International Journal of Health Care Finance and Economics

, Volume 14, Issue 2, pp 109–126

Stability of children’s insurance coverage and implications for access to care: evidence from the Survey of Income and Program Participation

Authors

    • Ross School of Business and Department of Health Management and PolicyUniversity of Michigan
    • National Bureau of Economic Research
  • Sean M. Orzol
    • Mathematica Policy Research
  • Lara Shore-Sheppard
    • National Bureau of Economic Research
    • Williams College
Article

DOI: 10.1007/s10754-014-9141-1

Cite this article as:
Buchmueller, T., Orzol, S.M. & Shore-Sheppard, L. Int J Health Care Finance Econ (2014) 14: 109. doi:10.1007/s10754-014-9141-1

Abstract

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.

Keywords

Health insuranceMedicaidAccess to care Panel data

JEL Classification

I13

Copyright information

© Springer Science+Business Media New York 2014