jurnal trends in type of health insurance coverage for us children and their parents

7/23/2019 Jurnal Trends in Type of Health Insurance Coverage for US Children and Their Parents

1/11

Trends in Type of Health Insurance Coverage

for US Children and Their Parents, 1998!11

"ennifer #$ %e&oe, '%, %Phil( Carrie "$ Tillotson, 'PH( 'iguel 'arino, Ph%("ean )*'alley, 'PH( Heather +ngier, 'PH( orraine S$ -allace, Ph%(.achel /old, Ph%, 'PH

0ro the %epartent of 0aily 'edicine 2%r %e&oe, %r 'arino, and 's +ngier3, %ivision of 4iostatistics, %epartent of Pu5lic Healthand Preventive 'edicine 2's Tillotson, %r 'arino, and 's )*'alley3, )regon Health 6 Science University, Center for Health .esearch,7aiser Peranenteorthest 2%r /old3, Portland, )re( and %epartent of 0aily 'edicine, The )hio State University, Colu5us, )hio2%r -allace3The authors declare that they have no conflict of interest$+ddress correspondence to Heather +ngier, 'PH, %epartent of 0aily 'edicine, )regon Health 6 Science University, :181 Sa "ac;son.d, 'ailcode 0', Portland, ). 9 angierh? ohsu$ed u3$.eceived for pu5lication "anuary To eAaine trends in health insurance typeaong

US children and their parents$'#TH)%S> Using the 'edical #Apenditure Panel Survey21998!113, e lin;ed each child 2n B 1!,@1( eightedn C

patterns of full=year health insurance type, stratified 5y

incoe$ -e eAained longitudinal insurance trends using

Doinpoint regression and further eAplored these trends ith

adDusted regression odels$.#SUTS> -hen coparing 1998 to !11, the percentage oflo=incoe failies ith 5oth child and parent or parents pri=

vately insured decreased fro 9$E to 19$1E, ith an esti=

ated decline of !$8F 29@E confidence interval, 1$1!,

!$F:3 unadDusted percentage points per year( iddle=incoe

failies eAperienced a drop fro


2/11

%#&)# #T + +C+%#'IC P#%I+T.ICS

a nationally representative saple$ %etails a5out the'#PS=HC are availa5le elsehere$1@,1F

The study population included children aged ! to 1 to identify statistically sig=

nificant changes in trend over tie 2in direction or rate of

decrease or increase3 and to Ouantify that change through

an annual percentage of change statistic$ This approach

has 5een used to assess teporal trends in health

insurance and other health care outcoes$GF

The null

hypothesis in this analysis as no change in trend, and the

alternative hypothesis as a significant increase or

decrease in the prevalence of each health insurance

coverage pattern$ The iniu nu5er of Doinpoints

alloed as ! 2ie, a straight line over tie3, indicating no

change in child and parent health insurance coverage

patterns over tie$ The aAiu nu5er of Doinpoints

as set at on the 5asis of an algorith ta;ing intoaccount the nu5er of tie points availa5le,

:ith

one eAception> the child


3/11

+C+%#'IC P#%I+T.ICS 0+'I H#+TH ISU.+C#T.#%S, 1998!11 :

pu5licKparent private, iddle=incoe group as liited to

only 1 Doinpoint as a result of sall cell sies 2n M :!3 in

the years 1998 to !!! and thus had feer tie points

avail= a5le$ + 'onte Carlo perutation ethod as used

to select the odel ith the 5est fit, and yearly

percentage point changes ere calculated for each

segent$ Statisti= cally significant changes ere those

that increased or decreased over tie and ere

significantly different than an annual percentage change

of ! 2no change over tie3$To account for potential differences 5eteen child and

parent health insurance types in our analysis of change

patterns over tie, e used trend segents identified in

Doinpoint regression analyses ith ultinoial logistic

regression to allo inclusion of potential confounders$ In

these odels, the child and parent co5ined health insur=

ance type as the outcoe varia5le 29 categories3 and

year as the priary independent varia5le$ 0or the lo=

incoe odels, all 9 categories ere included in the

outcoe var= ia5le( hoever, for the iddle=incoe

odels, the child privateKparent pu5lic and child

uninsuredKparent pu5lic cat= egories ere eAcluded as aresult of sall andKor ero cells 2n M :!3$ -e adDusted for

all deographic characteristics eAained, as they are

;non to influence health insurancecoverage$

privateKprivate( pu5licKprivate,

pu5licKpu5lic, pu5= licKuninsured, uninsuredKprivate, and

uninsuredKuninsured 2Ta5le 3$

T.#%S I P.I&+T# ISU.+C# C).+/#

The percentage of childparent pairs ith private insur=

ance decreased steadily fro 9$E in 1998 to 19$1E

in !11 for lo=incoe failies 2M!!E0P3, the yearly

unadDusted percentage point decrease as !$8F per year

29@E confidence interval CIQ 1$1!, !$F:3$ The

prevalence of iddle=incoe pairs ith child and parent

privately insured fell significantly fro


4/11

1!! children ho 5ecae eligi5le for pu5licinsurance,


5/11

%#&)# #T + +C+%#'IC P#%I+T.ICSG

Ta5le 1$ %eographic Characteristics 5y 0aily Incoe, 1998!11R

o Incoe 2n B F@,G9F3 'iddle Incoe 2n B ::,GF3

Characteristic

Child*s age

Uneighted n -eighted E Uneighted n -eighted E

!G y 18,89@ :!$G

study period 21998!113 as 1 pooled saple$ Colun percentages are approAiately 1!!E 2rounded to nearest tenth of a percent3$

o incoe, M!!E federal poverty level 20P3( iddle incoe, !!E to MG!!E 0P$ The 0P for a faily of four in !11 as

L,:@!$Saple sies do not add to total uneighted colun nu5er as a result of eAclusion of sall nu5er of issing responses$

G gained pu5lic coverage, yet only of the ereuninsured 5efore gaining coverage( thus, crod out

eAplained half of the increase$:1

)ther studies, hoever,

found little or no evidence of crod out$:,::

In thisstudy, e sa a uch larger increase in pu5licly insuredchildren ith uninsured parents copared to pu5licly

insured children ith privately insured parents$ Thus, theincreasing cost of private health insurance, coupled ith

reductions in eployer=sponsored insurance offerings andthe historical lac; of opportunities for adults to gain

pu5lic coverage, li;ely account for the changes reportedhere$

-hen faced ith unafforda5le coverage options andKorreductions in 5enefit pac;ages, lo= and iddle=incoefailies ere forced to loo; 5eyond eployer=sponsored,

private coverage$:G,:@

%uring the tie period studied,any states eApanded their children*s health insuranceprogras hile siultaneously liiting eligi5ility and

pu5lic insurance enrollent opportunities for adults$:F

The changes in health insurance type seen in this study

ere not eAplained 5y differences in child or parent

charac= teristics, as evidenced 5y the consistent results

5eteen un= adDusted and adDusted analyses$ 0urtherresearch is needed

to assess the ipact of these increasing discordant faily

coverage patterns$

I'PIC+TI)S

%espite iproveents in children*s coverage rates, thisstudy suggests a trend of coverage loss for parents that

could negatively affect the hole faily$ Insured childrenith uninsured parents have higher odds of eAperiencing

health insurance coverage gaps and unet health careneeds copared to insured children ith insured

parents$8,: 'edical#Apenditure Panel Survey, 1998!11$

Ta5le :$ UnadDusted and +dDusted early Percentage Point Change in Child and Parent Health Insurance Type 5y 0aily Incoe,

1998!11

0ull=ear Health Insurance Type,

Child TypeKParent Type "oinpoint Identified Trend

o incoe

early Percentage Point Change 29@E CI3

UnadDusted +dDusted


8/11

%#&)# #T + +C+%#'IC P#%I+T.ICSFPrivateKprivate

PrivateKpu5lic

PrivateKuninsured

Pu5licKprivate

1998!11

$;

1998!11

1998!!G

!$8F 2 1$1!, !$F:3R

$;

!$!@ 2 !$11, !$!13

!$9! 2!$@


9/11

+C+%#'IC P#%I+T.ICS 0+'I H#+TH ISU.+C#T.#%S, 1998!11 lessons fro the

)re gon e A perient$ "+'+ P ediat r $ !1@(1F9>e1G: 1 G @$11$ Cohen .+, 'a;uc %', 4ernstein +4, et al$ Health insurance

c o v e rage trends, 19@9!! estiates fro the ational Health

Intervi e Sur v e y $ atl Health Stat .epor t$ !!9(1 1 @$

1$ %e & oe "#, Cr a ford C, +ngier H, et al$ The associat ion 5eteen

pu5= lic c o ver age for children and parents persists, !! ! 1!$

'aternChild Health "$ !1@( 1 9>1 a national health inforation resource$ InOuir y$

199F=199 < (::>:G G 9$19$ )lson ', T ang S 0, e achec; P - $ Children in the United States

ith discontin u ous health insurance c o ve r age$ #ngl " 'ed$ !!@(

:@:>: 8 :9 1$

!$ US %epartent of Health and Huan Services$ +nnual update of the

HHS po v erty guidelines$ 0 ed . eg$ 1998(F:>9: @ 9:8$

1$ US %epartent of Health and Huan Services$ +nnual update of the

HHS po v erty guidelines$ 0 ed . e g$ !11(:F: < :F:8$

$ - illias .$ + note on ro5ust v ariance estiat ion for cluste r=

correlated data$ 4ioetric s $ !!!(@F>FG@ FG F$:$ 7i H", 0ay ' P , 0euer #", et al$ Perutation tests for Doinpoint

re g ression ith applica tions to cancer rates> correction$ Stat 'e d$

!!!(1 9>::@:@ 1$

G$ - ong "., Harris "7, .odrigu e =/alindo C, et al$ Incidence of child=

hood and adolescent elanoa in the United States, 198G F 8@ G$@$ Sion +#, Uddin S/$ ational trends in priary cesarean del iv e ry,

la5or attepts, and la5or success, 199!!1!$ +1 " )5stet /yneco l$

!1:( !9>@@G$e@@1@@ G $e@@ 8$

F$ 4arnes .0 - , 'oore ', /arfein .S, et al$ T rends in ortali ty of

tu5erculo sis patients in the United States> the long=terperspect ive$

+nn #pideio l$ !11(1> < 91


11/11

%#&)# #T + +C+%#'IC P#%I+T.ICS8

::$ 'c'orr o S, 7 enney /', - aidann T, et al$ +ccess to pr ivate

cov erage for children enrolled in CHI P $ +cad P ediat r $ !1@(1@2:

suppl3>S@!S @ @$

:G$ oung .+, %e & oe "#$ -ho ill ha v e health insurance in thefuture[

+n updated proDection$ +nn 0 a 'ed$ !1(1!>1@F 1F $

:@$ /ould #$ #ploye r =sponsor e d health insurance erosion continues in

!!8 and is e Apected to orsen$ Int " Health Ser v $ !1!(G!>

htt p >KK $; f f $o r gK edi c ai d Kup loa d KS ta tes =.esp ond =to= 0iscal=

Pressure=State='edicaid=Spending=/roth=and=Cost=Contain

ent$pdf( !!:$ +ccessed +ugust :, !11$

: Henry "$ 7aiser

0ai ly 0o un=dation( !1@$

G$ 7aiser 0aily 0oundation$ Children*s health coverage> 'edicaid,

CHIP and the +C+$ +vaila5le at> http>KK; f f$orgK h ealth=refo rKissue=

5riefKchildr ens=health=c ov erage=edica id=chip=and= the=acaK( !1G$

+ccessed 0e5ruary :, !1@$

G:$ Health Policy 4rief> the faily glitch$ Health +ffairs, ove5er 1!,

!1G, +vaila5le at>http>KK $healtha f fairs$o r gKhealthp o li cy5riefsK

5rief$php [ 5riefZidB19$+ccessed "une 18, !1@$

GG$ Selden T', %u5ay , 'iller /#, et al$ 'a n y failies ay face

sharply higher costs if pu5lic health insurance for their children is

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