Examining Substitution: State Strategies to Limit "Crowd Out" in the Era of Children's Health Insurance Expansions. C. Substitution may also be linked to secular trends in the job market, insurance industry, and the general state of the economy.

12/09/1997

While research has shown varying estimates of substitution, few investigations have examined the motivating factors behind employer- and individual-based decisions regarding health insurance. At least some of the apparent substitution of public coverage may be linked to secular trends in the job market, insurance industry and the general economy. These secular trends may affect employer and individual decisions which, in turn, may affect rates of substitution. This section will focus on the impact of economic and political factors, managed care, types of employment, and employee contributions on substitution.