儿童保险覆盖面的稳定性及其对获得护理的影响:来自收入和计划参与调查的证据。

Thomas Buchmueller, Sean M Orzol, Lara Shore-Sheppard
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引用次数: 12

摘要

尽管拥有医疗保险的儿童人数有所增加,但保险范围的转换——加入和退出保险以及在公共和私人保险之间流动——已经变得更加普遍。使用1996年至2005年的数据,我们研究了保险不稳定性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覆盖面的稳定性和利用率,因此我们使用包含儿童固定效应的模型来估计保险与儿童每年至少就诊一次的概率之间的关系,以解释未观察到的异质性。虽然我们发现未观察到的异质性是影响横截面相关性的重要因素,但在儿童固定效应的条件作用下,我们发现保险覆盖稳定性与获得护理之间存在统计学和经济上显著的关系。有部分年度公共或私人保险的孩子比没有全年保险的孩子更有可能至少看一次医生,但比有全年保险的孩子更少。我们发现公共保险和私人保险的效果相当。尽管横断面分析表明,公共和私人保险之间的直接转换与较低的使用率有关,但当我们考虑儿童固定效应时,这种影响的证据要弱得多。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Stability of children's insurance coverage and implications for access to care: evidence from the Survey of Income and Program Participation.

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.

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