Evaluation of New York State's Child Health Plus: Access, utilization, quality of health care, and health status

Background. The recently enacted State Children's Health Insurance Program (SCHIP) is modeled after New York State's Child Health Plus (CHPlus) progra m. Since 1991, CHPlus has provided health insurance to children 0 to 13 yea rs old whose annual family income was below 222% of the federal poverty lev el and who were ineligible for Medicaid or did not have equivalent health i nsurance coverage. CHPlus covered the costs for ambulatory, emergency, and specialty care, and prescriptions, but not inpatient services. Objectives. To assess the change associated with CHPlus regarding 1) access to health care; 2) utilization of ambulatory, inpatient, and emergency ser vices; 3) quality of health care; and 4) health status. Setting. Six western New York State counties (including the city of Rochest er). Subjects. Children (0-6.99 years old) enrolled for at least 9 consecutive m onths in CHPlus. Methods. The design was a before-and-after study, comparing individual-leve l outcomes for the 12 months immediately before CHPlus enrollment and the 1 2 months immediately after enrollment in CHPlus. Parent telephone interview s and medical chart reviews conducted 12 months after enrollment to gather information. Subjects' primary care charts were located by using interview information; emergency department (ED) charts were identified by searching patient records at all 12 EDs serving children in the study; and health dep artment charts were identified by searching patient records at the 6 county health department clinics. Logistic regression and Poisson regression were used to compare the means of dependent measures with and without CHPlus co verage, while controlling for age, prior insurance type, and gap in insuran ce coverage before CHPlus. Results. Complete data were obtained for 1730 children. Coverage by CHPlus was associated with a significant improvement in access to care as measured by the proportion of children reported as having a usual source of care (p reventive care: +1.9% improvement during CHPlus and sick care: +2.7%). CHPl us was associated, among children 1 to 5 years old, with a significant incr ease in utilization of preventive care (+.23 visits/child/year) and sick ca re (+.91 visits/child/year) but no measurable change in utilization of spec ialty, emergency, or inpatient care. CHPlus was also associated, among chil dren 1 to 5 years old, with significantly higher immunization rates (up-to- date for immunizations: 76% vs 71%), and screening rates for anemia (+11% i ncreased proportion screened/year), lead (+9%), vision (+11%), and hearing (+7%). For 25% of the children, a parent reported that their child's health was improved as a result of having CHPlus. Conclusion. After enrollment in CHPlus, access to and utilization of primar y care increased, continuity of care improved, and many quality of care mea sures were improved while utilization of emergency and specialty care did n ot change. Many parents reported improved health status of their child as a result of enrollment in CHPlus. Implication. This evaluation suggests that SCHIP programs are likely to imp rove access to, quality of, and participation in primary care significantly and may not be associated with significant changes in specialty or emergen cy care.