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. - PowerPoint PPT PresentationTRANSCRIPT
Increased Family Cost-Sharing in SCHIP: How Much Can Families
Afford?
Betsy ShenkmanBruce Vogel
Institute for Child Health Policy Department of Epidemiology and
Health Policy ResearchUniversity of Florida
June 25, 2005
Project Purposes
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 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 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
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 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 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
Percent disenrollees
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
Mar-03 Apr-03 May-03 Jun-03 Jul-03 Aug-03 Sep-03 Oct-03 Nov-03 Dec-03 Jan-04 Feb-04 Mar-04
Key Findings 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 Findings 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 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 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