addresses the reason families shift their children from private to public insurance, while taking into account the concept of crowd-out by examining the transition of children from private to public health insurance in the wake of establishment of public programs that provide coverage to the uninsured alongside the continued offering of private health insurance. He identifies such programs as the State Children's Health Insurance Program (SCHIP) and using the Survey of Income and Program Participation (SIPP), a nationally representative household survey, identifies children who moved from private to public coverage and compares them to those who remain on private insurance and to all other children (Shaefer et al., 2011, p 359).
The Concept of Crowd-Out.
The concept of crowd-out refers to the extent to which the expansions of public coverage displace private insurance. This became a central issue especially during the passage of SCHIP and its reauthorization in 2007 when groups became concerned that instead of principally helping uninsured families, the SCHIP expansions shifted privately insured consumers to public health insurance coverage. Researchers seeking to determine whether public insurance has crowded-out private health insurance since the creation of SCHIP, have varying estimates. However theoretical literature is in agreement that crowd-out will occur when the value of public insurance to individuals and their families outweighs that of private insurance (p 359-360).
Private to Public Transition.
This refers to the move from public health insurance coverage to private coverage. Since public insurance is generally less expensive and more comprehensive than most private insurance, the switch from private to public is desirable. Apart from the expansion in public insurance coverage, families have other reasons to move from private to public insurance. These include but are not limited to loss of employment, onset of serious illness that warrants high medical expenditures as well as loss of employer-based health insurance due to job switch.
