Buchmueller Thomas, Orzol Sean M, Shore-Sheppard Lara
Ross School of Business and Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA,
Int J Health Care Finance Econ. 2014 Jun;14(2):109-26. doi: 10.1007/s10754-014-9141-1. Epub 2014 Feb 7.
Even as the number of children with health insurance has increased, coverage transitions--movement into and out of coverage and between public and private insurance--have become more common. Using data from 1996 to 2005, we examine whether insurance instability has implications for access to primary care. Because unobserved factors related to parental behavior and child health may affect both the stability of coverage and utilization, we estimate the relationship between insurance and the probability that a child has at least one physician visit per year using a model that includes child fixed effects to account for unobserved heterogeneity. Although we find that unobserved heterogeneity is an important factor influencing cross-sectional correlations, conditioning on child fixed effects we find a statistically and economically significant relationship between insurance coverage stability and access to care. Children who have part-year public or private insurance are more likely to have at least one doctor's visit than children who are uninsured for a full year, but less likely than children with full-year coverage. We find comparable effects for public and private insurance. Although cross-sectional analyses suggest that transitions directly between public and private insurance are associated with lower rates of utilization, the evidence of such an effect is much weaker when we condition on child fixed effects.
尽管拥有医疗保险的儿童数量有所增加，但保险覆盖转换——进入和退出保险以及在公共保险和私人保险之间的转换——已变得更加普遍。利用1996年至2005年的数据，我们研究了保险不稳定是否对获得初级保健有影响。由于与父母行为和儿童健康相关的未观察到的因素可能会影响保险覆盖的稳定性和利用率，我们使用一个包含儿童固定效应的模型来估计保险与儿童每年至少看一次医生的概率之间的关系，以考虑未观察到的异质性。尽管我们发现未观察到的异质性是影响横截面相关性的一个重要因素，但在考虑儿童固定效应的情况下，我们发现保险覆盖稳定性与获得医疗服务之间存在统计上和经济上显著的关系。有半年公共或私人保险的儿童比全年无保险的儿童更有可能至少看一次医生，但比全年有保险的儿童可能性小。我们发现公共保险和私人保险有类似的效果。尽管横截面分析表明，直接在公共保险和私人保险之间转换与较低的利用率相关，但当我们考虑儿童固定效应时，这种影响的证据要弱得多。
