Increased family cost sharing in schip how much can families afford
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Increased Family Cost-Sharing in SCHIP: How Much Can Families Afford?. Betsy Shenkman Bruce Vogel Institute for Child Health Policy Department of Epidemiology and Health Policy Research University of Florida June 25, 2005. Project Purposes.

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Increased family cost sharing in schip how much can families afford

Increased Family Cost-Sharing in SCHIP: How Much Can Families Afford?

Betsy Shenkman

Bruce Vogel

Institute for Child Health Policy

Department of Epidemiology and

Health Policy Research

University of Florida

June 25, 2005


Project purposes
Project Purposes Families Afford?

  • To examine the responsiveness of disenrollment to premium changes and child health and sociodemographic characteristics in one state SCHIP;

  • To calculate a price elasticity for families in the short-term


Study setting
Study Setting Families Afford?

  • Florida Healthy Kids Program

    • 5-19 year olds between 101% FPL and 200% FPL receive subsidized premiums

    • Family share prior to July 1, 2003 was $15 per family per month (PFPM)

    • Termination due to non-payment of premium after two months

    • Until July 1, 2004, passive renewal process used; so overall disenrollment in the program relatively low


Program changes
Program Changes Families Afford?

  • Premiums increased on July 1, 2003 from $15 per PFPM to $20 PFPM for all families receiving subsidized premiums

  • The Center for Medicare and Medicaid Services (CMS) – exceeded Federal cost sharing limits for families at or below 150% FPL

  • October 1, 2003 – premiums reduced back to $15 PFPM for those at or below 150% FPL; remained at $20 PFPM for those above


Study time frame and sample
Study Time Frame and Sample Families Afford?

  • Time frame for analyses – March 2003 through March 2004

  • Disenrollees – Children enrolled for at least two months and disenrolled for at least two months during the time period


Data Families Afford?

  • Enrollment files – months enrolled, age, gender, address information, subsidy level

  • Health care claims and encounter data linked to enrollment files

  • Clinical Risk Groups used to classify children into health status categories

    • Healthy, Significant Acute, Minor Chronic, Moderate, and Major Chronic Conditions


Analyses
Analyses Families Afford?

  • Cox proportional hazards models were used to estimate the responsiveness of disenrollment to premium changes, age, sex, income, CRG health status category, and months enrolled.


Disenrollees from healthy kids n 237 178
Disenrollees From Healthy Kids N=237,178 Families Afford?

  • Percent disenrollees


Key findings
Key Findings Families Afford?

  • With the $20 premium increase, families 2x as likely to disenroll as before increase

  • The Price elasticity for the disenrollment hazard rate of 2.2, was calculated

  • Given this price elasticity, a 10% increase in the monthly premium would produce a 22% increase in the disenrollment hazard rate

  • An increase in the premium from $15 per month to $20 per month (a 33% increase), would increase the disenrollment hazard rate by approximately 73%, or from a baseline hazard rate of 1.4% to 2.4%


Key findings1
Key Findings Families Afford?

  • Families at or below 150% FPL 35% more likely to leave compared to higher income

  • Rural areas 6% more likely to leave than those in urban areas

  • Health status an important predictor – 8% to 17% less likely to disenroll with significant acute or chronic condition than those who are healthy


Conclusions
Conclusions Families Afford?

  • In the short-term, families are very price sensitive

  • Cannot determine if this is an equilibrium response but

  • Saw a large effect that perhaps could be moderated across time


Policy implications
Policy Implications Families Afford?

  • Premium increases need to be considered very carefully

  • At least in the short-term can have a strong impact

  • Can differentially affect certain groups of children


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