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Health Care Costs and Financing

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CHIRI™ study finds that SCHIP benefits low-income children, and vulnerable children share in the improvements

The State Children's Health Insurance Program (SCHIP) in three States with separate, freestanding SCHIP programs increased vulnerable and other enrollees' access to and satisfaction with health care, according to a study from the Child Health Insurance Research Initiative (CHIRI™), funded by the Agency for Healthcare Research and Quality (HS10465, HS10536, and HS10450), The David and Lucile Packard Foundation, and the Health Resources and Services Administration. SCHIP was enacted in 1997 to provide health insurance coverage to low-income, uninsured children who lack private insurance but are ineligible for Medicaid.

Researchers in Florida, Kansas, and New York examined the impact of SCHIP on selected sub-groups of vulnerable low-income children: minorities, children and adolescents with special health care needs (CSHCN and ASHCN, respectively), and the long-term uninsured. These sub-groups represent a significant proportion of SCHIP enrollees.

The study found that among all new SCHIP enrollees, more children had a usual source of care (reaching levels as high as 98 percent in one State), had received a preventive visit (an 8 percent to 13 percent increase), and fewer children had unmet health care needs (a 12 percent to 43 percent reduction) as a result of being enrolled in SCHIP for 1 year. Families of new SCHIP enrollees were more satisfied with the health care their children received after enrollment as compared with before SCHIP. In spite of these gains, 19 percent to 28 percent of children and adolescents did not receive a preventive care visit while enrolled in SCHIP. Furthermore, 19 percent to 23 percent of children and adolescents still had unmet health care needs.

In order to determine the impact of SCHIP on vulnerable children, researchers examined whether being black or Hispanic, having a special health care need, or being long-term uninsured made a difference in the gains experienced by SCHIP enrollees. For the most part, vulnerable children shared in most of the SCHIP gains in access and satisfaction as compared to their counterparts with a few exceptions. For instance, Hispanic children did not experience a substantial increase in preventive visits after SCHIP enrollment.

SCHIP eliminated disparities between children and adolescents who were long-term uninsured and other enrollees. Although SCHIP minimized many racial/ethnic health care disparities, some disparities remained after SCHIP enrollment. The inability of SCHIP to fully eliminate these disparities was due to insufficient improvements for black and Hispanic children in areas where white children gained. Some vulnerable children—almost one-third of CSHCN and ASHCN—had substantial unmet needs after SCHIP enrollment.

The authors conclude that many vulnerable children experienced significant improvements in access to and satisfaction with their health care after enrolling in SCHIP and suggest several areas for further improvement. Given the high success rate of increasing children's access to a usual source of care, improvements could be made in other areas of access and quality such as ensuring smooth transitions to SCHIP and new providers. There is considerable opportunity to improve preventive care use for all SCHIP enrollees, particularly Hispanic children and adolescents. Finally, strategies to reduce unmet health care needs could be implemented, including conducting needs assessments, identifying CSHCN, changing reimbursement to reflect greater needs of some enrollees, expanding benefit packages, and arranging for wrap-around services (e.g., case management) from other programs and agencies.

More findings can be found in, "SCHIP impact in three States: How do the most vulnerable children fare?" by Andrew W. Dick, Cindy Brach, R. Andrew Allison, and others, in the September/October 2004 Health Affairs, 23(5):63-75.

Reprints (AHRQ Publication No. 04-R066) are available from the AHRQ Publications Clearinghouse.

A CHIRI™ Issue Brief, SCHIP's Impact on Vulnerable Children, highlighting key findings from the study for policymakers will be available in November.

Editor's Note: CHIRI™ provides policymakers with information to help them improve the quality of health care and access to care for low-income children. Select for additional CHIRI™ findings.

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