Crowd-out in the State Children's Health Insurance Program (SCHIP)

Incidence, Enrollee Characteristics and Experiences, and Potential Impact on New York's SCHIP

Published In: Health Services Research, v. 43, no. 1, pt . 2, Feb. 2008, p. 419-434

Posted on RAND.org on January 31, 2008

by Laura P. Shone, Paula M. Lantz, Andrew W. Dick, Michael E. Chernew, Peter G. Szilagyi

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BACKGROUND: The extent to which the State Children's Health Insurance Program (SCHIP) crowds our private insurance is poorly understood. OBJECTIVE: To assess the incidence of crowd-out and enrollee characteristics associated with crowd-out. DATA: Parent telephone survey for 2,644 children after enrollment in NY SCHIP. MEASURES AND ANALYSES: Crowd-out is measured based on enrollee reports of coverage (and loss of coverage) before SCHIP.Multivariate logistic regression is used to relate crowd-out to enrollee characteristics. PRINCIPAL FINDINGS: Only 7.1 percent of SCHIP enrollees dropped private coverage < 6 months before SCHIP, suggesting relatively modest crowd-out. Crowd-out was associated with some enrollee traits including income, but not with health status. IMPLICATIONS: Most movement from private to public insurance in NY was not crowd-out. Under current program structure in NY, crowd-out concerns should not dampen enthusiasm for SCHIP.

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