HealthCore, Inc., Wilmington, DE 19801, USA.
Med Care Res Rev. 2011 Feb;68(1):56-74. doi: 10.1177/1077558710374620. Epub 2010 Jul 30.
This study examines the impact of disenrolling from Medicaid/State Children's Health Insurance Programs (SCHIP) on health care utilization and expenditures among children using the 1996-2005 Medical Expenditure Panel Survey data. Changes in expenditures and utilization upon Medicaid/SCHIP disenrollment were examined for two disenrollment groups, children who became uninsured and those who transitioned to private insurance; relative to a control group, those continuously enrolled in Medicaid/SCHIP during the study period. In multivariate analysis, a modified two-part model and difference-in-difference analytic approach were used. The dependent variables were changes in total expenditures and changes in utilization (i.e., well-child visits, physician visits, emergency room visits, hospitalizations, and prescription drug use) from pre- to post-disenrollment round. This study found that losing Medicaid/SCHIP coverage is associated with decreased preventive care utilization among children, regardless of the insurance status post-disenrollment. In addition, children who become uninsured following Medicaid/SCHIP disenrollment may also experience reductions in physician visits and prescription drug use.
本研究使用 1996-2005 年医疗支出面板调查数据，考察了从医疗补助/州儿童健康保险计划（SCHIP）中退保对儿童医疗保健利用和支出的影响。考察了两组退保者的支出和利用变化，即失去医疗保险的儿童和转为私人保险的儿童；并与研究期间持续参加医疗补助/SCHIP 的对照组进行了比较。在多变量分析中，采用了修正的两部分模型和差分分析方法。因变量是从退保前到退保后一轮的总支出变化和利用变化（即儿童健康检查、医生就诊、急诊就诊、住院和处方药使用）。本研究发现，无论退保后的保险状况如何，失去医疗补助/SCHIP 保险都会导致儿童预防保健利用减少。此外，在医疗补助/SCHIP 退保后失去医疗保险的儿童，其医生就诊和处方药使用也可能减少。
