Healthcare Utilization After a Children's Health Insurance Program Expansion in Oregon

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• 作者：Steffani R. Bailey ; Miguel Marino ; Megan Hoopes…
• 关键词：Health insurance ; Children ; Utilization ; Electronic health records ; Medicaid ; CHIP
• 刊名：Maternal and Child Health Journal
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：20
• 期：5
• 页码：946-954
• 全文大小：1,024 KB
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• 作者单位：Steffani R. Bailey (1)
  Miguel Marino (1) (2)
  Megan Hoopes (3)
  John Heintzman (1)
  Rachel Gold (3) (4)
  Heather Angier (1)
  Jean P. O’Malley (2)
  Jennifer E. DeVoe (1) (3)
  
  1. Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
  2. School of Public Health, Division of Biostatistics, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
  3. OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA
  4. Kaiser Permanente Center for Health Research Northwest, 3800 N. Interstate Avenue, Portland, OR, 97227, USA
  
• 刊物主题：Public Health; Sociology, general; Population Economics; Pediatrics; Gynecology; Maternal and Child Health;
• 出版者：Springer US
• ISSN：1573-6628

文摘

Objective The future of the Children’s Health Insurance Program (CHIP) is uncertain after 2017. Survey-based research shows positive associations between CHIP expansions and children’s healthcare utilization. To build on this prior work, we used electronic health record (EHR) data to assess temporal patterns of healthcare utilization after Oregon’s 2009–2010 CHIP expansion. We hypothesized increased post-expansion utilization among children who gained public insurance. Methods Using EHR data from 154 Oregon community health centers, we conducted a retrospective cohort study of pediatric patients (2–18 years old) who gained public insurance coverage during the Oregon expansion (n = 3054), compared to those who were continuously publicly insured (n = 10,946) or continuously uninsured (n = 10,307) during the 2-year study period. We compared pre-post rates of primary care visits, well-child visits, and dental visits within- and between-groups. We also conducted longitudinal analysis of monthly visit rates, comparing the three insurance groups. Results After Oregon’s 2009–2010 CHIP expansions, newly insured patients’ utilization rates were more than double their pre-expansion rates [adjusted rate ratios (95 % confidence intervals); increases ranged from 2.10 (1.94–2.26) for primary care visits to 2.77 (2.56–2.99) for dental visits]. Utilization among the newly insured spiked shortly after coverage began, then leveled off, but remained higher than the uninsured group. Conclusions This study used EHR data to confirm that CHIP expansions are associated with increased utilization of essential pediatric primary and preventive care. These findings are timely to pending policy decisions that could impact children’s access to public health insurance in the United States.