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挤入效应:私人医疗保险市场对医疗补助需求的影响

Crowd-in: the effect of private health insurance markets on the demand for Medicaid.

作者信息

Perreira Krista M

机构信息

Department of Public Policy, University of North Carolina, Abernethy Hall, CB#3435, Chapel Hill, NC 27599-3435, USA.

出版信息

Health Serv Res. 2006 Oct;41(5):1762-81. doi: 10.1111/j.1475-6773.2006.00563.x.

Abstract

OBJECTIVE

To investigate the effects of local labor market conditions and the availability of employer-sponsored health insurance on exits from the Medicaid program.

DATA SOURCE

Data for this project come from a unique administrative database containing a 2 percent sample of all cases on California's Medicaid program in 1987 and a 2 percent sample of all new cases starting each year between 1987 and 1995.

STUDY DESIGN

The results are estimated using a discrete duration model where the monthly exit probability is a function of demographic characteristics, local labor market variables, the probability of having employer-sponsored insurance, and fixed year and county effects.

PRINCIPAL FINDINGS

Improvements in labor market opportunities (i.e., employment growth, wage growth, and increases in the availability of employer-sponsored health insurance) promote exits off the Medicaid program. A 2.5 percentage point increase in the availability of employer-sponsored insurance leads to a 6 percent increase in the probability that a completed spell lasts no more than 2 years. It would take a 2 percentage point decrease in unemployment rates or a 10 percent increase in average quarterly earnings to yield an equivalent increase in the likelihood of exiting Medicaid within 2 years. These effects are robust to the inclusion of county-level fixed effects and time effects.

CONCLUSIONS

Medicaid expenditures and caseloads are sensitive to local economic fluctuations and secular trends in the availability of health insurance. Continued decreases in employer-based health insurance coverage will greatly increase the demand for public insurance coverage and the financial pressures on state governments.

摘要

目的

研究当地劳动力市场状况以及雇主提供的医疗保险的可获得性对退出医疗补助计划的影响。

数据来源

本项目的数据来自一个独特的行政数据库,该数据库包含1987年加利福尼亚州医疗补助计划所有案例的2%样本,以及1987年至1995年期间每年开始的所有新案例的2%样本。

研究设计

结果采用离散持续时间模型进行估计,其中每月退出概率是人口特征、当地劳动力市场变量、拥有雇主提供保险的概率以及固定年份和郡县效应的函数。

主要发现

劳动力市场机会的改善(即就业增长、工资增长以及雇主提供的医疗保险可获得性的增加)促使人们退出医疗补助计划。雇主提供保险的可获得性提高2.5个百分点,会导致一个完整参保期持续不超过2年的概率增加6%。失业率下降2个百分点或平均季度收入增长10%,才能在2年内使退出医疗补助计划的可能性产生同等程度的增加。这些影响在纳入郡县层面的固定效应和时间效应后依然稳健。

结论

医疗补助支出和病例数量对当地经济波动以及医疗保险可获得性的长期趋势较为敏感。基于雇主的医疗保险覆盖范围持续下降,将大幅增加对公共保险覆盖的需求以及给州政府带来的财政压力。

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