Evaluation of a state health insurance program for low-income children: Implications for State Child Health Insurance Programs

Background. The State Child Health Insurance Program (SCHIP) is the largest public investment in child health care in 30 years, targeting 11 million u ninsured children, yet little is known about the impact of health insurance on uninsured children. In 1991, New York State implemented Child Health Pl us (CHPlus), a health insurance program that became a model for SCHIP. Objective. To examine changes in access to care, utilization of services, a nd quality of care among children enrolled in CHPlus. Design. A pre-post design was used to evaluate the health care experiences of children in the year before enrollment in CHPlus and during the year aft er CHPlus enrollment. Setting. New York State, stratified into 4 regions: New York City, urban co unties around New York City, upstate urban counties, and upstate rural coun ties. Participants. A total of 2126 children (0-12.99 years of age) who enrolled in CHPlus in 1992-1993. Data Collection. Parents were interviewed by telephone, and primary care me dical charts were reviewed for 694 children (0-3.99 years of age). Analysis. Access, utilization, and quality of care measures for each child were compared for the year before and the year after CHPlus enrollment, con trolling for age, geographic region, previous insurance coverage, and CHPlu s plan type (indemnity or managed care). Results. Enrollment in CHPlus was associated with fewer children lacking a medical home (5% before CHPlus vs 1% during CHPlus), with the greatest chan ge occurring in New York City (11% vs 1%), where access before CHPlus was l owest. CHPlus was also associated with increased primary care visits: by 25 % for preventive visits, by 52% for acute visits, and by 42% for total visi ts. The number of specialists seen during CHPlus was more than twice as hig h than before CHPlus. CHPlus was not associated with changes in emergency d epartment utilization, although hospitalizations, which were not covered by CHPlus, were 36% lower during CHPlus coverage. Use of public health depart ments for immunizations declined by 64%, with more immunizations delivered in the medical home during CHPlus coverage. One third of parents reported i mproved quality of health care for their child as a result of CHPlus, and v irtually none noted worse quality of care. Conclusions. This statewide health insurance program for low-income childre n was associated with improved access, utilization, and quality of care, su ggesting that SCHIP has the potential to improve health care for low-income American children.