Stability of children’s insurance coverage and implications for access to care: evidence from the Survey of Income and Program Participation
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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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- Stability of children’s insurance coverage and implications for access to care: evidence from the Survey of Income and Program Participation
International Journal of Health Care Finance and Economics
Volume 14, Issue 2 , pp 109-126
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Health insurance
- Access to care
- Panel data
- Author Affiliations
- 1. Ross School of Business and Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
- 2. National Bureau of Economic Research, Cambridge, MA, USA
- 3. Mathematica Policy Research, Ann Arbor, MI, USA
- 4. Williams College, Cambridge, MA, USA