When Coverage Expands: Children's Health Insurance Program as a Natural Experiment in Use of Health Care Services
dc.contributor.author | Haggins, Adrianne | en_US |
dc.contributor.author | Patrick, Stephen | en_US |
dc.contributor.author | Demonner, Sonya | en_US |
dc.contributor.author | Davis, Matthew M. | en_US |
dc.contributor.author | Lewis, Lawrence M. | en_US |
dc.date.accessioned | 2013-11-01T19:00:57Z | |
dc.date.available | 2014-11-03T16:20:37Z | en_US |
dc.date.issued | 2013-10 | en_US |
dc.identifier.citation | Haggins, Adrianne; Patrick, Stephen; Demonner, Sonya; Davis, Matthew M.; Lewis, Lawrence M. (2013). "When Coverage Expands: Children's Health Insurance Program as a Natural Experiment in Use of Health Care Services." Academic Emergency Medicine (10): 1026-1032. <http://hdl.handle.net/2027.42/100287> | en_US |
dc.identifier.issn | 1069-6563 | en_US |
dc.identifier.issn | 1553-2712 | en_US |
dc.identifier.uri | https://hdl.handle.net/2027.42/100287 | |
dc.description.abstract | Background Expanding insurance coverage is designed to improve access to primary care and reduce use of emergency department ( ED ) services. Whether expanding coverage achieves this is of paramount importance as the United States prepares for the Affordable Care Act. Objectives Emergency and outpatient department use was examined after the State Children's Health Insurance Program ( CHIP ) coverage expansion, focusing on adolescents (a major target group for CHIP ) versus young adults (not targeted). The hypothesis was that coverage would increase use of outpatient services, and ED use would decrease. Methods Using the National Ambulatory Medical Care Survey ( NAMCS ) and the National Hospital Ambulatory Medical Care Survey ( NHAMCS ), the years 1992–1996 were analyzed as baseline and then compared to use patterns in 1999–2009, after the CHIP launch. Primary outcomes were population‐adjusted annual visits to ED versus nonemergency outpatient settings. Interrupted time series were performed on use rates to ED and outpatient departments between adolescents (11 to 18 years old) and young adults (19 to 29 years old) in the pre‐ CHIP and CHIP periods. Outpatient‐to‐ ED ratios were calculated and compared across time periods. A stratified analysis by payer and sex was also performed. Results The mean number of outpatient adolescent visits increased by 299 visits per 1,000 persons (95% confidence interval [ CI ] = 140 to 457), while there was no statistically significant increase in young adult outpatient visits across time periods. There was no statistically significant change in the mean number of adolescent ED visits across time periods, while young adult ED use increased by 48 visits per 1,000 persons (95% CI = 24 to 73). The adolescent outpatient‐to‐ ED ratio increased by 1.0 (95% CI = 0.49 to 1.6), while the young adults ratio decreased by 0.53 across time periods (95% CI = –0.90 to –0.16). Conclusions Since CHIP , adolescent non‐ ED outpatient visits have increased, while ED visits have remained unchanged. In comparison to young adults, expanding insurance coverage to adolescents improved use of health care services and suggests a shift to non‐ ED settings. Expanding insurance through the Affordable Care Act of 2010 will likely increase use of outpatient services, but may not decrease ED volumes. Resumen Cuando la Cobertura se Amplia: Programa de Seguro Sanitario de Niños como un Experimento Natural en el Uso de los Servicios Sanitarios Introducción La ampliación de la cobertura del seguro se diseñó para mejorar el acceso a la atención primaria y reducir el uso de los servicios de urgencias ( SU ). El que esta ampliación de la cobertura lo consiga es de una importancia capital ya que Estados Unidos se prepara para la Ley del Cuidado de Salud Asequible (Affordable Care Act). Objetivos Se examinó el uso del servicio ambulatorio y de urgencias tras la ampliación de la cobertura del Programa de Seguro Sanitario de los Niños (Children's Health Insurance Program, CHIP ), por parte de los adolescentes (un gran grupo contemplado por el CHIP ) frente a los adultos jóvenes (no contemplado). La hipótesis fue que la cobertura incrementaría el uso de los servicios ambulatorios y disminuiría el de los SU . Metodología Utilizando la National Ambulatory Medical Care Survey y la National Hospital Ambulatory Medical Care Survey, se analizaron los años 1992–1996 como basal y después se compararon con los patrones de uso en 1999–2009, tras la introducción del CHIP . Los resultados principales fueron las visitas anuales a los SU frente a los servicios ambulatorios no urgentes ajustadas por la población. Se realizaron series temporales interrumpidas en las tasas de uso de los SU y los servicios ambulatorios entre adolescentes (11 a 18 años) y adultos jóvenes (19 a 29 años) en los periodos pre‐ CHI y CHIP . Se calcularon los porcentajes ambulatorio‐ SU y se compararon a través de los periodos de tiempo. Se realizó también un análisis estratificado por sexo y pagador. Resultados El número medio de visitas ambulatorias de adolescentes se incrementó 299 visitas por 1.000 personas ( IC 95% = 140 a 457), mientras que no hubo un incremento significativo en las visitas ambulatorias de adultos jóvenes a lo largo de los periodos de tiempo. No hubo cambio estadísticamente significativo en la media de número de visitas al SU de adolescentes a lo largo de los periodos de tiempo, mientras que se incrementó el uso de los SU de los adultos jóvenes, 48 visitas por 1.000 personas ( IC 95% = 24 a 73). La proporción ambulatorio‐ SU del adolescente se incrementó un 1,0 ( IC 95% = 0,49 a 1,6), mientras que la proporción de los adultos jóvenes descendió un 0,53 a lo largo de los periodos de tiempo ( IC 95% = –0,90 a –0,16). Conclusiones Desde el CHIP , las visitas ambulatorias no urgentes de los adolescentes se han incrementado, mientras que las visitas a los SU permanecen sin cambios. En comparación con los adultos jóvenes, la ampliación de la cobertura del seguro a los adolescentes mejoró el uso de los servicios sanitarios y sugiere un cambio hacia los servicios no relacionados con el SU . La ampliación del seguro a través de la Ley de Cuidado de Salud Asequible de 2010 incrementará probablemente el uso de los servicios ambulatorios, pero puede no disminuir los volúmenes del SU . | en_US |
dc.publisher | Wiley Periodicals, Inc. | en_US |
dc.title | When Coverage Expands: Children's Health Insurance Program as a Natural Experiment in Use of Health Care Services | en_US |
dc.type | Article | en_US |
dc.rights.robots | IndexNoFollow | en_US |
dc.subject.hlbsecondlevel | Medicine (General) | en_US |
dc.subject.hlbtoplevel | Health Sciences | en_US |
dc.description.peerreviewed | Peer Reviewed | en_US |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/100287/1/acem12236.pdf | |
dc.identifier.doi | 10.1111/acem.12236 | en_US |
dc.identifier.source | Academic Emergency Medicine | en_US |
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dc.owningcollname | Interdisciplinary and Peer-Reviewed |
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