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Child/Adolescent Health

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State Children's Health Insurance Programs have improved access to care for previously uninsured children

A study of the Georgia and Alabama State Children's Health Insurance Programs (SCHIPs) recently examined the impact on children's healthcare use of very different SCHIP structures in the two States. Many low-income children who were previously insured by Medicaid shifted to SCHIP when they lost Medicaid eligibility, while others were previously uninsured. Researchers compared children's use of care in SCHIP and Medicaid-covered populations in two different systems: one where all the children shared the same provider network and primary care case management (PCCM) system with the same Medicaid fee structure, and another where the SCHIP was structured as a fee-for-service (FFS) system using a private insurance provider network and fee schedule.

Researchers found more use of well-child care among Medicaid-covered children in programs where SCHIP and Medicaid Programs shared a PCCM system, but more use of office-based physician care among SCHIP-covered children. Between the Medicaid PCCM-based and the private insurance FFS-based system, they found more use of primary and specialty care in the FFS system. They found more use of well-child care and less use of emergency departments for nonurgent care in the PCCM-based system.

Analysis of other factors affecting use of care revealed that personal characteristics (for example, race, ethnicity, age, and sex), community level poverty, and health care provider proximity also had an independent influence on children's use of health care, no matter what type of health insurance they had. Health insurance is critical to ensure access to health care, but it is not sufficient for ensuring equivalent usage of care across covered populations, concludes Janet M. Bronstein, Ph.D., of the University of Alabama. Her study was supported in part by the Agency for Healthcare Research and Quality (HS10435).

See "SCHIP structure and children's use of care," by Dr. Bronstein, E. Kathleen Adams, Ph.D., and Curtis S. Florence, Ph.D., in the Summer 2006 Health Care Financing and Review 27(4), pp. 41-51.

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