title: The effects of cost sharing on access to care among childless adults.
abstract: OBJECTIVE
  To analyze the impact of public health insurance expansions and the use of enrollee cost sharing on insurance status and receipt of clinically indicated preventive screenings and physician services.
  
  
  METHODS
  This study uses Behavioral Risk Factor Surveillance System (BRFSS) data from 1997 to 2007.
  
  
  METHODS
  This study uses multivariate difference-in-difference logistic regression modeling of pooled cross-sectional time series data. The effect of the expansions on insurance status and access to care is identified by cross-state variation in program implementation, as well as cross-state and within-state variation in program eligibility criteria over time.
  
  
  RESULTS
  Childless adult expansions, regardless of cost-sharing levels, reduced uninsurance rates and decreased the likelihood that childless adults needed to see a physician but did not because of cost. Expansions with traditional public insurance cost-sharing requirements increased the use of preventive screenings, while expansions with increased cost-sharing requirements did not.
  
  
  CONCLUSIONS
  Cost-sharing requirements did not have an impact on the ability to see a physician when needed, but they played an important role in the utilization of preventive services. Expanding public health insurance to low-income, childless adults presents a promising policy opportunity, but there are trade-offs between the efficiencies obtained through increased cost sharing and the potential inefficiencies due to the lower use of preventive services.
authors.affiliation: Rollins School of Public Health, Emory University, 1518 Clifton Road, Room 623, Atlanta, GA 30322, USA. gguy@sph.emory.edu
authors.forename: Gery P
authors.initials: GP
authors.lastname: Guy
mesh_terms: D000328:Adult; D017047:Cost Sharing; D005260:Female; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014481:United States; D055815:Young Adult
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