Venkataramani Maya, Pollack Craig Evan, Roberts Eric T
Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and.
Pediatrics. 2017 Dec;140(6). doi: 10.1542/peds.2017-0953. Epub 2017 Nov 13.
Since the passage of the Affordable Care Act, Medicaid enrollment has increased by ∼17 million adults, including many low-income parents. One potentially important, but little studied, consequence of expanding health insurance for parents is its effect on children's receipt of preventive services.
By using state Medicaid eligibility thresholds linked to the 2001-2013 Medical Expenditure Panel Surveys, we assessed the relationship between changes in adult Medicaid eligibility and children's likelihood of receiving annual well-child visits (WCVs). In instrumental variable analyses, we used these changes in Medicaid eligibility to estimate the relationship between parental enrollment in Medicaid and children's receipt of WCVs.
Our analytic sample consisted of 50 622 parent-child dyads in families with incomes <200% of the federal poverty level, surveyed from 2001 to 2013. On average, a 10-point increase in a state's parental Medicaid eligibility (measured relative to the federal poverty level) was associated with a 0.27 percentage point higher probability that a child received an annual WCV (95% confidence interval: 0.058 to 0.48 percentage points, = .012). Instrumental variable analyses revealed that parental enrollment in Medicaid was associated with a 29 percentage point higher probability that their child received an annual WCV (95% confidence interval: 11 to 47 percentage points, = .002).
In our study, we demonstrate that Medicaid expansions targeted at low-income adults are associated with increased receipt of recommended pediatric preventive care for their children. This finding reveals an important spillover effect of parental insurance coverage that should be considered in future policy decisions surrounding adult Medicaid eligibility.
自《平价医疗法案》通过以来，医疗补助计划的参保成年人增加了约1700万，其中包括许多低收入父母。为父母扩大医疗保险一个潜在的重要但很少被研究的后果是其对儿童接受预防性服务的影响。
通过使用与2001 - 2013年医疗支出面板调查相关的州医疗补助资格阈值，我们评估了成年医疗补助资格的变化与儿童接受年度健康儿童检查（WCV）可能性之间的关系。在工具变量分析中，我们利用这些医疗补助资格的变化来估计父母参加医疗补助计划与儿童接受WCV之间的关系。
我们的分析样本包括2001年至2013年期间对收入低于联邦贫困水平200%的家庭中的50622对亲子二元组进行的调查。平均而言，一个州的父母医疗补助资格提高10分（相对于联邦贫困水平衡量）与儿童接受年度WCV的概率高出0.27个百分点相关（95%置信区间：0.058至0.48个百分点，P = 0.012）。工具变量分析显示，父母参加医疗补助计划与他们的孩子接受年度WCV的概率高出29个百分点相关（95%置信区间：11至47个百分点，P = 0.002）。
在我们的研究中，我们证明针对低收入成年人的医疗补助扩展与他们的孩子更多地接受推荐的儿科预防性护理相关。这一发现揭示了父母保险覆盖的一个重要溢出效应，在未来围绕成年医疗补助资格的政策决策中应予以考虑。
