Demand for Medical Services Among Previously Uninsured Children: The Roles of Race and Rurality.

摘要

This project examined the use of medical services over nearly two years among newly insured and continuously insured children, ages six through twelve, in the CHIP and Medicaid programs in South Carolina and West Virginia. We asked whether newly insured children had a different pattern of utilization than children who had been continuously insured. This information is needed to project the cost of extending coverage to uninsured children. However, the results of previous studies are conflicting, with some finding pent-up demand for care among newly insured children and others finding a gradual increase in demand. We hypothesized that the findings of previous studies were contradictory because of differences in the race and rurality of the children studied. Some studies were conducted in urban areas, others were rural. Some examined mainly white children, others mainly African-Americans. Our study improved on these studies because we were able to examine both white and African-American children in urban and rural areas in the same state - South Carolina - and rural and urban children in West Virginia. We also studied a longer time period than most other studies and were able to determine whether demand for medical services among newly insured children differed over the long-term from that of continuously insured children. The study examined utilization of ambulatory care, prescription drug, emergency room, and inpatient hospital services, using number of services received and expenditures for services as the two measures of demand. The models controlled for age and sex of child as well as presence of chronic conditions including asthma, psychosocial problems, diabetes, congenital anomalies, and nervous system disorders. Continuously insured children had been insured for at least the year prior to the study period.