The health and healthcare impact of providing insurance coverage to uninsured children: A prospective observational study

BMC Public Health

Research Article

Rick Allgeyer¹  Hua Lin²  Marco Fierro²  Michael Lee³  Glenn Flores⁴  Candice Walker⁵  Monica Henry⁶  Kenneth Massey⁶  Alberto Portillo⁶  Janet M. Currie⁷ 

[1] Center for Strategic Decision Support, Texas Health and Human Services Commission, 4900 N. Lamar, 78751, Austin, TX, USA;Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, 75390–9063, Dallas, TX, USA;Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, 75390–9063, Dallas, TX, USA;Medica Research Institute, MR-CW105, P.O. Box 9310, 55440, Minneapolis, MN, USA;Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St SE, 55455, Minneapolis, MN, USA;Department of Pediatrics, University of Minnesota School of Medicine, 2450 Riverside Ave, 55454, Minneapolis, MN, USA;Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA;Texas Scottish Rite Hospital for Children, 2222 Welborn St, 75219, Dallas, TX, USA;University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, 75390–9063, Dallas, TX, USA;Woodrow Wilson School of Public and International Affairs, 316 Wallace Hall, Princeton University, 08544, Princeton, NJ, USA;

关键词: Medically uninsured;    Insurance;    Medicaid;    Children’s Health Insurance Program;    Children;    Adolescent;    Hispanic Americans;    African Americans;    Poverty;    Health policy;   

DOI  :  10.1186/s12889-017-4363-z

 received in 2016-05-12, accepted in 2017-05-03,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundOf the 4.8 million uninsured children in America, 62–72% are eligible for but not enrolled in Medicaid or CHIP. Not enough is known, however, about the impact of health insurance on outcomes and costs for previously uninsured children, which has never been examined prospectively.MethodsThis prospective observational study of uninsured Medicaid/CHIP-eligible minority children compared children obtaining coverage vs. those remaining uninsured. Subjects were recruited at 97 community sites, and 11 outcomes monitored monthly for 1 year.ResultsIn this sample of 237 children, those obtaining coverage were significantly (P < .05) less likely than the uninsured to have suboptimal health (27% vs. 46%); no PCP (7% vs. 40%); experienced never/sometimes getting immediate care from the PCP (7% vs. 40%); no usual source of preventive (1% vs. 20%) or sick (3% vs. 12%) care; and unmet medical (13% vs. 48%), preventive (6% vs. 50%), and dental (18% vs. 62%) care needs. The uninsured had higher out-of-pocket doctor-visit costs (mean = $70 vs. $29), and proportions of parents not recommending the child’s healthcare provider to friends (24% vs. 8%) and reporting the child’s health caused family financial problems (29% vs. 5%), and lower well-child-care-visit quality ratings. In bivariate analyses, older age, birth outside of the US, and lacking health insurance for >6 months at baseline were associated with remaining uninsured for the entire year. In multivariable analysis, children who had been uninsured for >6 months at baseline (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.4–10.3) and African-American children (OR, 2.8; 95% CI, 1.1–7.3) had significantly higher odds of remaining uninsured for the entire year. Insurance saved $2886/insured child/year, with mean healthcare costs = $5155/uninsured vs. $2269/insured child (P = .04).ConclusionsProviding health insurance to Medicaid/CHIP-eligible uninsured children improves health, healthcare access and quality, and parental satisfaction; reduces unmet needs and out-of-pocket costs; and saves $2886/insured child/year. African-American children and those who have been uninsured for >6 months are at greatest risk for remaining uninsured. Extrapolation of the savings realized by insuring uninsured, Medicaid/CHIP-eligible children suggests that America potentially could save $8.7–$10.1 billion annually by providing health insurance to all Medicaid/CHIP-eligible uninsured children.

【 授权许可】

CC BY   
© The Author(s). 2017