Dataset Information

The effect of renewal policy changes on SCHIP disenrollment.

ABSTRACT:

Objective

To examine the impact of changing from a passive renewal process to an active renewal process in Florida's State Children's Health Insurance Program (SCHIP) on disenrollment.

Data sources

Administrative records, containing enrollment and demographic data, were used to identify 414,396 enrollment spells from January 2004 through February 2006. Health care claims data were used to classify the children's health status.

Study design

A Cox proportional hazards model was used to analyze the impact of changing to an active renewal process on the children's risk of disenrolling, controlling for the children's sociodemographic characteristics. Differential effects of the policy change by the children's health status were examined, and transfers to other public health insurance programs were taken into account.

Principal findings

Children faced almost a 10-fold greater risk of disenrolling in their renewal month under active renewal than under passive renewal. We did not detect differential impacts of the policy change across children with different health status levels.

Conclusions

The switch to an active renewal process in Florida's SCHIP significantly increased disenrollment rates, and the effect of this policy change does not appear to vary by health status.

SUBMITTER: Herndon JB

PROVIDER: S-EPMC2613999 | biostudies-literature | 2008 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

The effect of renewal policy changes on SCHIP disenrollment.

Herndon Jill Boylston JB Vogel W Bruce WB Bucciarelli Richard L RL Shenkman Elizabeth A EA

Health services research 20080603 6

<h4>Objective</h4>To examine the impact of changing from a passive renewal process to an active renewal process in Florida's State Children's Health Insurance Program (SCHIP) on disenrollment.<h4>Data sources</h4>Administrative records, containing enrollment and demographic data, were used to identify 414,396 enrollment spells from January 2004 through February 2006. Health care claims data were used to classify the children's health status.<h4>Study design</h4>A Cox proportional hazards model w ...[more]

PMID: 18522669

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Project description:BackgroundPublic health strategies that focus on legislative and policy change involving chronic disease risk factors such as unhealthy diet and physical inactivity have the potential to prevent chronic diseases and improve quality of life as a whole. However, many public health policies introduced as part of public health reform have not yet been analyzed, such as in British Columbia and Ontario. The purpose of this paper is to present the results of a descriptive, comparative analysis of public health policies related to the Healthy Living Core Program in British Columbia and Chronic Disease Prevention Standard in Ontario that are intended to prevent a range of chronic diseases by promoting healthy eating and physical activity, among other things.MethodsPolicy documents were found through Internet search engines and Ministry websites, at the guidance of policy experts. These included government documents as well as documents from non-governmental organizations that were implementing policies and programs at a provincial level. Documents (n = 31) were then analysed using thematic content analysis to classify, describe and compare policies in a systematic fashion, using the software NVivo.ResultsThree main categories emerged from the analysis of documents: 1) goals for chronic disease prevention in British Columbia and Ontario, 2) components of chronic disease prevention policies, and 3) expected outputs of chronic disease prevention interventions. Although there were many similarities between the two provinces, they differed somewhat in terms of their approach to issues such as evidence, equity, and policy components. Some expected outputs were adoption of healthy behaviours, use of information, healthy environments and increased public awareness.ConclusionsThe two provincial policies present different approaches to support the implementation of related programs. Differences may be related to contextual factors such as program delivery structures and different philosophical approaches underlying the two frameworks. These differences and possible explanations for them are important to understand because they serve to contextualize the differences in health outcomes across the two provinces that might eventually be observed. This analysis informs future public health policy directions as the two provinces can learn from each other.

Project description:Associative learning refers to our ability to learn about regularities in our environment. When a stimulus is repeatedly followed by a specific outcome, we learn to expect the outcome in the presence of the stimulus. We are also able to modify established expectations in the face of disconfirming information (the stimulus is no longer followed by the outcome). Both the change of environmental regularities and the related processes of adaptation are referred to as extinction. However, extinction does not erase the initially acquired expectations. For instance, following successful extinction, the initially learned expectations can recover when there is a context change - a phenomenon called the renewal effect, which is considered as a model for relapse after exposure therapy. Renewal was found to be modulated by reminder cues of acquisition and extinction. However, the mechanisms underlying the effectiveness of reminder cues are not well understood. The aim of the present study was to investigate the impact of reminder cues on renewal in the field of human predictive learning. Experiment I demonstrated that renewal in human predictive learning is modulated by cues related to acquisition or extinction. Initially, participants received pairings of a stimulus and an outcome in one context. These stimulus-outcome pairings were preceded by presentations of a reminder cue (acquisition cue). Then, participants received extinction in a different context in which presentations of the stimulus were no longer followed by the outcome. These extinction trials were preceded by a second reminder cue (extinction cue). During a final phase conducted in a third context, participants showed stronger expectations of the outcome in the presence of the stimulus when testing was accompanied by the acquisition cue compared to the extinction cue. Experiment II tested an explanation of the reminder cue effect in terms of simple cue-outcome associations. Therefore, acquisition and extinction cues were equated for their associative histories in Experiment II, which should abolish their impact on renewal if based on simple cue-outcome associations. In contrast to this prediction, Experiment II replicated the findings from Experiment I indicating that the effectiveness of reminder cues did not require direct reminder cue-outcome associations.

Dataset Information

The effect of renewal policy changes on SCHIP disenrollment.

Objective

Data sources

Study design

Principal findings

Conclusions

Publications

The effect of renewal policy changes on SCHIP disenrollment.

Similar Datasets

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