Davidson Gestur, Blewett Lynn A, Call Kathleen Theide, Williams Claudia H
University of Minnesota School of Public Health.
Synth Proj Res Synth Rep. 2004 Jun(5). Epub 2004 Jun 1.
Coverage expansions by Medicaid, SCHIP and other state programs significantly increased the number of people covered by public insurance. Crowd-out occurs when people drop private coverage for public coverage, when those enrolled in public insurance turn down private coverage when eligible, or when employers opt not to offer private insurance because of the existence of a public program. This synthesis examines the extent of crowd-out and whether it can be reduced. Key findings include: Estimates of crowd-out are imprecise and vary depending on the type of coverage expansion; the assumptions, methods and data used; and the time period covered. Crowd-out is more likely to occur in programs that enroll families, and among families with incomes greater than 200 percent FPL. Programs have used waiting periods and cost-sharing to limit crowd-out, but these techniques can be difficult and costly to implement, and may reduce program participation by the uninsured.
医疗补助计划（Medicaid）、儿童健康保险计划（SCHIP）及其他州计划扩大覆盖范围，显著增加了参加公共保险的人数。当人们放弃私人保险转而参加公共保险、参加公共保险的人在符合条件时拒绝私人保险，或者雇主因存在公共计划而选择不提供私人保险时，就会出现挤出效应。本综述探讨了挤出效应的程度以及是否可以减少这种效应。主要发现包括：挤出效应的估计并不精确，且因覆盖范围扩大的类型、所使用的假设、方法和数据以及所涵盖的时间段而异。挤出效应更有可能发生在覆盖家庭的计划中，以及收入超过联邦贫困线200%的家庭中。各计划已采用等待期和费用分摊来限制挤出效应，但这些方法实施起来可能困难且成本高昂，并且可能会减少未参保者对计划的参与度。
