Evaluating the state children's health insurance program: Critical considerations

The Balanced Budget Act of August 1997 was intended to improve the insuranc e coverage of low-income children. Although no specific mandates for evalua tion accompanied the legislation, states are expected to assess its impact. Insurance improves access to and use of health services. The extent to whi ch this is associated with better health depends on the kinds of services r eceived. Access to a regular source of care is a critical characteristic. I f this source of care provides good primary care, a variety of benefits wou ld be expected to accrue. Thus, evaluation of the benefits of the State Chi ldren's Health Insurance Program should address not only improved coverage by health insurance for eligible children, but also the extent to which chi ldren receive high-quality primary care, including appropriate referrals wh en needed. Maternal access to and use of services is also a critical factor . Targets for evaluation include state activities to (a) enroll through out reach, inform through education, and develop information systems for tracki ng; (b) assess the degree of penetration of insurance among low-income chil dren and their mothers, the availability of health care personnel, and the adequacy of benefits conferred by the insurance, primary-care services, and back-up specialty services; and (c) obtain evidence of improved health sta tus. This article details approaches that can appropriately be used to addr ess each of these aspects of concern.