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AHCPR, Packard Foundation, and HRSA award $9.1 million for studies on improving health care for low-income children

The Agency for Health Care Policy and Research, the David and Lucile Packard Foundation, and the Health Resources and Services Administration (HRSA) are supporting a group of research studies to help public health insurance programs and health care delivery systems improve health care quality and access to care for low-income children. The new projects were announced October 12 by President Clinton. Overall funding will total $9.1 million over 3 years for nine research projects.

According to 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, 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. SCHIP 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.

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 other publicly subsidized health insurance. 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 white children.

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 delivery systems with various insurance and organizational features. The coordinating committee will receive guidance from a users' group made up 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, use of, and satisfaction with health services. Two substudies, one of black 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, IL; $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, MA; $872,321; 9/30/99-9/29/02.

This study will compare access to, satisfaction with, and the 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, DC; $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, AHCPR's Medical Expenditure Panel Survey (MEPS), and the Area Resource File to model the impact of key benefit features on low-income children's access to and use of health care.

Evaluation of Kansas Healthwave. Principal investigator: Robert St. Peter, M.D., Kansas Health Institute, Topeka, KS; $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, use, and insurance status, including children who remain uninsured. This study will include a special focus on the vulnerable populations of rural, urban black, and Hispanic children.

Access and Quality of Care for Low-Income Adolescents. Principal investigator: Elizabeth Shenkman, Ph.D., University of Florida, Gainesville, FL; $920,191; 9/30/99-9/29/02.

This study will focus on 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 white youths.

Health Care Access, Quality, and Insurance for CSHCN. Principal investigator: Nancy Swigonski, Ph.D., Indiana University, Indianapolis, IN; $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, NY; $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, use, 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, MI; $667,369; 9/30/99-9/29/02.

This study will investigate the impact of a voluntary managed care program for children with special health care needs on Medicaid-eligible children.

Editor's Note: 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 and families, communities, conservation, and the arts.

HRSA, AHCPR's sister agency, is a component of the U.S. Public Health Service. HRSA directs health programs to improve the health of the nation by assuring quality health care to underserved, vulnerable, and special-need populations and by promoting appropriate practices and capacity in the health professions workforce, particularly in primary care and public health.

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