Effects of the State Children's Health Insurance Program Expansions on Children With Chronic Health Conditions

Abstract

ABSTRACT. Objective. To estimate the effects of the State Children's Health Insurance Program (SCHIP) expansions on insurance coverage, use of health care services, and access to care for children with chronic health conditions.Methods. The primary source of data was the National Health Interview Survey. Children with chronic health conditions were identified primarily through reported diagnoses of common chronic conditions (eg, asthma, attention-deficit disorder, mental retardation, Down syndrome, cerebral palsy, muscular dystrophy, sickle cell disease, diabetes, arthritis, heart disease) and on the presence of activity limitations caused by a health problem lasting at least 12 months. We examined changes in a broad array of outcomes for children with chronic health conditions who gained eligibility under SCHIP or who were already eligible for coverage under Medicaid, comparing the periods before and after implementation of the program. Changes for these treatment groups were compared with children with slightly higher incomes, who should not have been affected by the eligibility expansions. Comparisons were made with adjustment for child, family, and other characteristics that might have independent effects on the outcomes of interest. Outcomes included health insurance coverage, use of general and specialty services, access to care, and out-ofpocket spending on health care. Selected analyses were conducted for children not identified as having chronic health conditions.Results. The SCHIP expansions resulted in a 9.8 percentage point increase in the proportion of children with chronic conditions reporting public insurance and a 6.4 percentage point decline in the proportion uninsured. Unmet need for health care decreased by 8 percentage points, with most of the decline found for dental care. Increases in specialist, eye care, and dental visits and decreases in out-of-pocket spending and emergency-department and mental health visits were observed but did not meet standards of statistical significance. Estimated reductions in unmet need were greater for children with chronic conditions than for other children.Conclusions. Recent expansions in public insurance eligibility under SCHIP have improved coverage for children with chronic conditions, with selected improvements in access to care. However, some eligible children with chronic conditions remain uninsured, and the impact on access to care and service use were limited. Additional progress may require targeted outreach to children with chronic conditions and improvements in Medicaid and SCHIP service-delivery systems. Given the current fiscal environment and the fact that children with chronic conditions have not generally been protected from cutbacks, the recent progress documented in this study may be reversed. Pediatrics 2005;116:e34-e42. URL: www.pediatrics.org/cgi

The Effect of the Children’s Health Insurance Program on Pediatricians’ Work Hours

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Who And Where Are The Children Yet To Enroll In Medicaid And The Children’s Health Insurance Program?

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Coverage, Utilization, and Health Outcomes of the State Children's Health Insurance Program

“…The first strand of the literature has approached the problem by examining the connection between eligibility expansions and utilization. Studies in this group have investigated either a single measure of utilization, such as immunization (Joyce and Racine 2005), or examined one group of children (e.g., children with special needs, such as in Davidoff, Kenney, and Dubay 2005, or elementary school students, as in Cullen, DeCicca, and Volden 2005). Findings have been mixed on the utilization impacts of SCHIP and Medicaid in this group of studies.…”