View Research by Author - Amy J. Davidoff

Citation URL: http://www.urban.org/AmyJDavidoff

The authors use variation across states and over time in managed care (MC) programs for publicly insured children to examine whether effects differ for children with chronic health conditions (CWCHC) and those without. The authors pool data from the 1997 to 2002 National Health Interview Survey and link county, year, and health status information on type of MC programs implemented. Findings show that the effects of MC are concentrated on CWCHC and that CWCHC experience reductions in use of specialist, mental health, and prescription drugs. Capitated programs with mental health or specialty carve-outs are associated with a greater number and larger decreases in service use compared to integrated capitated programs. While it is not possible to determine whether MC programs resulted in more appropriate use of services, corresponding reductions in perceived access were not observed, suggesting that net effects of MC on service use represent improvements in care coordination.

Using data primarily from the National Health Interview Survey, this study investigates the effects of SCHIP expansions on insurance coverage, health care services use, and access to care for children with chronic health conditions. The expansions resulted in a 9.8 percentage point increase in the proportion of children with chronic conditions reporting public insurance and a 6.4 percentage point decline in the proportion uninsured. Unmet need for health care decreased by 8 percentage points, and estimated reductions in unmet need were greater for children with chronic conditions than for other children. Impact on access to care and service use was limited. (Davidoff, Amy, Genevieve Kenney, and Lisa Dubay. July 2005. "Effects of the State Children's Health Insurance Program Expansions on Children with Chronic Health Conditions." Pediatrics 116(1): e34-e42.)

This study examines how uninsured adults with chronic health problems are faring vis-a-vis access to care. The analysis is based on the 2003 National Health Interview Survey, relying on self-reports of chronic health conditions. We find that almost half of uninsured adults with chronic conditions forgo needed medical care or prescription drugs due to cost and that they forgo care at much higher rates than their insured counterparts. Serious identifiable gaps in needed medical care were found for every racial, ethnic, and chronic illness subgroup examined.

A specific focus for state regulations of the small group insurance market was to increase offers and stabilize premiums for firms with high-risk workers. We examine the effect of reforms implemented from 1993 through 1996 on the likelihood of employer sponsored insurance coverage. We find that packages of reforms that included both guaranteed issue of some products and some form of rate variance restriction had significant positive effects on ESI coverage for high-risk compared with low-risk workers within small firms and a small negative effect on low-risk workers in small compared with large firms. (Davidoff, Amy, Blumberg, Linda and Nichols, Len. 2005. "State Health Insurance Market Reforms and Access to Insurance for High-Risk Employees." Journal of Health Economics 24(4): 725-750.)

Using data from the 1999 National Survey of America's Families, this brief provides details of uninsurance among low-income workers in 13 states. States with relatively high rates of uninsurance among low-income workers tend to have greater than average proportions of: Hispanics (both citizens and noncitizens); workers in fair or poor health; and workers in agriculture and construction. The research did not find differences in uninsurance among low-income workers by employer size. The brief reviews uninsurance rates for low-income workers across 13 states by race/ethnicity/citizenship, health status, employer size, industry, and employment status.

This study examines the effects of having an uninsured parent on access to health care for low-income children. Data from the 1999 National Survey of America's Families indicates that having an uninsured parent decreases the likelihood that a child will have any medical provider visit by 6.5 percentage points, and decreases the likelihood of a well-child visit by 6.7 percentage points. Efforts to increase insurance coverage of parents, either by extending eligibility for public insurance or through other policy interventions, will have positive spillover effects on access to care for children. (Davidoff, Amy, Genevieve Kenney, and Alshadye Yemane. Fall 2003. "The Effect of Parents' Insurance Coverage on Access to Care for Low-Income Children." Inquiry 40(3): 254-268.)

Medicaid enrollees' access to and use of health care may be affected by the type of Medicaid managed care (MMC) program operating in their county. Using National Health Interview Survey data linked to county-level Medicaid managed care characteristics, we found that, relative to traditional fee-for-service programs, mandatory programs with both primary care case management (PCCM) and HMO options did the most to improve health care access and utilization for children. In contrast, we found potentially negative health care impacts for women in mandatory HMO programs. Mandatory PCCM programs had virtually no effects on access and use for women or children. (Health Services Research 38(2): 575–94.)

This report examines a Medicare-based approach to reducing the ranks of the uninsured that would permit early retirees between the ages of 62 and 65 to purchase coverage under Medicare. The paper begins with an overview of the challenges of insuring the near-elderly and explores the potential effects of a Medicare buy-in on coverage of this population. The authors conclude that, unless premiums for such coverage were low or tied to enrollees' income, this approach would have a relatively small impact on both the number of uninsured near-elderly and retirement decisions. (Published by the Henry J. Kaiser Family Foundation; 2002 February.)

A Medicare buy-in allowing persons below the age of full eligibility to purchase Medicare coverage has been discussed as one way to help uninsured near elderly persons obtain insurance coverage. This brief summarizes findings from an Urban Institute report that examined potential participation rates in alternative buy-in plans and measured their potential impact on rates of uninsurance. Many individuals younger than 65 would purchase Medicare coverage, but without subsidies participation would be limited to those who could afford substantial premiums. Buy-ins would reduce uninsurance rates only if they provided subsidies to make the plans affordable to those with limited incomes.

Navigating health insurance and health care delivery systems to obtain adequate access to health care can be challenging, and parents must act as advocates for their children in this process. Parents who are covered by the same insurance as their children are likely to be the most effective advocates because they are familiar with the specific systems. The burden on parents may be magnified if the child and the parents have different insurance plans or different types of coverage. Parents who do not have their own insurance are likely to be the least effective in working with the insurance system that covers their child. Changes in public program eligibility over the past 15 years have enhanced access to public insurance coverage, but they have created a situation in many low-income families where only some members are eligible for specific programs.

Return to list of authors