Saloner Brendan, Hochhalter Stephanie, Sabik Lindsay
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and
Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia.
Pediatrics. 2016 Mar;137(3):e20152440. doi: 10.1542/peds.2015-2440. Epub 2016 Feb 19.
Premiums are required in Medicaid and the Children's Health Insurance Program in many states. Effects of premiums are raised in policy debates.
Our objective was to review effects of premiums on children's coverage and access.
PubMed was used to search academic literature from 1995 to 2014.
Two reviewers initially screened studies by using abstracts and titles, and 1 additional reviewer screened proposed studies. Included studies focused on publicly insured children, evaluated premium changes in at least 1 state/local program, and used longitudinal or repeated cross-sectional data with pre/postchange measures.
We identified 263 studies of which 17 met inclusion criteria.
Four studies examined population-level coverage effects by using national survey data, 11 studies examined trends in disenrollment and reenrollment by using administrative data, and 2 studies measured additional outcomes. No eligible studies evaluated health status effects. Increases in premiums were associated with increased disenrollment rates in 7 studies that permitted comparison. Larger premium increases and stringent enforcement tended to have larger effects on disenrollment. At a population level, premiums reduce public insurance enrollment and may increase the uninsured rate for lower-income children. Little is known about effects of premiums on spending or access to care, but 1 study reveals premiums are unlikely to yield substantial revenue.
Effect sizes were difficult to compare across studies with administrative data.
Public insurance premiums often increase disenrollment from public insurance and may have unintended consequences on overall coverage for low-income children.
在许多州，医疗补助计划和儿童健康保险计划都需要缴纳保险费。保险费的影响在政策辩论中被提及。
我们的目的是回顾保险费对儿童医保覆盖范围和可及性的影响。
使用PubMed搜索1995年至2014年的学术文献。
两名评审员最初通过摘要和标题筛选研究，另外一名评审员筛选提议的研究。纳入的研究聚焦于参加公共保险的儿童，评估至少一个州/地方项目中的保险费变化，并使用纵向或重复横截面数据以及变化前后的测量方法。
我们识别出263项研究，其中17项符合纳入标准。
四项研究使用全国调查数据检验了对总体覆盖范围的影响，11项研究使用行政数据检验了退保和重新参保的趋势，两项研究测量了其他结果。没有符合条件的研究评估对健康状况的影响。在七项允许进行比较的研究中，保险费增加与退保率上升相关。保险费增幅越大且执行越严格，对退保的影响往往越大。在总体层面，保险费会减少公共保险的参保人数，并可能提高低收入儿童的未参保率。关于保险费对支出或医疗服务可及性的影响知之甚少，但有一项研究表明保险费不太可能带来可观的收入。
不同研究之间难以通过行政数据比较效应大小。
公共保险费常常会增加公共保险的退保率，可能会对低收入儿童的总体医保覆盖产生意想不到的后果。
