Discontinuous Health Insurance and Its Effects on Access to Physician Services

Research Objective: This project examines the impact of discontinuous enrollment in California's Medicaid program or State Children's Health Insurance Program (MC/HF) on access to physician services, as measured by five indicators: 1) having a usual source of care, 2) having seen a doctor in the past year, 3) number of doctor visits in the past year, 4) having a delay in needed care, and 5) use of doctor's private offices as compared to safety net providers. Study Design: This study will use the 2003 California Health Interview Survey (CHIS 2003), which includes the relevant health outcomes, insurance, individual- and family-level variables. Contextual variables at the county level will augment the dataset from a variety of sources. Independent variables will be used as a set of constant predictors in each of five different models. Logistic regression will be used to estimate the impact of insurance status for the three dichotomous outcome measures, while a zero-inflated negative binomial regression will be used for the number of doctor visits and a multinomial logistic regression will be performed for categorical outcome measure (type of usual source of care), including calculations of odds ratios and relative risks. Population Studied: 4,313 children, ages 0-18, who either had current MC/HF coverage or were currently uninsured. Principal Findings: Preliminary results from an examination of a reduced model show that, compared to having MC/HF all year, children who lost their public health insurance were two and half times as likely to report a delay in getting care (RR = 2.25; OR = 2.53, p = 0.000) and slightly less likely to have seen a doctor in the past year (RR = 0.93; OR = 0.59, p = 0.044). Children who were uninsured all year fared the worst on all measures. The multinomial logistic model did not yield conclusive results. Conclusions: Dropping out of MC/HF does indeed worsen access to physician services. Children who gained coverage, however, had slightly better outcomes than did children who were uninsured all year, indicating MC/HF have beneficial effects on access to care. Impact on Policy: These findings support claims that increased enrollment and retention of children in MC/HF will improve their access to physician services, indicating MC/HF expansion would positively impact children's health. This study will demonstrate the important linkage between continuous enrollment in Medi-Cal and Healthy Families and positive health outcomes for children.