Ketsche Patricia, Adams E Kathleen, Snyder Angela, Zhou Mei, Minyard Karen, Kellenberg Rebecca
Institute of Health Administration, Robinson College of Business, Georgia State University, Atlanta, GA 30302-3988, USA.
Health Serv Res. 2007 Dec;42(6 Pt 2):2410-23. doi: 10.1111/j.1475-6773.2007.00795.x.
To investigate disenrollment from public insurance at the 6-year transitional birthday when eligibility for many children moves from Medicaid to State Children's Health Insurance Program (S-CHIP).
Data from Georgia's S-CHIP (PeachCare) and Medicaid programs from 2000 to 2002.
The likelihood of dropping public coverage after the reference birthday is modeled for children turning age 6 compared with a control cohort of children turning age 9 controlling for demographic and geographic differences between enrollees.
Over 17 percent of 6-year-olds versus only 7 percent of the control cohort dropped coverage. After controlling for other factors (e.g., race/ethnicity, prior enrollment, and geographic region) having lower historical expenditures is predictive of dropping coverage among all children, although the unadjusted effect is stronger among children enrolled in PeachCare before their sixth birthday. Only 1 percent of Medicaid children who remained covered transitioned to PeachCare.
Turnover at transitional birthdays identifies a common pathway for children into the ranks of the uninsured. Facilitating continuous enrollment would retain in the programs children with lower than average expenditures. This may be one of the more cost effective ways of reducing the number of uninsured children in Georgia.
调查众多儿童的医保资格从医疗补助计划转为州儿童健康保险计划(S-CHIP)时,在6岁这个过渡生日上儿童退出公共保险的情况。
2000年至2002年佐治亚州S-CHIP(桃子关怀计划)和医疗补助计划的数据。
将满6岁儿童在参照生日后放弃公共医保覆盖的可能性,与满9岁儿童的对照队列进行建模比较,同时控制参保者的人口统计学和地理差异。
超过17%的6岁儿童放弃了医保覆盖,而对照队列中只有7%。在控制了其他因素(如种族/族裔、之前的参保情况和地理区域)后,历史支出较低预示着所有儿童都会放弃医保覆盖,尽管在6岁生日前参加桃子关怀计划的儿童中,未调整的影响更强。仍享有医保覆盖的医疗补助计划儿童中,只有1%转为参加桃子关怀计划。
过渡生日时的人员更替揭示了儿童进入未参保行列的一个常见途径。促进持续参保将使支出低于平均水平的儿童留在这些计划中。这可能是减少佐治亚州未参保儿童数量的更具成本效益的方法之一。