Seminar Series

2004 - 2005

The Division of Health Policy and Management sponsors two seminar series:

• Health Services Research Seminars (HSR) - Nationally and internationally known leaders in health services research speak on current topics. These seminars are free and open to the public.
• Work in Progress (WIP) - Faculty research, guest speakers, and student topics of interest are presented in an informal setting, open to the University community. All WIP seminars are held in Mayo D-330 from 11:30 am -1:00 pm, except as noted. Feel free to bring your lunch.

2004-2005 Schedule

Archives

2005-2006 | 2004-2005 | 2003-2004 | 2002-2003 | 2001-2002 | 2000-2001 | 1999-2000 | 1998-1999

Abstracts for HSR Series

Stephen Zuckerman, Ph.D.
Principal Research Associate, Health Policy Center, The Urban Institute

“Are State Coverage Expansions Reducing Uninsurance Among Adults?”

Abstract

The biggest change in public health insurance during the past decade was the State Children’s Health Insurance Program (SCHIP). As SCHIP was getting started in every state, a small number of states implemented major expansions of public coverage for adults. Some states focused on the parents of children eligible for Medicaid and SCHIP, while others expanded coverage to all types of low-income adults. Moreover, income eligibility standards varied across states. These public coverage expansions can also provide incentives to forego private coverage, making it critical to consider the program’s effects on enrollment and its net effects on overall coverage.

We estimate the program impacts on the rate of uninsurance and displacement of private coverage using a difference-in-differences (DD) framework that compares changes in coverage among eligible adults in the states with expansions to adults with comparable characteristics in states without expansions. Such comparison groups provide the counterfactual for what would have happened if a state’s coverage rules had remained fixed. Because DD estimates may be sensitive to the choice of the comparison states, we draw on several different comparison groups to explore the robustness of our analysis. The comparison groups include adults who meet eligibility standards in each of the expansion states but reside in a state without an expansion.

We use data on low-income adults in the 1997, 1999 and 2002 rounds of the National Survey of America’s Families (NSAF), a nationally representative survey of the economic, health and social characteristics of children and non-aged adults. The survey oversamples families with incomes below 200 percent of the federal poverty level and families in 13 study states, including five of the states that have expanded coverage to adults (Massachusetts, New York, New Jersey, Wisconsin and California), and allows us to compare outcomes prior to and following the coverage expansions.

Our results will show the impact of each state program separately, because they are all somewhat different in terms of the policies they adopted and state demographics and, as such, need to be studied with different comparison groups. We applied similar methods to the 1997 and 1999 NSAF to show that MassHealth, the Massachusetts coverage expansion, reduced the share of low-income adults without insurance by nearly 30 percent. At the same time, there was little change in private insurance coverage, indicating that the MassHealth expansions led to only modest crowd out of employer-sponsored coverage.

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Esther Duflo, Ph.D.
Castle Krob Associate Professor, Department of Economics, MIT (Massachusetts Institute of Technology)

“Health Care and Health Status in Udaipur, Rajasthan”

Abstract

This seminar will present results from an in-depth study of the health status, health seeking behavior, and health care options of 1,000 households in 100 villages in the Udaipur district of the Indian State of Rajasthan. The survey, conducted over a year and a half, contains household interviews, interviews with all the public and private facilities these household use, and a weekly monitoring of presence and usage in the 134 public facilities serving those villages.

The seminar will start by showing a 50-minute documentary, "The Name of the Disease," conducted in the same area in conjunction with the survey. Those findings paint a bleak picture of health care and health status in the areas: health status is poor, with many individuals suffering from limitation in their activities of daily living and reporting symptoms in the past months. Demand for health care is high: on average, households spend 7% of their monthly budget on health care. Available health care is of very poor quality: absenteeism in public facilities reaches 43%. As a result, most households seek health care in private facilities or from traditional providers instead. A minority of the "private doctors," however, hold a medical degree. A sizeable minority did not graduate from high school. The treatment given includes drips and injections in 68% of the visits.

The seminar will conclude by presenting on-going action-research projects, which will evaluate alternative ways to remedy this situation.

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