title: Response to health insurance by previously uninsured rural children.
abstract: OBJECTIVE
  To examine the healthcare utilization and costs of previously uninsured rural children.
  
  
  METHODS
  Four years of claims data from a school-based health insurance program located in the Mississippi Delta. All children who were not Medicaid-eligible or were uninsured, were eligible for limited benefits under the program. The 1987 National Medical Expenditure Survey (NMES) was used to compare utilization of services.
  
  
  METHODS
  The study represents a natural experiment in the provision of insurance benefits to a previously uninsured population. Premiums for the claims cost were set with little or no information on expected use of services. Claims from the insurer were used to form a panel data set. Mixed model logistic and linear regressions were estimated to determine the response to insurance for several categories of health services.
  
  
  RESULTS
  The use of services increased over time and approached the level of utilization in the NMES. Conditional medical expenditures also increased over time. Actuarial estimates of claims cost greatly exceeded actual claims cost. The provision of a limited medical, dental, and optical benefit package cost approximately $20-$24 per member per month in claims paid.
  
  
  CONCLUSIONS
  An important uncertainty in providing health insurance to previously uninsured populations is whether a pent-up demand exists for health services. Evidence of a pent-up demand for medical services was not supported in this study of rural school-age children. States considering partnerships with private insurers to implement the State Children's Health Insurance Program could lower premium costs by assembling basic data on previously uninsured children.
authors.affiliation: Center for Applied Research and Evaluation (CARE), Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock 72205, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Tilford
authors.forename: J M
authors.initials: JM
authors.lastname: Robbins
authors.forename: S J
authors.initials: SJ
authors.lastname: Shema
authors.forename: F L
authors.initials: FL
authors.lastname: Farmer
mesh_terms: D001131:Arkansas; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000706:statistics & numerical data*; D005249:Fees and Charges / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007342:Insurance Benefits / Q000191:economics / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured / Q000208:ethnology / Q000706:statistics & numerical data; D011203:Poverty / Q000191:economics / Q000208:ethnology / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data