Health Insurance Eligibility, Utilization of Medical Care, and Child Health

Abstract

Two economists applied data from the Current Population Survey and the National Health Interview Survey and state-level data on child mortality to a simulation model of utilization of medical care that varies only with the states legislative environment to examine the utilization of medical care and health effects of Medicaid eligibility on low income children. The models took into consideration the recent expansions of Medicaid to low income children. 38% of those ineligible for Medicaid in 1984 who became eligible due to changes during 1984-1992 were uninsured. Between 1984 and 1992 expansions of the Medicaid program increased the proportion of children eligible for Medicaid almost two-fold (16.1% vs. 31.2%); yet coverage rates were always lower than eligibility rates (13.2% vs. 16.1% in 1984 and 20.3% vs. 31.2% in 1992) and the increase in coverage rates was only about 50% of the increase in eligibility rates. During 1984-1992 the probability that a child was eligible for Medicaid increased the probability of health insurance coverage by 29.77%. When the model considered bias in variables (e.g. a recession in a state) the take-up rate was only 22.73%. Nevertheless Medicaid markedly increased use of medical care. For example eligibility for Medicaid increased the likelihood of making a visit to a physicians office in the last two weeks by about 50%. It also increased the probability of a child visiting the hospital suggesting inefficiency in the way that providers deliver care to Medicaid enrollees. Medicaid eligibility had a significant effect on reducing child mortality. The 15.1 percentage point increase in eligibility during 1984-1992 reduced child mortality by 4.5%. When the researchers examined parent-assessed subjective health measures Medicaid eligibility had no effect on child health. Medicaid eligibility reduced race and education-based disparities in the number of visits and racial differences in mortality; yet it may actually intensify current disparities in health care delivery site.