Switching Health Insurance and Its Effects on Access to Physician Services

Lavarreda, Shana Alex; Gatchell, Melissa; Ponce, Ninez A.; Brown, E. Richard; Chia, Y. Jenny

doi:10.1097/mlr.0b013e318187d8db

Cited by 43 publications

(21 citation statements)

References 17 publications

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“…Interruptions in Medicaid coverage are associated with lower rates of primary and preventive care use, 13–15 and persons who defer preventive care may ultimately use more acute care services, which can lead to greater downstream health care costs. For example, one study, which focused on Medicaid coverage interruptions among children in California, estimated that the rate of pediatric hospitalizations for ambulatory care sensitive conditions declined by 26% after the state provided qualifying children with 12 months of continuous Medicaid eligibility.…”

mentioning

confidence: 99%

Does Churning in Medicaid Affect Health Care Use?

Roberts

Pollack²

2016

Medical Care

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Background Transitions into and out of Medicaid, termed churning, may disrupt access to and continuity of care. Low-income, working adults who became eligible for Medicaid under the Affordable Care Act are particularly susceptible to income and employment changes that lead to churning. Objective To compare health care use among adults who do and do not churn into and out of Medicaid. Data Longitudinal data from 6 panels of the Medical Expenditure Panel Survey. Methods We used differences-in-differences regression to compare health care use when adults reenrolled in Medicaid following a loss of coverage, to utilization in a control group of continuously enrolled adults. Outcome Measures Emergency department (ED) visits, ED visits resulting in an inpatient admission, and visits to office-based providers. Results During the study period, 264 adults churned into and out of Medicaid and 627 had continuous coverage. Churning adults had an average of approximately 0.05 Medicaid-covered office-based visits per month 4 months before reenrolling in Medicaid, significantly below the rate of approximately 0.20 visits in the control group. Visits to office-based providers did not reach the control group rate until several months after churning adults had resumed Medicaid coverage. Our comparisons found no evidence of significantly elevated ED and inpatient admission rates in the churning group following reenrollment. Conclusions Adults who lose Medicaid tend to defer their use of office-based care to periods when they are insured. Although this suggests that enrollment disruptions lead to suboptimal timing of care, we do not find evidence that adults reenroll in Medicaid with elevated acute care needs.

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confidence: 99%

Does Churning in Medicaid Affect Health Care Use?

Roberts

Pollack²

2016

Medical Care

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“…5 Other large studies have found similar results. More than 14% of California's population had discontinuity in insurance status during 2003, 6 and federal employees switch health plans at a rate of 12% per year. 7…”

Section: Incidence: How Common Is This Problem?mentioning

confidence: 99%

A 37-Year-Old Man Trying to Choose a High-Quality Hospital

Howell¹

2009

JAMA

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“…Because providers are not consistently included in all insurance networks, such switching could compel patients to change physicians to avoid significant out-of-pocket expenses, which could interrupt clinical relationships and create additional costs in time and effort for both patients and physicians. 9 Prior evidence shows that individuals switching insurance carriers are more likely to have changes in their usual source of care, 6,10,11 a problem that may be exacerbated as narrow networks become more common. 12 Since prior research has focused on the transition from no insurance to insurance coverage, 2,13 there is little evidence addressing changes in health care utilization for people who switch health insurance carriers when there are no disruptions in coverage.…”

Section: Introductionmentioning

confidence: 99%

Insurance Transitions and Changes in Physician and Emergency Department Utilization: An Observational Study

et al. 2017

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BACKGROUND: Shopping for health insurance is encouraged as a way to find the most affordable coverage that best meets an enrollee's needs. However, the extent to which individuals switch insurance and subsequent changes in health care utilization that might arise, particularly new physician visits, are not well understood. OBJECTIVE: To examine the relationship between insurance switching and new physician and emergency department visits around the time of a switch. DESIGN: Observational study using a difference-indifferences design to compare those switching insurance carriers with propensity score-matched controls who did not switch, stratified based on whether individuals initially had private or Medicaid insurance coverage. All analyses adjusted for individual and insurance characteristics. PARTICIPANTS: Continuously insured, non-elderly individuals with private or Medicaid insurance coverage in Massachusetts from 2010 to 2013. MAIN MEASURES: Rates of new primary care and specialist physician visits, as well as rates of emergency department visits. KEY RESULTS: Before matching, among 1,628,057 continuously insured individuals, 418,231 (26%) switched insurance carriers during a 2-year period. Characteristics of switchers and non-switchers were similar after matching (n = 316,343 in each group). After matching, switching plans was associated with a 203% and 47.5% increase in the rate of new primary care physician visits following switching for those initially with Medicaid or private coverage, respectively (both p < 0.001), with a large shortterm increase, diminishing over time. Among those with Medicaid coverage, switching was associated with a 14.9% higher rate of ED visits during the month of switching (p < 0.001), but otherwise decreased modestly after switching. CONCLUSIONS: Insurance switching is common, and is associated with increased new physician visits and temporarily increased ED use among the publicly insured. As insurance markets become more volatile in the current policy environment, understanding changes in utilization after insurance switching may become increasingly important.

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Switching Health Insurance and Its Effects on Access to Physician Services

Cited by 43 publications

References 17 publications

Does Churning in Medicaid Affect Health Care Use?

Does Churning in Medicaid Affect Health Care Use?

A 37-Year-Old Man Trying to Choose a High-Quality Hospital

Insurance Transitions and Changes in Physician and Emergency Department Utilization: An Observational Study

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