Volume 47 | Number 3pt1 | June 2012

Abstract List

Chapin White Ph.D.


To compare the effects of a coverage expansion versus a edicaid physician fee increase on children's utilization of physician services.

Primary Data Source

ational ealth nterview urvey (1997–2009).

Study Design

We use the hildren's ealth nsurance rogram, enacted in 1997, as a natural experiment, and we performed a panel data regression analysis using the state‐year as the unit of observation. Outcomes include physician visits per child per year and the following indicators of access to primary care: whether the child saw a physician, pediatrician, or visited an in the last year, and whether the parents reported experiencing a non‐cost‐related access problem. We analyzed these outcomes among all children, and separately among socioeconomic status () quartiles defined based on family income and parents' education.

Principal Findings

hildren's ealth nsurance rogram had a major impact on the extent and nature of children's insurance coverage. However, it is not associated with any change in the aggregate quantity of physician services, and its associations with indicators of access are mixed. Increases in physician fees are associated with broad‐based improvements in indicators of access.


The findings suggest that (1) coverage expansions, even if they substantially reduce patient cost sharing, do not necessarily increase physician utilization, and (2) increasing the generosity of provider payments in public programs can improve access among low‐ children, and, through spillover effects, increase higher‐ children as well.