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Press Release Date: October 12, 1999
President Clinton today announced that the U.S. Agency for Health Care Policy and Research (AHCPR), the David and Lucile Packard Foundation, and the U.S. Health Resources and Services Administration (HRSA) will fund a set of research studies to help public health insurance programs and health care delivery systems improve the quality of, and access to, health care for low-income children. Overall funding will total $9.1 million over three years for nine research projects.
AHCPR Deputy Administrator Lisa Simpson, M.B., B.Ch., and Eugene Lewit, Ph.D., Senior Program Manager in the Children, Families and Communities Program of the Packard Foundation, noted the studies are especially timely in light of the growth of managed care and other recent changes in the financing and delivery of health care, including the State Children's Health Insurance Program (SCHIP). SCHIP, enacted as part of the Balanced Budget Act of 1997, helps states offer affordable health insurance to low-income, uninsured children in working families that earn too much for Medicaid but too little to afford private coverage.
According to Dr. Simpson, "These studies will seek to uncover which health insurance and delivery features work best for low-income children—particularly minority children and those with special health care needs. The studies should benefit SCHIP as well as other public insurance programs and delivery systems, including Medicaid and State- and locally subsidized health insurance."
"These projects emphasize policy relevance and dissemination, ensuring that they will provide timely information to policy makers," Dr. Lewit said.
Seven of the projects focus exclusively on or have separate analyses of children with special health care needs, and five explore disparities between minority and non-minority children. HRSA Administrator Claude Earl Fox, M.D., M.P.H., said, "These research projects mark an unparalleled effort to understand how to improve health care for vulnerable children, including children who remain uninsured, and the institutions that serve them."
A key feature of this set of projects is that the principal investigators will participate in a national Coordinating Committee that will undertake activities to strengthen individual studies, and make it possible for the results to be applied across locations, populations, and insurance design and organizational delivery system features. The Coordinating Committee will receive guidance from a Users Group, consisting of federal, state and local government representatives.
The following awards were made:
Provider Participation and Access in Alabama and Georgia. Principal investigator: Janet Bronstein, Ph.D., University of Alabama at Birmingham. $1,188,628; 9/30/99-9/29/02.
This study will examine the effect of SCHIP and Medicaid changes and expansions in Alabama and Georgia on provider availability and on low-income children's subsequent access to, utilization of, and satisfaction with health services. Two substudies, one of African-American children and one of children with special health care needs, will be undertaken.
Impact of Publicly Funded Programs on Child Safety Nets. Principal investigator: Peter Budetti, M.D., J.D., Northwestern University, Evanston, Ill. $985,469; 9/30/99-9/29/02.
The purpose of this national study is to look at the impact of Medicaid managed care and SCHIP on the survival and financial viability of pediatric safety net providers.
Medicaid vs. Premium Subsidy: Oregon's SCHIP Alternatives. Principal investigator: Janet Mitchell, Ph.D., Center for Heath Economics Research, Waltham, Mass. $872,321; 9/30/99-9/29/02.
This study will compare the access to, satisfaction with, and quality of health care of Oregon children who choose to enroll in the SCHIP Medicaid-look-alike program, those who choose to enroll in the premium subsidy program, and those who remain uninsured. There will be a focus on Hispanics, who are
disproportionately represented among the uninsured. Researchers will also investigate continuity of enrollment and the reasons why some fail to re-enroll in the SCHIP program.
Special Health Care Need Children: SCHIP Responsiveness. Principal investigator: Sara Rosenbaum, J.D., George Washington University, Washington, D.C. $951,687; 9/30/99-9/29/02.
This study will explore how states exercise their flexibility in SCHIP program design by describing eligibility criteria in freestanding SCHIP programs and all managed care design features in SCHIP programs nationwide. Researchers also will analyze the data from the National Health Interview Survey, the Medical Expenditure Panel Survey and the Area Resource File to model the impact of key benefit features on low-income children's access to and utilization of health care.
Evaluation of Kansas Healthwave. Principal investigator: Robert St. Peter, M.D., Kansas Health Institute, Topeka, Kan. $614,290; 9/30/99-9/29/02.
The purpose of this study is to evaluate the impact of the Kansas SCHIP program on low-income children's health care access, quality, utilization and status, including children who remain uninsured. This study will include a special focus on the vulnerable populations of rural, urban African-American and Hispanic children.
Access and Quality of Care for Low-Income Adolescents. Principal investigator: Elizabeth Shenkman, Ph.D., University of Florida, Gainesville, Fla. $920,191; 9/30/99-9/29/02.
This is a study of the impact of the organizational features of Florida's SCHIP plans and providers on adolescents' access to and quality of care, health and functioning, and expenditures, including a comparative analysis of minority and non-minority youths.
Health Care Access, Quality, and Insurance for CSHCN. Principal investigator: Nancy Swigonski, Ph.D., Indiana University, Indianapolis, Ind. $1,118,744; 9/30/99-9/29/02.
This study will analyze the impact of Indiana's various SCHIP arrangements on children with special health care needs regarding health care access, utilization, quality, satisfaction, expenditures, health outcomes and family impact.
New York's SCHIP: What Works for Vulnerable Children. Principal investigator: Peter Szilagyi, M.D., M.P.H., University of Rochester, N.Y. $1,751,260; 9/30/99-9/29/02.
The purpose of this study is to assess the impact of New York's SCHIP health plan features on enrollees' access, utilization and quality of care, including substudies of children with asthma and minority children. In addition, investigators will examine continuity of enrollment, the magnitude and reasons for loss of commercial insurance, the impact of SCHIP on uncompensated inpatient care and the factors that cause some eligible families not to enroll.
Analysis of Fee-for-Service vs. Managed Care CSHCN. Principal investigator: Janet Zimmerman, Ph.D., Michigan Public Health Institute, Okemos, Mich. $667,369; 9/30/99-9/29/02.
This Michigan study will investigate the impact of a voluntary managed care program for children with special health care needs on Medicaid-eligible children.
AHCPR, a part of the U.S. Public Health Service, is the lead agency charged with supporting research designed to improve the quality of health care, reduce its cost and broaden access to essential services. AHCPR sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use and access. The information helps health care decisionmakers—patients and clinicians, health system leaders, and policymakers—make more informed decisions and improve the quality of health care services.
The David and Lucile Packard Foundation is a private family foundation founded in 1964. The Foundation provides grants in a number of program areas, including science, children, families and communities, population, conservation, and the arts.
HRSA, also a part of the U.S. Public Health Service, directs national health programs that improve the health of the nation by assuring quality health care to underserved, vulnerable and special-need populations and by promoting appropriate health professions workforce capacity and practice, particularly in primary care and public health.
For additional information, please contact: AHCPR— Salina Prasad, (301) 427-1864 (SPrasad@ahrq.gov); Packard—John Walker, (650) 917-7122; HRSA—Mona Finch, (301) 443-5630