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The State Children's Health Insurance Program can improve care access, use, and quality for children with special health care needs and adolescents

The State Children's Health Insurance Program (SCHIP) provides health insurance coverage to low-income children and youth who are neither eligible for Medicaid nor covered by private health insurance. In two separate studies supported by the Agency for Healthcare Research and Quality (AHRQ grant HS10450), researchers found that SCHIP improves the care of children with special health care needs (CSHCN) and for adolescents enrolled in the New York SCHIP. A third AHRQ-supported study (HS10463 and HS10465) found that many adolescents newly enrolled in the Florida and New York SCHIP reported unmet health care needs, disparities in care access, and suboptimal care prior to SCHIP enrollment. The three studies are summarized here.

Szilagyi, P.G., Shone, L.P., Klein, J.D., and others (2007, January). "Improved health care among children with special health care needs after enrollment into the State Children's Health Insurance Program." Ambulatory Pediatrics 7(1), pp. 10-17.
Based on interviews with parents, 17 percent of 2,290 children enrolled in New York's SCHIP had special health care needs. Peter G. Szilagyi, M.D., M.P.H., and University of Rochester School of Medicine and Dentistry colleagues compared CSHCN's access to care and quality of care 1 year before and 1 year during SCHIP enrollment.

Enrollment in SCHIP was generally associated with improved access to care. Unmet needs for prescription medications declined 3-fold for all subgroups (for example, from 36 to 9 percent among previously uninsured children). Also, unmet needs for specialty care declined more than 4-fold among CSHCN who were previously insured (48 to 10 percent) or had mental/behavioral conditions (32 to 2 percent).

SCHIP enrollment was also associated with improved continuity of care. CSHCN enrolled in SCHIP were more likely to have a usual source of care and better parent-reported quality of care and less worry, irrespective of prior insurance or the child's type of chronic condition. The study was part of a larger evaluation of CSHCN who enrolled in New York's SCHIP between 2001 and 2002.

The researchers identified CSHCN by need for use of prescribed medications (72 percent of CSHCN), followed by needing or using more medical, mental health, or educational services (45 percent), having an emotional, developmental, or behavioral problem that needs treatment (28 percent), limitations in ability to engage in age-appropriate activities (23 percent), and needing or getting special therapy (13 percent).

More than half of the children had been uninsured for all 12 months prior to SCHIP, and of those with any prior insurance, about half had Medicaid. About one-fifth were deemed less healthy than other children.

Klein, J.D., Shone, L.P., Szilagyi, P.G., and others (2007, April). "Impact of the State Children's Health Insurance Program on adolescents in New York." Pediatrics 119(4), pp. e885-e892.
Among New York youth, 70 percent of whom were uninsured before enrollment, SCHIP insurance was associated with greater access to a usual source of care; more use of preventive care, specialty care, and prescription medications; and fewer unmet care needs. SCHIP also seemed to eliminate preexisting racial disparities in care access.

Researchers from the University of Rochester School of Medicine and Dentistry interviewed by telephone a random sample of adolescents who were new enrollees in the New York SCHIP and their parents shortly after enrollment and 1 year later. About 17 percent more adolescents reported having a usual source of care during SCHIP (87.1) than before (69.9 percent).

The proportion of those with any unmet health care need diminished from 54.3 to 42.1 percent and the proportion of those with unmet need for preventive care shrunk from 53.8 to 40.6 percent. After SCHIP enrollment, more teens reported having had a preventive care visit (74.2 vs. 65.9 percent), yet emergency department use did not change.

Also, parents worried less about their adolescents' health during SCHIP enrollment, even though neither teens nor their parents reported any changes in teens' health status. Both adolescents and parents reported improved quality of care. Slightly more than half of teens and parents reported that teens had an opportunity to speak privately with their provider.

They also reported more preventive counseling on several health topics. Nevertheless, there is room for improvement, with over 40 percent of adolescents still reporting some unmet health care need after SCHIP enrollment.

Klein, J.D., Shenkman, E., Brach, C., and others (2006, November). "Prior health care experiences of adolescents who enroll in SCHIP." Journal of Health Care for the Poor and Underserved 17, pp. 789-807.
A study of adolescent State Children's Health Insurance Program (SCHIP) enrollees in Florida and New York States found that most new enrollees were 12 to 16 years old, black or Hispanic, and lived in poverty. Nearly three-fourths were without health insurance the year before SCHIP.

Despite high rates of health care use, 25 percent of Florida SCHIP adolescents and over 40 percent of New York SCHIP adolescents reported having unmet health care needs (especially dental care) during the year before SCHIP. One in five U.S. adolescents had at least one serious illness or handicap, with impoverished minority youth most at risk for health problems.

Nearly 6 percent of surveyed adolescents in Florida and nearly 12 percent in New York reported fair or poor health status, particularly Hispanic youths. Also, 12 percent of adolescents in Florida and 18 percent of those in New York reported special health care needs. Minority adolescents were more likely than their white counterparts to describe themselves as being in poor or fair health, to have been uninsured the entire year, to have been previously covered by Medicaid, and not to have had a usual source of care.

The quality of care received prior to SCHIP enrollment was also suboptimal. States may need to enhance outreach and enrollment efforts to insure older adolescents and design programs and benefits to meet the substantial "catch-up" health needs of newly enrolled adolescents, note the researchers.

The study was based on data from Child Health Insurance Research Initiative (CHIRI) surveys of new SCHIP adolescent enrollees and their parents in Florida and New York. Reprints (AHRQ Publication No. 07-R032) are available from the AHRQ Publications Clearinghouse.

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