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Tricia J. Johnson, PhD, Department of Health Systems Management, Rush University Medical Center, 1700 West Van Buren Street, TOB Suite 126b, Chicago, IL 60612, 312-942-7107, tricia_j_johnson@rush.edu and Amy M. Bartels, MPH, School of Health Administration and Policy, Arizona State University, Box 874506, Tempe, AZ 85287-4506.
Introduction: This study uses micro-data from a unique community health data system in Yuma County, Arizona (YCHDS) to study the patterns of insurance coverage for children who utilized health care services over a three-year period of time across race and ethnicity, age, and geographic proximity to health care providers. The YCHDS merges data from the hospital system, federally qualified community health centers, private pediatric practices, state Medicaid and immunization data, employer-based health insurance and a survey of primarily Hispanic neighborhoods. We create seven main patterns of health insurance coverage experienced by children utilizing some form of health care in each of three years. The patterns are comprised of Medicaid or SCHIP, private insurance and spells without insurance. Population Studied: Yuma County is a sparsely populated county spanning more than 5,000 square miles in the southwestern corner of Arizona. More than 60% of children are Hispanic. The sample includes 19,020 children ages 0 to 17 in 1999 who utilized at least one service in each of the three years of study, 1999 to 2001. Principal Findings: Nearly three-quarters of the children in the sample have a single consistent source of coverage, either Medicaid or private insurance, across the three years. An additional 16% switch between Medicaid and private insurance with no uninsured spells. Overall, 89% of the children experienced no uninsured spell of medical care during the three-year study period, while 11% of the children experienced at least one spell of medical care without insurance. Nearly 7% of the children switched between Medicaid and no insurance. Conclusion: We show that having no insurance coverage is not synonymous with receiving no medical care. In this very low income community, where nearly one in four families with dependent children live below the federal poverty line, more than one in ten children experienced at least one spell of medical care without insurance over three years. Most children seeking medical care, however, experience one year or less without insurance. Implications for Policy, Delivery or Practice: In an effort to reduce Medicaid expenditures, states such as Arizona are considering a shift to more frequent re-enrollment and eligibility checks. These changes, coupled with the lack of assistance with re-enrollment processes, are likely to increase churning between Medicaid and no insurance. Maintaining a consistent source of health care coverage is likely to reduce unnecessary and inappropriate health care utilization for low-income children.
Learning Objectives:
Keywords: Insurance-Related Barriers, Access and Services
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.