Health Policy Center Authors

Publications by Amy J. Davidoff for Health Policy Center

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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.)

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.

When uninsured Medicaid-eligible adults are compared with Medicaid-enrolled adults with the same health and demographic characteristics, the uninsured are more likely to report unmet need, to lack a usual source of care, and to make less use of physician services. Families of the uninsured are also more likely to be burdened with out-of-pocket health care costs. Medicaid-eligible adults with private health insurance coverage are less likely to report unmet medical needs than their Medicaid-enrolled counterparts, but they are more likely to be burdened by out-of-pocket health care costs. Research is based upon data from the 1997 National Health Interview Survey.

This paper contrasts changes that took place among urban safety net hospitals (SNHs) during the period 1990 to 1997 with changes that occurred at other urban facilities. We use data from American Hospital Association Annual Survey and define three groups of SNHs based on 1990 provision of uncompensated care (UC): those that provided a large share of UC in their market; those for which UC imposed a burden because it represented a large share of their expenses; and those meeting both conditions. We found that, through 1997, high market share/high burden SNHs lost service volume relative to non-SNHs, but did not undertake reductions in staffing levels and expenses or reduce UC. High market share only hospitals were similar to non-SNHs, but reduced their UC market share and were more likely to enter into a merger. High burden only SNHs were most likely to close, but those that remained open experienced growth in volume and maintained their financial position. (Health Affairs 2001 July/August; 20(4):159-168)

Many Medicaid eligible children are not enrolled in Medicaid and are not covered by private insurance. In this paper, data from the 1994 and 1995 National Health Interview Survey are used to explore the role of child and family characteristics, as well as local area availability of private insurance and free or low-cost medical services, on insurance coverage for Medicaid eligible children. The study finds that increased availability of community health centers has a positive effect on the likelihood of Medicaid enrollment, while improved availability and decreased cost of employer sponsored coverage has a positive effect on private insurance. Policies that encourage offers of insurance by employers, and reduce premiums faced by workers, will increase coverage for this population. (Medical Care 2001 June; 39(6): 523-535).

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