Insurance Transitions and Changes in Health Care Utilization: Evidence from All Payer Claims Databases
Discussant: Jonathan Holmes
We use data on insurance enrollment and health care utilization from the Arkansas, Colorado, and Rhode Island All Payer Claims Databases to document changes in utilization associated with transitions across sources of coverage. All-Payer Claims Databases hold considerable promise for studying transitions in coverage, but they have been utilized in relatively few such studies to date. We focus on individuals who have experienced insurance transitions between private insurance sources (employer-sponsored insurance, Exchange coverage, and other non-group coverage) and Medicaid, using event-study regression models to document patterns of utilization six months before and six months after transitions to and from Medicaid. We consider office visits, emergency department (ED) visits, inpatient stays, and prescription fills, with a particular emphasis on Opioid and Medication Assisted Treatment (MAT) prescriptions.
We find clear evidence that transitions between private coverage and Medicaid are associated with major changes in health care utilization. However, we also find that utilization of some types of care leading up to a switch in coverage are systematically different from those observed among individuals who do not experience a change in the source of coverage--both in the level of health care utilization and in the trends in utilization of certain services and medications. Findings from Colorado include the following:
- Utilization by individuals who will leave or join Medicaid is systematically different from individuals who have continuous Medicaid coverage even prior to their insurance transition.
- Those who will switch between private and Medicaid coverage are more likely to use office-based care and less likely to use ED care or prescription drugs.
- After joining Medicaid, enrollees change their utilization patterns. Particularly, among individiuals joining Medicaid from Employer-Sponsored Insurance or Exchange coverage, we observe decreases in offices visits and increases in ED visits, inpatient stays, and prescription drug fills.
- Among those who leave Medicaid, we also see changes in utilization. In contrast to Medicaid joiners, Medicaid leavers increase their use of office visits and decrease their use of ED visits, inpatient stays, and prescription drugs.