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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