Adverse Selection in the Children’s Health Insurance Program
This study investigates whether new enrollees in the Alabama Children’s Health Insurance Program have different claims experience from renewing enrollees who do not have a lapse in coverage and from continuing enrollees. The analysis compared health services utili...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2015-06-01
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| Series: | Inquiry: The Journal of Health Care Organization, Provision, and Financing |
| Online Access: | http://inq.sagepub.com/content/52/0046958015593559.full.pdf |
| Summary: | This study investigates whether new enrollees in the Alabama
Children’s Health Insurance Program have different claims experience from renewing
enrollees who do not have a lapse in coverage and from continuing enrollees. The
analysis compared health services utilization in the first month of enrollment for new
enrollees (who had not been in the program for at least 12 months) with utilization
among continuing enrollees. A second analysis compared first-month utilization of those
who renew immediately with those who waited at least 2 months to renew. A 2-part model
estimated the probability of usage and then the extent of usage conditional on any
utilization. Claims data for 826 866 child-years over the period from 1999 to 2012 were
used. New enrollees annually constituted a stable 40% share of participants. Among those
enrolled in the program, 13.5% renewed on time and 86.5% of enrollees were late to renew
their enrollment. In the multivariate 2-part models, controlling for age, gender, race,
income eligibility category, and year, new enrollees had overall first-month claims
experience that was nearly $29 less than continuing enrollees. This was driven by lower
ambulatory use. Late renewals had overall first-month claims experience that was $10
less than immediate renewals. However, controlling for the presence of chronic health
conditions, there was no statistically meaningful difference in the first-month claims
experience of late and early renewals. Thus, differences in claims experience between
new and continuing enrollees and between early and late renewals are small, with greater
spending found among continuing and early renewing participants. Higher claims
experience by early renewals is attributable to having chronic health
conditions. |
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| ISSN: | 0046-9580 1945-7243 |