+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Evaluation of a state health insurance program for low-income children: implications for state child health insurance programs



Evaluation of a state health insurance program for low-income children: implications for state child health insurance programs



Pediatrics 105(2): 363-371



Background. The State Child Health Insurance Program (SCHIP) is the largest public investment in child health care in 30 years, targeting 11 million uninsured children, yet little is known about the impact of health insurance on uninsured children. In 1991, New York State implemented Child Health Plus (CHPlus), a health insurance program that became a model for SCHIP. Objective. To examine changes in access to care, utilization of services, and quality of care among children enrolled in CHPlus. Design. A pre-post design was used to evaluate the health care experiences of children in the year before enrollment in CHPlus and during the year after CHPlus enrollment. Setting. New York State, stratified into 4 regions: New York City, urban counties around New York City, upstate urban counties, and upstate rural counties. Participants. A total of 2126 children (0-12.99 years of age) who enrolled in CHPlus in 1992-1993. Data Collection. Parents were interviewed by telephone, and primary care medical charts were reviewed for 694 children (0-3.99 years of age). Analysis. Access, utilization, and quality of care measures for each child were compared for the year before and the year after CHPlus enrollment, controlling for age, geographic region, previous insurance coverage, and CHPlus plan type (indemnity or managed care). Results. Enrollment in CHPlus was associated with fewer children lacking a medical home (5% before CHPlus vs 1% during CHPlus), with the greatest change occurring in New York City (11% vs 1%), where access before CHPlus was lowest. CHPlus was also associated with increased primary care visits: by 25% for preventive visits, by 52% for acute visits, and by 42% for total visits. The number of specialists seen during CHPlus was more than twice as high than before CHPlus. CHPlus was not associated with changes in emergency department utilization, although hospitalizations, which were not covered by CHPlus, were 36% lower during CHPlus coverage. Use of public health departments for immunizations declined by 64%, with more immunizations delivered in the medical home during CHPlus coverage. One third of parents reported improved quality of health care for their child as a result of CHPlus, and virtually none noted worse quality of care. Conclusions. This statewide health insurance program for low-income children was associated with improved access, utilization, and quality of care, suggesting that SCHIP has the potential to improve health care for low-income American children.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 010613837

Download citation: RISBibTeXText

PMID: 10654957

DOI: 10.1542/peds.105.2.363


Related references

Who's enrolled in the State Children's Health Insurance Program (SCHIP)? An overview of findings from the Child Health Insurance Research Initiative (CHIRI). Pediatrics 112(6 Pt 2): E499, 2003

Trends in private insurance, Medicaid/State Children's Health Insurance Program, and the health-care safety net: implications for asthma disparities. Chest 132(5 Suppl.): 818s-830s, 2007

Trends in private insurance, Medicaid/State Children's Health Insurance Program, and the Healthcare Safety Net: implications for vulnerable populations and health disparities. Annals of the new York Academy of Sciences 1136: 137-148, 2008

State child health; implementing regulations for the State Children's Health Insurance Program. Health Care Financing Administration (HCFA), HHS. Final rule. Federal Register 66(8): 2490-2688, 2001

State child health; State Children's Health Insurance Program allotments and payments to states. Health Care Financing Administration (HCFA), HHS. Final rule. Federal Register 65(101): 33616-33633, 2000

Federally sponsored insurance programs for children: the State Children's Health Insurance Program. Journal of Pediatric Nursing 18(2): 134-136, 2003

Child health benefits packages: lessons from Minnesota for State Children's Health Insurance Programs. Maternal and Child Health Journal 2(1): 55-58, 1998

The impact of school enrollment-based health insurance on the State Children's Health Insurance Program (SCHIP). Journal of School Health 70(9): 381-384, 2000

Who transitions from private to public health insurance?: Lessons from expansions of the State Children's Health Insurance Program. Journal of Health Care for the Poor and Underserved 22(1): 359-370, 2011

The Effects of the State Childrens Health Insurance Program on Insurance Status and Health Care Utilization of Children. Journal of Family and Economic Issues 32(2): 373-383, 2011

Incorporating school mental health programs in SCHIP plans. State Children's Health Insurance Program. Psychiatric Services 53(7): 902, 2002

Incorporating expanded school mental health programs in state children's health insurance program plans. Journal of School Health 71(2): 73-76, 2001

Disruptions in insurance coverage: patterns and relationship to health care access, unmet need, and utilization before enrollment in the State Children's Health Insurance Program. Pediatrics 120(4): E1009-E1016, 2007

Evolution of a children's health insurance program: lessons from New York State's Child Health Plus. Pediatrics 105(3 Suppl E): 692-696, 2000

Access to health Insurance: State Children's Health Insurance Program. Issue brief. Issue Brief: 1-22, 2011