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Table 3 Summary of articles addressing the effects of public insurance on access to specialty care.

From: Effects of insurance status on children's access to specialty care: a systematic review of the literature

Author

Year

Sample Size

Data Source

Study Design

Access Measure

Statistic

Comparison

Findings

Endogeneity/Selection

Cabana et al. [21]

2002

3,163

Single MCO

Cross-sectional

Utilization

Logistic regression; likelihood of specialty care

Medicaid vs. non-Medicaid insured

Private with copay: OR = 2.52, p < 0.05 Private w/o copay: OR = 3.40, p = NS

Single MCO with Medicaid and private; patients do not choose

Damiano et al. [22]

2003

463

State SCHIP

Prospective cohort

Unmet need

McNemar; unmet need pre- vs. post-enrollment

SCHIP vs. prior coverage

40% vs. 13%; p < 0.05

No consideration of selection into program

Davidoff et al. [23]

2005

3413

National Health Interview Survey

Quasi-experimental

Utilization

Change in proportion with any visit

SCHIP ineligible vs. SCHIP eligible

+3.8, p = NS

Groups compared on eligibility, not enrollment

Forrest et al. [24]

1999

27,104

National practice-based research network

Prospective

Referral rates

t-test, percent referred; logistic regression, likelihood of referral to specialty

Medicaid vs. Private

4.46% vs. 2.61%, p < 0.001

No consideration of selection into coverage type

Holl et al [25]

2000

1,730

Single SCHIP

Quasi-experimental

Utilization

Change in proportion with any specialist visit

Prior to SCHIP enrollment vs. after enrollment

Age < 1 year: 15.5% vs. 16.1%, p = NS; Age 1–5 years: 19.7% vs. 19.4%, p = NS

No consideration of selection into program

Hwang et al. [26]

2005

54

Clinics in a single state

Cross-sectional

Appointment availability

t-test, proportion offering appointment

Private insurance vs. Medicaid

96% vs. 41%, p < 0.0001

Physician offices; no patient selection

Kempe et al. [27]

2000

596

Pediatric practices in a single state

Retrospective cohort

Referral rates

χ2; proportion with referral

Private insurance vs. Medicaid

11% vs. 20%, p = 0.09

No consideration of selection into coverage type

Kempe et al [28]

2005

480

Single SCHIP

Prospective cohort

Utilization

Logistic regression; saw specialist when needed; any specialist visit

Prior to enrollment vs. after enrollment

OR = 1.96, p < 0.05; OR = 1.22, p = NS

No consideration of selection into program

Mayer et al. [13]

2004

38,866

National Survey of CSHCN

Cross-sectional

Unmet need

Logistic regression; likelihood of unmet need for specialty care

Private insurance vs. Medicaid and SCHIP

Medicaid: OR = 1.26, p = NS; SCHIP: OR = 0.82, p = NS

No consideration of selection into coverage type

Ortega et al. [29]

2001

1,002

Multiple hospitals; single geographic region

Retrospective cohort

Utilization

χ2;percent seeing an asthma specialist

Private insurance vs. Medicaid

30% vs. 6%, p < 0.001

No consideration of selection into coverage type

Park et al. [14]

2002

1,985

National Health Interview Survey

Cross-sectional

Utilization

Proportion having seen a specialist

Private insurance vs. public insurance

Less likely vs. private insurance

No consideration of selection into coverage type

Perlstein et al. [15]

1997

544

Regional cardiac registry

Retrospective cohort

Time to referral

t-test; mean age at referral

Medicaid vs. "commercial"

168 days vs. 80 days, p < 0.05

No consideration of selection into coverage type

Price et al. [34]

1999

94

Single hospital

Cross-sectional

Utilization

t-test; number of specialist visits

Medicaid vs. fee-for-service

All: 3 vs. 6, p = NS; asthma-related: 2 vs.4, p < 0.05

No consideration of selection into coverage type

Szilagyi, et al. [31]

2000

187

Single SCHIP, children with asthma

Quasi-experimental

Utilization

χ2 and t-test; percent seeing specialist, number of visits

Prior to SCHIP enrollment vs. after enrollment

Any specialist: 30% vs. 40%, p = 0.02; Visits: 0.36 vs. 0.48, p = 0.02

No consideration of selection into program

Szilagyi, et al. [16]

2000

2,126

Single SCHIP

Quasi-experimental

Utilization

t-test, difference in number of specialist visits

Prior to SCHIP enrollment vs. after enrollment

0.174 more visits after enrollment, p < 0.001

No consideration of selection into program

Szilagyi et al. [30]

2004

2,644

Single SCHIP

Prospective cohort

Utilization and unmet need

Logistic regression, change in unmet needs pre- and post-enrollment

Prior to SCHIP enrollment vs. after enrollment

15.5 percentage point decrease after enrollment, p < 0.01

No consideration of selection into program

Wang et al. [32]

2004

100

Clinics in single state

Cross-sectional

Appointment availability

Percentage comparisons, no statistical test, percent offering an appointment

Private PPO vs. Medicaid

97% vs. 27%

Physician offices; no patient selection

Zwanziger, et al. [33]

2000

1,910

Single SCHIP

Quasi-experimental

Utilization

OLS, change in expenditures pre- and post-enrollment

Prior to SCHIP enrollment vs. after enrollment

$71.85 increase after enrollment

No consideration of selection into program