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  • SAGE Publications  (6)
  • Morrisey, Michael A.  (6)
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  • SAGE Publications  (6)
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  • 1
    Online Resource
    Online Resource
    Adverse Selection in the Children’s Health Insurance Program
    SAGE Publications ; 2015
    In:  INQUIRY: The Journal of Health Care Organization, Provision, and Financing Vol. 52 ( 2015-01-01), p. 004695801559355-
    Details
    In: INQUIRY: The Journal of Health Care Organization, Provision, and Financing, SAGE Publications, Vol. 52 ( 2015-01-01), p. 004695801559355-
    Abstract: This study investigates whether new enrollees in the Alabama Children’s Health Insurance Program have different claims experience from renewing enrollees who do not have a lapse in coverage and from continuing enrollees. The analysis compared health services utilization in the first month of enrollment for new enrollees (who had not been in the program for at least 12 months) with utilization among continuing enrollees. A second analysis compared first-month utilization of those who renew immediately with those who waited at least 2 months to renew. A 2-part model estimated the probability of usage and then the extent of usage conditional on any utilization. Claims data for 826 866 child-years over the period from 1999 to 2012 were used. New enrollees annually constituted a stable 40% share of participants. Among those enrolled in the program, 13.5% renewed on time and 86.5% of enrollees were late to renew their enrollment. In the multivariate 2-part models, controlling for age, gender, race, income eligibility category, and year, new enrollees had overall first-month claims experience that was nearly $29 less than continuing enrollees. This was driven by lower ambulatory use. Late renewals had overall first-month claims experience that was $10 less than immediate renewals. However, controlling for the presence of chronic health conditions, there was no statistically meaningful difference in the first-month claims experience of late and early renewals. Thus, differences in claims experience between new and continuing enrollees and between early and late renewals are small, with greater spending found among continuing and early renewing participants. Higher claims experience by early renewals is attributable to having chronic health conditions.
    Type of Medium: Online Resource
    ISSN: 0046-9580 , 1945-7243
    URL: Article
    DOI: 10.1177/0046958015593559
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
    detail.hit.zdb_id: 2147137-X
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  • 2
    Online Resource
    Online Resource
    The Great Recession of 2007–2009 and Public Insurance Coverage for Children in Alabama: Enrollment and Claims Data from 1999–2011
    SAGE Publications ; 2016
    In:  Public Health Reports Vol. 131, No. 2 ( 2016-03), p. 348-356
    Details
    In: Public Health Reports, SAGE Publications, Vol. 131, No. 2 ( 2016-03), p. 348-356
    Abstract: This study examined the impact of the Great Recession of 2007–2009 on public health insurance enrollment and expenditures in Alabama. Our analysis was designed to provide a framework for other states to conduct similar analyses to better understand the relationship between macroeconomic conditions and public health insurance costs. Methods. We analyzed enrollment and claims data from Medicaid and the Children's Health Insurance Program (CHIP) in Alabama from 1999 through 2011. We examined the relationship between county-level unemployment rates and enrollment in Medicaid and CHIP, as well as total county-level expenditures in the two programs. We used linear regressions with county fixed effects to estimate the impact of unemployment changes on enrollment and expenditures after controlling for population and programmatic changes in eligibility and cost sharing. Results. A one-percentage-point increase in a county's unemployment rate was associated with a 4.3% increase in Medicaid enrollment, a 0.9% increase in CHIP enrollment, and an overall increase in public health insurance enrollment of 3.7%. Each percentage-point increase in unemployment was associated with a 6.2% increase in total public health insurance expenditures on children, with Medicaid spending rising by 7.5% and CHIP spending rising by 1.8%. In response to the 6.4 percentage-point increase in the state's unemployment rate during the Great Recession, combined enrollment of children in Alabama's public health insurance programs increased by 24% and total expenditures rose by 40%. Conclusion. Recessions have a substantial impact on the number of children enrolled in CHIP and Medicaid, and a disproportionate impact on program spending. Programs should be aware of the likely magnitudes of the effects in their budget planning.
    Type of Medium: Online Resource
    ISSN: 0033-3549 , 1468-2877
    URL: Article
    DOI: 10.1177/003335491613100219
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
    detail.hit.zdb_id: 2017700-8
    SSG: 20,1
    SSG: 27
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    Online Resource
  • 3
    Online Resource
    Online Resource
    Continuity of Insurance Coverage and Ambulatory Care–Sensitive Hospitalizations/ED Visits : Evidence From the Children’s Health Insurance Program
    SAGE Publications ; 2011
    In:  Clinical Pediatrics Vol. 50, No. 10 ( 2011-10), p. 963-973
    Details
    In: Clinical Pediatrics, SAGE Publications, Vol. 50, No. 10 ( 2011-10), p. 963-973
    Abstract: Objective: To assess the effects of continuity of insurance coverage on treatment of ambulatory-care sensitive conditions (ACSC). Study Population: 42,382 children enrolled in ALL Kids (Alabama Children’s Health Insurance Program) for 3 or more years. Methods: We model annual hospitalizations and ED visits for six ACSCs identified by the AHRQ - bacterial pneumonia, dehydration, perforated appendix, urinary tract infection, gastroenteritis, and severe ear, nose and throat infection. Results: In unadjusted models, we find lower risk of ACSC hospitalizations and ED visits in the second and third years of continuous enrollment. Risk of hospitalization in year 3 was significantly lower for pneumonia (OR 0.608, 95% CI: 0.421-0.878) and gastroenteritis (OR 0.549, 95% CI: 0.404-0.746). These beneficial effects of duration of coverage disappear after controlling for age, year and other enrollee characteristics. Conclusions: Hospitalizations and ED visits for ACSCs are rare and do not decrease with additional years of coverage.
    Type of Medium: Online Resource
    ISSN: 0009-9228 , 1938-2707
    URL: Article
    DOI: 10.1177/0009922811410229
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2011
    detail.hit.zdb_id: 2066146-0
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  • 4
    Online Resource
    Online Resource
    The Impact of CHIP Coverage on Children With Asthma in Alabama
    SAGE Publications ; 2012
    In:  Clinical Pediatrics Vol. 51, No. 3 ( 2012-03), p. 247-253
    Details
    In: Clinical Pediatrics, SAGE Publications, Vol. 51, No. 3 ( 2012-03), p. 247-253
    Abstract: This study evaluates the impact of coverage in ALL Kids, the Alabama Child Health Insurance Program (CHIP), by examining asthma-related utilization and outcomes among children continuously enrolled for 3 years (N = 1954)with persistent asthma at enrollment. Outcomes and costs were compared for the first, second, and third years of enrollment using repeated measures analysis of variance and controlling for age, gender, and year fixed-effects. Compared with subsequent years, first year enrollment utilization was higher for asthma-related hospitalizations (6% vs 2% vs 2%; P 〈 .0001) and emergency visits (10% vs 3% vs 2%; P 〈 .0001). Also decreasing were asthma-related outpatient visits (1.46 vs 1.12 vs 0.94; P 〈 .0001), quick-relief prescriptions (2.6 vs 2.2 vs 2.1; P 〈 .0001), and long-term control prescriptions (5.8 vs 5.2 vs 4.4; P 〈 .0001). As a result, significant declines in the mean costs per child were observed. Ongoing ALL Kids coverage is associated with improved disease-management and lower costs for persistent asthma.
    Type of Medium: Online Resource
    ISSN: 0009-9228 , 1938-2707
    URL: Article
    DOI: 10.1177/0009922811420713
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2012
    detail.hit.zdb_id: 2066146-0
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  • 5
    Online Resource
    Online Resource
    Co-payments and the Use of Emergency Department Services in the Children’s Health Insurance Program
    SAGE Publications ; 2013
    In:  Medical Care Research and Review Vol. 70, No. 5 ( 2013-10), p. 514-530
    Details
    In: Medical Care Research and Review, SAGE Publications, Vol. 70, No. 5 ( 2013-10), p. 514-530
    Abstract: Research suggests that more than half of all emergency department (ED) visits in the United States are for nonurgent conditions, leading to billions of dollars in potentially avoidable spending annually. In this study, we examine the effects of co-payment changes on ED utilization among children enrolled in ALL Kids, Alabama’s Children’s Health Insurance Program We separately model the effect of the 2003 co-payment increases on the monthly probability of any ED visit, and visits within three severity categories, using linear probability models that control for beneficiary characteristics and time trends that are allowed to vary in the pre- and postperiods. We observe a small decline in the probability of ED visits 1 year after the co-payment increase. However, low-severity visits, which we hypothesize to be more price sensitive, show no significant evidence of a decline. Our study suggests that the modest co-payment changes were not effective in improving the efficiency of ED utilization.
    Type of Medium: Online Resource
    ISSN: 1077-5587 , 1552-6801
    URL: Article
    DOI: 10.1177/1077558713491501
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2013
    detail.hit.zdb_id: 2070248-6
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  • 6
    Online Resource
    Online Resource
    Health Expenditure Concentration and Characteristics of High-Cost Enrollees in CHIP
    SAGE Publications ; 2016
    In:  INQUIRY: The Journal of Health Care Organization, Provision, and Financing Vol. 53 ( 2016-01-01), p. 004695801664500-
    Details
    In: INQUIRY: The Journal of Health Care Organization, Provision, and Financing, SAGE Publications, Vol. 53 ( 2016-01-01), p. 004695801664500-
    Abstract: Devising effective cost-containment strategies in public insurance programs requires understanding the distribution of health care spending and characteristics of high-cost enrollees. The aim was to characterize high-cost enrollees in a state’s public insurance program and determine whether expenditure inequality changes over time, or with changes in cost-sharing policies or program eligibility. We use 1999-2011 claims and enrollment data from the Alabama Children’s Health Insurance Program, ALL Kids. All children enrolled in ALL Kids were included in our study, including multiple years of enrollment (N = 1,031,600 enrollee-months). We examine the distribution of costs over time, whether this distribution changes after increases in cost sharing and expanded eligibility, patient characteristics that predict high-cost status, and examine health services used by high-cost children to identify what is preventable. The top 10% (1%) of enrollees account for about 65.5% (24.7%) of total program costs. Inpatient and outpatient costs are the largest components of costs incurred by high-cost utilizers. Non-urgent emergency department costs are a relatively small portion. Average expenditure increases over time, particularly after expanded eligibility, and the share of costs incurred by the top 10% and 1% increases slightly. Multivariable logistic regression results indicate that infants and older teens, Caucasian children, and those with chronic conditions are more likely to be high-cost utilizers. Increased cost sharing does not reduce cost concentration or average expenditure among high-cost utilizers. These findings suggest that identifying and targeting potentially preventable costs among high-cost utilizers are called for to help reduce costs in public insurance programs.
    Type of Medium: Online Resource
    ISSN: 0046-9580 , 1945-7243
    URL: Article
    DOI: 10.1177/0046958016645000
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
    detail.hit.zdb_id: 2147137-X
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