low-income children become enrolled in Medicaid or SCHIP because of a health care visit.
Data Source. The study uses data from four panels of the Medical Expenditure Panel Survey, covering the time period 1999 through 2003. Data on children are linked with data on parents. Information from the core household survey is combined with information from separate files on conditions and service utilization. The analysis file contains data on roughly 9,000 low-income children and their parent(s).
Study Design. Longitudinal data are used to follow the experiences of low income children for the 24-month duration of their involvement in the panel. Transition rates for uninsured low income children are compared for children with and without different types of health care visits. Accidents/injuries are employed to instrument for visits to address concerns about an endogenous relationship between visits and enrollment.
Principal Findings. Roughly three-fourths of low-income uninsured children remain uninsured despite having had some type of health care visit, and 63 percent remain uninsured despite having had a visit to the emergency department or hospital. A health care visit has a significant but small effect on transitions from uninsured to insured among low-income children. The effect is largest for hospitalizations (26 percentage points) and visits to an emergency department (11 percentage points) among children in families with income below 125% of the federal poverty level. A visit is estimated to increase the probability of enrollment by at most 26 percentage points. The average probability of enrollment among uninsured low income children without a visit is 12 percent, whereas the probability of enrollment among low-income children with an emergency department or hospital visit increases to between 22 and 40 percent. Results using accidents/injuries to instrument for health care visits are generally consistent with results from the analysis of non-instrumented visit effects.
Conclusions. Many low-income uninsured children are not becoming enrolled despite having a health care visit. Contrary to what is often assumed, we should not consider uninsured low-income children to be "conditionally enrolled." Outreach efforts should be strengthened to address barriers that keep parents and providers from enrolling eligible children in public coverage.
Author: Crow, Sarah ; Harrington, Mary ; McLaughlin, Catherine
Working Paper: Sources of Vulnerability: A Critical Review of the Literature on Racial/Ethnic Minorities, Immigrants, and Persons with Chronic Mental Illness (PDF) ; October 2002
This critical synthesis provides background material for a special ERIU research initiative on vulnerable populations. (For the papers that resulted from that undertaking, see /events/papers_2004vpops.html) It develops a conceptual framework to use when studying the relationship between vulnerability and health insurance coverage and summarizes existing research on the factors influencing coverage outcomes for racial and ethnic minorities, immigrants, and people with chronic mental illness. Particular attention is placed on literature that explores the dynamic relationship between labor markets and coverage. The review includes a summary of data sources that can be employed to study coverage dynamics for these vulnerable populations.