(SDAS) Health Plan Turnover and Disenrollment, Health Care Quality and Expenditures in State Children's Health Insurance Programs
Grantee: University of Florida
Principal Investigator: Sema K. Aydede
Project Number: R40MC07843
Project Date: 1/1/2007
Final Report
Age group(s)
- Perinatal/Infancy (0-12 months)
- Toddlerhood (13-35 months)
- Early Childhood (3-5 years)
- Middle Childhood (6-11 years)
- Adolescence (12-18 years)
Abstract
Most states in the nation have experienced health plan turnover in their public health insurance programs due to health plan exits/acquisitions. When health plans exit State Children's Health Insurance Programs (SCHIP), their enrollees must transfer to remaining or new health plans or disenroll from the program. In contrast to voluntary transfers based on beneficiary preference or medical need, these involuntary transfers may have a negative impact on beneficiaries. We will analyze the quality of care provided to enrollees and their health care expenditures before and after an involuntary transfer in managed care settings. Our study will examine the experiences of both healthy children and children with special health care needs (CSHCN) and will control explicitly for relevant case-mix or illness burden. Our study also will investigate disenrollment from SCHIP due to plan turnover. Consequently, this proposal addresses issues that are relevant to three of the Maternal and Child Health Bureau (MCHB) Strategic Research Issues: (1) Strategic Research Issue #1 that supports the study of the effects of infrastructure and systems of care on maternal and child health (MCH) populations; (2) Strategic Research Issue # II that encourages the examination of health disparities for MCH populations; and (3) Strategic Research Issue # III that addresses the quality of care for MCH populations. This project will use data from SCHIP in both Texas and Florida, two of the nation's most populous states. Although our study analyzes experiences in Texas and Florida, we believe that our study findings will provide valuable information to other states because we will analyze the experience of a broad range of health plans including those affiliated with large national companies, community-based, and locally-owned plans. This study will bring together several data sources. The person-level enrollment and health care claims and encounter datasets for SCHIP in both Texas and Florida are already housed at the Institute for Child Health Policy (ICHP). These data are provided to ICHP as part of contractual arrangements with the two states. These data will be merged with three other datasets (Health Plan Interview files housed at ICHP, the Area Resource File, and the National Association of Insurance Commissioners Annual Statements) to incorporate health plan and market characteristics. We will use a robust quasi-experimental pre-post design with treatment and comparison groups to examine consequences of health plan exits. Our estimation techniques will rely on two-stage regression methods that explicitly account for the fact that individuals were not randomly assigned to treatment and comparison groups. Findings from our study can be used to develop statewide policies and strategies to facilitate the transfer of enrollees from one plan to another when plan exits/acquisitions occur.<< Previous Next >>