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RESEARCH TRIANGLE INSTITUTE I Alt rl% \ THEIMPACTOFMEDICAIDONCHILDREN'SHEALTHSERVICEUSE: ATEN-YEARRETROSPECTIVEANALYSIS March1996 revisedSeptember17,1996 by NormaI.Gavin ResearchTriangleInstitute and DeoS.Bencio MathematicaPolicyResearch,Inc. FinalReportforHCFA Contract#500-92-066 Submittedto: Submittedby: FeatherDavis,Ph.D. NormaI.Gavin,Ph.D. OfficeofResearchandDemonstrations ResearchTriangleInstitute HealthCareFinancingAdministration P.O.Box12194 REPORTS ORDC3-22-26 3040CornwallisRoad R1J02 7Ba5l0t0imSoerceu,riMtyDBo2u1l2e4v4a-r1d850 ResearchTrianglePark,NC 27709 G38 1996 CSU4L)CornwallisRoad • PostOfficeBox 12194 . ResearchTrianglePark,NorthCarolina27709-2194USA \ r TABLEOFCONTENTS Page ACKNOWLEDGMENTS v EXECUTIVESUMMARY vii A. INTRODUCTIONANDBACKGROUND 1 B. DATASOURCESANDMETHODOLOGY 4 1. IdentificationoftheAnalysisSample 4 2. SelectionofChildreninthe1982NHISfortheMultivariateAnalyses 7 3. IdentificationofMothersinthe1982and1991NHIS .8 4. ProviderSupplyInformationandMedicaidProgramData 9 5. Methodology 10 C. COMPARISONOFCHILDPOPULATIONCHARACTERISTICS 13 1. HealthInsuranceandIncome 13 2. DemographicCharacteristics 22 3. GeographicLocation 23 4. FamilyCharacteristics 25 5. SummaryandConclusions 27 D. COMPARISONOFHEALTHSTATUSINDICATORS 30 1. IncidenceofAcuteConditions 30 2. PrevalenceofActivityLimitationsfromChronicConditions 33 3. PerceivedHealthStatus 36 4. SummaryandConclusions 37 E. COMPARISONOFHEALTHSERVICEUSEINDICATORS: DESCRIPTIVE ANALYSIS 40 1. PhysicianContacts 40 2. UsualSourceofCare 47 3. Hospitalizations 50 4. DentalVisits 53 5. Immunizations 55 6. SummaryandConclusions 62 F. COMPARISONOFHEALTHSERVICEUSEINDICATORS: MULTIVARIATE ANALYSIS 67 1. ProbabilityofAnyPhysicianContacts 75 2. NumberofContactsamongChildrenwithContacts 83 3. TheProbabilityofAnyDentalVisits 86 4. TheNumberofDentalVisits 89 5. TheProbabilityofCompletingtheBasicImmunizationSeries 90 6. SummaryandConclusions 91 REFERENCES 95 i - I» LISTOFTABLES (continued) APPENDIXTABLES: Page TableA-l IncomeLevelsApproximating200PercentoftheFederalPoverty Level,1982,1988and1991NHIS 101 TableA-2 SelectedDemographic,Geographic,andFamilyCharacteristicsof ChildrenByHealthInsuranceandIncomeGroup,1982,1988and 1991NHIS 102 TableA-3 SelectedDemographic,Geographic,andFamilyCharacteristicsof ChildrenByHealthInsuranceandIncomeGroup,1982RandomSample 103 TableA-4 ComparisonofCharacteristicsofActualandMatchedMothers, 1988NHIS 105 TableA-5 PercentageofChildrenUnderSixYearsofAgeUp-to-Datein ImmunizationsforChildhoodDiseasesByHealthInsuranceand IncomeGroupandAge,1992NHIS 106 TableA-6 LogisticRegressionsoftheProbabilityofAnyPhysician Contacts,1982,1988and1991NHIS 109 TableA-7 OLSRegressionsoftheNumberofPhysicianContacts,1982,1988 and1991NHIS Ill iii - ACKNOWLEDGMENTS Ihaveincurredmanydebtsinthepreparationofthisreportand amhappyto acknowledgethemhere. Iamgratefulforthesupportofthemanyprogrammerswhohavebeen involvedinthisstudy,includingDeoS.Bencio,NancyAllen,HarleneGogan,PeterCanovai, andJillKavee,andtothesecretarieswhotypedandrevisedthemanytables,includingMichele Feaster,NancyBeasley,andLindaFonville. Iamalsoindebtedtothemanyreviewersofthis reportanditspredecessor,includingTheodoreJoyce,E.KathleenAdams,JeffreyWasserman, MarilynEllwood,andLisaHerz. MydeepestthanksgoestoFeatherDavis,theHCFAProject Officer,whotogetherwithMarilynHirschrecognizedtheneedforstudiesofthehealthstatus andhealthserviceuseoflow-incomechildrenintheUnitedStates,workedhardtogettheproject funded,andhasprovidedhelpfuloversightthroughouttheprogressofthestudy. v - EXECUTIVESUMMARY From1984to1990,majorchangesoccurredinMedicaidcoverageofchildren. Eligibility criteriawereexpandedandbecamemoreuniformacrosstheStates,coveredserviceswere broadenedandenhanced,andbarrierstoproviderparticipationwereremoved. Thisreportlooks athealthserviceuseamongMedicaidchildrenandothergroupsofchildrenintheUnitedStates from1982to1991todeterminewhetherthesechangesintheMedicaidprogramachieved significantimprovementsinhealthcareaccessforchildrenfromlow-incomefamiliesand whetherthechangesprovidedMedicaidchildrenaccesstocareequaltothatobservedamong childreninhigherincomefamilies. OuranalysisinvestigatesthreeyearsofdatafromtheNationalHealthInterviewSurveys (NHIS)duringthisten-yearperiod-1982,1988,and1991. Theseyearsprovidesnapshotsof thehealthstatusandhealthserviceuseofchildrenbefore,during,andshortlyaftertheprogram changes. Childrenareseparatedintofivehealthinsuranceandincomegroupsforanalysis: (1) childrenwithMedicaidcoverageandnootherinsurancecoverage;(2)childrenwithMedicaid andotherinsurancecoverage;(3)uninsuredchildreninfamilieswithincomesbelow200percent oftheFederalpovertylevel(FPL);(4)childrenwithotherhealthinsuranceinfamilieswith incomesbelow200percentoftheFPL;and(5)childreninfamilieswithincomesatorabove200 percentoftheFPL. Wefirstinvestigatedifferencesinthedistributionsofthesechildrenovervarious demographic,geographic,andfamilycharacteristicsbelievedtoimpacthealthstatusandhealth care-seekingbehavior. Wealsoinvestigatechangesinthesecharacteristicsovertime. Wethen presentdescriptiveanalysesofvarioushealthstatusandhealthserviceuseindicatorsonthe NHISfiles. Weinvestigatebothacuteandchronichealthconditionsandillness-relatedand preventivehealthcareservices. Finally,wepresentmultivariateanalysesofselectedhealth serviceusemeasurestoshowtherelativeimpactofMedicaidcoverageonchildren'shealth serviceuse,holdinghealthstatusandthedemographic,geographic,andfamilycharacteristics constant. WealsoinvestigatedifferencesintheimpactofMedicaidforselectedprogram vii