Impact of discontinuity in health insurance on resource utilization

Ritesh Banerjee,Jeanette Y Ziegenfuss,Nilay D Shah

doi:10.1186/1472-6963-10-195

Ritesh Banerjee, Jeanette Y Ziegenfuss + Show 1 more

Open Access

https://doi.org/10.1186/1472-6963-10-195

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Abstract

BackgroundThis study sought to describe the incidence of transitions into and out of Medicaid, characterize the populations that transition and determine if health insurance instability is associated with changes in healthcare utilization.Methods2000-2004 Medical Expenditure Panel Survey (MEPS) was used to identify adults enrolled in Medicaid at any time during the survey period (n = 6,247). We estimate both static and dynamic panel data models to examine the effect of health insurance instability on health care resource utilization.ResultsWe find that, after controlling for observed factors like employment and health status, and after specifying a dynamic model that attempts to capture time-dependent unobserved effects, individuals who have multiple transitions into and out of Medicaid have higher emergency room utilization, more office visits, more hospitalizations, and refill their prescriptions less often.ConclusionsIndividuals with more than one transition in health insurance status over the study period were likely to have higher health care utilization than individuals with one or fewer transitions. If these effects are causal, in addition to individual benefits, there are potentially large benefits for Medicaid programs from reducing avoidable insurance instability. These results suggest the importance of including provisions to facilitate continuous enrollment in public programs as the United States pursues health reform.

Highlights

This study sought to describe the incidence of transitions into and out of Medicaid, characterize the populations that transition and determine if health insurance instability is associated with changes in healthcare utilization
Transitions into and out of health insurance coverage can bring a number of deleterious consequences, both for the health care of the enrollee and for the accountability of providers and insurers
Transitions between coverage status can be problematic for individuals with public program coverage in the United States

Summary

Introduction

This study sought to describe the incidence of transitions into and out of Medicaid, characterize the populations that transition and determine if health insurance instability is associated with changes in healthcare utilization. Transitions between coverage status can be problematic for individuals with public program coverage in the United States. Adults qualify for Medicaid based on a number of characteristics including income, having children, being pregnant, and/ or being disabled. Both eligibility requirements and need to verify eligibility status varies from state to state. Disruptions in Medicaid coverage are common,[1] even among individuals with chronic diseases[2]. Individuals can transition from Medicaid either due to a change in the criteria that made them eligible (i.e., income as a percent of poverty, being pregnant, or having a child that ages out of the program) or because they passively do not enroll from one period the

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