Zwanziger J, Mukamel D B, Szilagyi P G, Trafton S, Dick A W, Holl J L, Rodewald L E, Shone L P, Jarrell L, Raubertas R F
Department of, University of Rochester School of Medicine, Rochester, New York 14642, USA.
Pediatrics. 2000 Mar;105(3 Suppl E):728-32.
In response to the increase in the number of American children without health insurance, new federal and state programs have been established to expand health insurance coverage for children. However, the presence of insurance reduces the price of care for families participating in these programs and stimulates the use of medical services, which leads to an increase in health care costs. In this article, we identified the additional expenditures associated with the provision of health insurance to previously uninsured children.
We estimated the expenditures on additional services using data from a study of children living in the Rochester, New York, area who were enrolled in the New York State Child Health Plus (CHPlus) program. CHPlus was designed specifically for low-income children without health insurance who were not eligible for Medicaid. The study sample consisted of 1910 children under the age of 6 who were initially enrolled in CHPlus between November 1, 1991 and August 1, 1993 and who had been enrolled for at least 9 continuous months. We used medical chart reviews to determine the level of primary care utilization, parent interviews for demographic information, as well as specialty care utilization, and we used claims data submitted to CHPlus for the year after enrollment to calculate health care expenditures. Using this information, we estimated a multivariate regression model to compute the average change in expenditures associated with a unit of utilization for a cross-section of service types while controlling for other factors that independently influenced total outpatient expenditures.
Expenditures for outpatient services were closely related to primary care utilization-more utilization tended to increase expenditures. Age and the presence of a chronic condition both affected expenditures. Children with chronic conditions and infants tended to have more visits, but these visits were, on average, less expensive. Applying the average change in expenditures to the change in utilization that resulted from the presence of insurance, we estimated that the total increase in expenditures associated with CHPlus was $71.85 per child in the year after enrollment, or a 23% increase in expenditures. The cost increase was almost entirely associated with the provision of primary care. Almost three-quarters of the increase in outpatient expenditures was associated with increased acute and well-child care visits.
CHPlus was associated with a modest increase in expenditures, mostly from additional outpatient utilization. Because the additional primary care provided to young children often has substantial long-term benefits, the relatively modest expenditure increases associated with the provision of insurance may be viewed as an investment in the future.
为应对美国未参保儿童数量的增加，联邦和州已设立新的项目以扩大儿童医疗保险覆盖范围。然而，保险的存在降低了参与这些项目家庭的医疗费用价格，并刺激了医疗服务的使用，这导致了医疗保健成本的增加。在本文中，我们确定了为先前未参保儿童提供医疗保险所产生的额外支出。
我们使用对纽约州罗切斯特地区参加纽约州儿童健康加护（CHPlus）项目的儿童进行研究的数据，估算了额外服务的支出。CHPlus是专门为不符合医疗补助资格的低收入未参保儿童设计的。研究样本包括1910名6岁以下儿童，他们于1991年11月1日至1993年8月1日期间首次加入CHPlus，且连续参保至少9个月。我们通过查阅病历确定初级保健的使用水平，通过家长访谈获取人口统计学信息以及专科护理的使用情况，并使用参保后一年提交给CHPlus的理赔数据来计算医疗保健支出。利用这些信息，我们估计了一个多元回归模型，以计算在控制其他独立影响门诊总支出的因素的同时，与一系列服务类型的单位使用量相关的支出平均变化。
门诊服务支出与初级保健的使用密切相关——使用量增加往往会导致支出增加。年龄和慢性病的存在都会影响支出。患有慢性病的儿童和婴儿就诊次数往往更多，但平均每次就诊费用较低。将支出的平均变化应用于因保险存在而导致的使用量变化，我们估计参保后一年与CHPlus相关的支出总增加额为每名儿童71.85美元，即支出增加了23%。成本增加几乎完全与初级保健的提供有关。门诊支出增加的近四分之三与急性病和儿童健康护理就诊次数增加有关。
CHPlus与支出适度增加相关，主要是由于门诊使用量增加。由于为幼儿提供的额外初级保健通常具有重大的长期益处，与提供保险相关的相对适度的支出增加可被视为对未来的一种投资。
