1 / 16

Marital Disruption and the Risk of Losing Health Insurance Coverage

Marital Disruption and the Risk of Losing Health Insurance Coverage. James Kirby AHRQ. Research Questions. To what extent does marital disruption increase the risk of losing health insurance? Does the association diminish over time?. Motivation.

mac
Download Presentation

Marital Disruption and the Risk of Losing Health Insurance Coverage

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Marital Disruption and the Risk of Losing Health Insurance Coverage James Kirby AHRQ

  2. Research Questions • To what extent does marital disruption increase the risk of losing health insurance? • Does the association diminish over time?

  3. Motivation • Many individuals get their health insurance coverage through their spouse • Many marriages end in divorce • Prior studies on coverage do not examine change • Understanding how events affect coverage loss is important to evaluate changes in health care policy

  4. Theoretical Background • Being married provides: • Opportunity for coverage • Incentives for coverage • People plan their lives around their marital status • Career, fertility, geographic location • Decisions have staying power • Two types of effects: • “Stable” disadvantage of being unmarried • “Transitional” disadvantage of becoming unmarried

  5. A Model of Change “Recovery” “Transitional” effect “Stable effect”

  6. Analytic Approach • Discrete-time, Proportional Hazards Model • General Linear Model with complimentary log-log link (instead of probit or logit) • Unit of Analysis: Person-Month • Results interpreted with Hazard Ratios

  7. Data Sources • Medical Expenditure Panel Survey (MEPS) • Analysis is restricted to 18+ • 2 years of data collected at 5 interview rounds • Three most recent panels are pooled • Unit of Analysis: Person-month

  8. Key Variables • Change in Insurance Coverage by Month • Change in Marital Status • Married in ALL prior rounds • Unmarried in ALL prior rounds • Divorced/separated/widowed in ANY prior round • UnmarriedMarried in ANY prior round • Interaction between change in marital status and time since change

  9. Controls for Multivariate Analysis • Demographics • Race, Ethnicity, Age, Sex • SES • Income, Education • Attitudes about health insurance & risk • Scale of four measures (α=0.78) • Health Status • Subjective mental and general health • Disability (ADLs and IADLs) • Number of serious chronic conditions • Children in household

  10. Hazard Ratios for Coverage Loss by Marital Status

  11. Monthly hazard of losing health insurance coverage by marital status

  12. Monthly hazard of losing health insurance coverage by marital status

  13. Monthly hazard of gaining health insurance coverage by marital status

  14. Summary • Marital Disruption is positively associated with the risk of losing coverage, but so is marriage • The associations decline over time • For every month that passes, hazard decreases by about 3% • Getting married is also positively associated with gaining insurance coverage. There is no such association for marital disruption

  15. Conclusions • Marital transitions should be recognized as a risk factor for losing health insurance • Eligibility is not the sole causal mechanism • Upheaval associated with marital change is a possible explanation for lapses in insurance coverage

  16. Hazard Rate Models: Hazard Ratios

More Related