title: Protecting low-income children's access to care: are physician visits associated with reduced patient dropout from Medicaid and the Children's Health Insurance Program?
abstract: OBJECTIVE
  Dropout among patients who are enrolled in Medicaid and the Children's Health Insurance Program contributes to a lack of health care access among millions of Americans. The purpose of this study was to determine which, if any, types of clinical contact with physicians are associated with reduced dropout among children who are enrolled in Medicaid and the Children's Health Insurance Program.
  
  
  METHODS
  The data are from the nationally representative Medical Expenditure Panel Survey, 1998-2002. The sample is composed of all children (n = 3043) who were reported to have Medicaid or Children's Health Insurance Program coverage throughout their first year in the survey and who did not acquire other insurance during the study period. The outcome measure is whether an individual remained enrolled in Medicaid or the Children's Health Insurance Program by the end of the following year. Exposure variables were clinical contact during an individual's first year in the survey: numbers of office visits, hospital outpatient department visits, emergency department visits, inpatient hospital stays, and dental visits. The analysis uses multivariate logistic regression to control for patient and family characteristics-most important, health status, functional status, and overall health care expenditures.
  
  
  RESULTS
  Eight percent of the children in the sample had left Medicaid/the Children's Health Insurance Program by the end of the second year in the survey. More frequent contact with clinicians in an office setting was associated with a significantly lower risk for dropping out of Medicaid/the Children's Health Insurance Program among children, even controlling for demographics, health and functional status, and overall health care expenditures. After multivariate adjustment, more frequent contact in hospital outpatient departments also was associated with reduced dropout, with a borderline statistically significant odds ratio. Notably, emergency visits and inpatient stays were not associated with any significant change in the risk of Medicaid/Children's Health Insurance Program dropout.
  
  
  CONCLUSIONS
  These results suggest that some but not all types of clinician visits are serving an important function in maintaining Medicaid and the Children's Health Insurance Program coverage among low-income patients. Two possible approaches to improve access to care among low-income children therefore would be (1) increased awareness among clinicians, especially in hospitals and emergency departments, regarding Medicaid/Children's Health Insurance Program retention as an issue in the ongoing care of their patients and (2) Medicaid/Children's Health Insurance Program reimbursement of clinicians and their staff for assisting patients with the public insurance renewal process.
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA. bsommers@post.harvard.edu
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Sommers
mesh_terms: D000385:Aid to Families with Dependent Children / Q000706:statistics & numerical data*; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000706:statistics & numerical data*; D015986:Confounding Factors, Epidemiologic; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D016015:Logistic Models; D008484:Medicaid / Q000706:statistics & numerical data*; D016017:Odds Ratio; D010352:Patient Dropouts; D010817:Physician-Patient Relations; D011203:Poverty; D014481:United States