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• W2188729731 abstract "This paper examines how the expansion of health insurance coverage that happened through the Children's Health Insurance Program (CHIP) affected pediatric hospitalizations. This question is important for evaluating past policy decisions as well as anticipating what could happen from reforms to extend government subsidized coverage to more of the low-income population. Providing insurance could lead to a lower probability of hospitalization through to timely ambulatory care for preventable conditions, and use of more appropriate physician care rather than emergency care. Health insurance could also lead to greater use of hospitals for the ill through the access effect of reduction of out of pocket costs for patients and increase in reimbursement (relative to treating the uninsured) for providers. Conditional on hospitalization, health insurance could lead to a decrease in intensity of services, if children are healthier at admission due to better preventive care. Health insurance could also lead to an increase in the intensity of services because of the provider reimbursements that accompany an insured hospitalization. Exploiting variation by time, age and state in the roll-out of the CHIP program, we investigate net impacts of the coverage expansions on hospitalization rates, separately for ambulatory care sensitive (ACS) conditions vs. others, and on intensity of care during hospital visits. Using the Nationwide Inpatient Sample (NIS) of hospitalizations during 1996-2002, we find evidence that the expansions lead on net to an increase in pediatric hospitalizations. In our main specification, we find that overall hospitalization rates (defined as the number of hospitalizations divided by the population of children) increased by 3.2 percent in response to a 10 percentage point increase in eligibility for public health insurance coverage. In terms of categories of hospitalization, the increase comes from non-ACS hospitalizations; there is no statistically significant increase in ACS hospitalizations, and there is a statistically significant decline in hospitalization rates for respiratory conditions, a specific ACS hospitalization category. We also find that the coverage expansions increased intensity of care overall in terms of the number of procedures performed and length of stays, and that this effect stems from an increase in care for children with non-ACS conditions." @default.
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• W2188729731 date "2010-01-01" @default.
• W2188729731 modified "2023-09-24" @default.
• W2188729731 title "How Do Public Health Insurance Expansions Affect Hospitalizations" @default.
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