Three Essays on the State Children's Health Insurance Program Öffentlichkeit
Xu, Jing (2013)
Abstract
This dissertation studies the impact of public health insurance expansions under the 1997 State Children's Health Insurance Program (SCHIP) on different health outcomes. The first chapter estimates the impact of the SCHIP expansion on vaccination status among children under age 2 in a timely manner. I employ a simulated instrumental variables strategy to address the issue of selection into public health insurance programs. I find that being eligible for public health insurance is associated with a higher probability that a child receives recommended vaccine series without lengthy delays. In contrast, I find little effect for the single-dose vaccines such as varicella and MMR. In light of the positive health consequences associated with vaccinations, these results imply that expanding health insurance coverage could improve social welfare and the welfare of children with low socioeconomic status. The second chapter investigates the impact of health insurance expansions under SCHIP on birth outcomes among teenage mothers. I employ ordered probit and quantile regression to evaluate the existence of heterogeneous eligibility effects on birth outcomes of teenage mothers. Results show that increased public insurance income eligibility is associated with significant improvements in prenatal care utilization among teenage mothers. For teenage mothers with singleton births, the expanded insurance eligibility is associated with a small but significant increase in birth weight. I also find that pregnancies with lower health endowments may benefit more from the expanded eligibilities than pregnancies with great endowments. The third paper is co-authored with David Frisvold. In this paper, we examine the impact of SCHIP/Medicaid eligibility expansions for children on the prevalence of food insecurity among families with children. Our results suggest that being eligible for SCHIP/Medicaid reduces the probability that a family with children has low food security. We also find that SCHIP/Medicaid eligibility has stronger effects on families in states that had higher uninsured rates among children before SCHIP expansion and low income families with income less than 185 percent of the Federal Poverty Level.
Table of Contents
Table of Contents
Contents
Page
Chapter 1: The U.S. Infant Immunization Coverage in the Post-SCHIP Era: An Instrumental Variables Approach
1
1.1.
Introduction
2
1.2.
Background
4
1.2.1.
SCHIP
4
1.2.2.
Childhood Vaccine
8
1.3.
Literature review
12
1.4.
Identification Strategy
15
1.5.
Data
18
1.6.
Results
25
1.7.
Robustness Checks
28
1.8.
Conclusion
31
References
33
Chapter 2: The State Children's Health Insurance Program (SCHIP) and Birth Outcomes of Teenage Mothers
51
2.1.
Introduction
52
2.2.
Background
53
2.2.1.
Teenage Pregnancy
53
2.2.2.
SCHIP
55
2.2.3.
Links between Eligibility Expansions and Birth Outcomes
58
2.3.
Literature Review
59
2.4.
Data
62
2.5.
Health Outcomes
64
2.6.
Identification Strategy
65
2.7.
Results
69
2.7.1.
Analysis of Prenatal Visits
69
2.7.2.
Analysis of Birth Outcomes among Singletons
70
2.7.3.
Analysis of Birth Outcomes among Twins
70
2.8.
Robustness Checks
71
2.9.
Conclusion
73
References
75
Chapter 3: The Impact of SCHIP Expansions on Food Insecurity among Low-Income Families with Children
93
3.1.
Introduction
94
3.2.
Background
96
3.3.
Literature Review
98
3.4.
Identification Strategy
100
3.5.
Data
102
3.6.
Results
106
3.7.
Conclusion
109
References
110
Table of Contents: List of Tables
Contents
Page
Table 1.1.
Summary of SCHIP Expansions by State and Time
38
Table 1.2.
Recommended Childhood Vaccine Schedule, January-June 1996
40
Table 1.3.
Fraction of Eligible Children under Age 2 in the SIPP
41
Table 1.4.
Summary Statistics
42
Table 1.5.
Summary Statistics for Outcome Variables
43
Table 1.6.
SCHIP/Medicaid Eligibility and UTD Vaccination Rate without Lengthy Delay (Linear Probability Models)
44
Table 1.7.
SCHIP/Medicaid Eligibility and Site of Delivery (Linear Probability Models)
46
Table 1.8.
IV Estimates for the Whole Sample with Different Sizes of Simulations
47
Table 1.9.
Subgroup Analysis Using IV
48
Table 1.10.
Marginal Effects of SCHIP/Medicaid Eligibility on the Probability of Being UTB for Childhood Vaccines without Lengthy Delays
49
Table 1.11.
Lower Bounds and Upper Bounds of the Impact of SCHIP Expansions on the Probability of Being UTD for Childhood Vaccines without Lengthy Delays
50
Table 2.1.
Summary of SCHIP expansions by State and Time
78
Table 2.2.
Summary Statistics
80
Table 2.3.
Fraction of Female Teenage Eligible for Public Insurance in the SIPP
81
Table 2.4.
Summary Statistics for Outcome Variables
82
Table 2.5.
SCHIP/Medicaid Income Eligibility by State over Time for Teenagers
83
Table 2.6.
Effects of SCHIP/Medicaid Expansions on the Number of Prenatal Care Visits
85
Table 2.7.
Effects of SCHIP/Medicaid Expansions on Singleton Births
87
Table 2.8.
Effects of SCHIP/Medicaid Expansions on Twin Births
88
Table 2.9.
Ordered Probit Estimation of the Impact of Eligibility Expansions on Birth Weight
89
Table 2.10.
Quantile Regression Results of the Impact of Eligibility Expansions on Birth Weight
90
Table 2.11.
Sensitivity Analysis of the Effects of Eligibility Expansions on Singleton Births
91
Table 3.1.
Summary of SCHIP expansions by State and Time
112
Table 3.2.
Fraction of Children under Age 18 Eligible for SCHIP/Medicaid in the SIPP
114
Table 3.3.
Summary Statistics
115
Table 3.4.
Summary Statistics for Outcome Variables
117
Table 3.5.
SCHIP/Medicaid Eligibility and Family Food Insecurity Status
118
Table 3.6.
Subgroup Analysis Using IV
118
Appendix 3.A.
Food Insecurity Measures in the United States
119
Appendix 3.B.
Complete Results for OLS and IV Estimation on the Impact of SCHIP/Medicaid Eligibility on Food Security
121
Table of Contents: List of Figures
Contents
Page
Figure 1.1.
SCHIP Enrollment 1998-2009
37
Figure 2.1.
SCHIP/Medicaid Income Eligibility 1996-2002
92
Figure 2.2.
Low Birth Weight Babies Born to Teenage Mothers, 1995-2002
92
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