Child/Adolescent Health

Enrollment in New York's State Children's Health Insurance Program improves asthma care quality and access

Low-income and minority children suffer the greatest burden of childhood asthma. They are also less likely to receive asthma care that prevents asthma episodes from leading to emergency department visits and hospitalizations. Enrollment of these children in New York's State Children's Health Insurance Program (SCHIP) was associated with improvements in access to asthma care, the quality of asthma care, and asthma-specific outcomes.

The SCHIP provides health insurance coverage to low-income children who are neither eligible for Medicaid nor covered by private health insurance. In this study, supported in part by the Agency for Healthcare Research and Quality (HS10450), 14 percent of 2,644 children had asthma when their parents were interviewed by telephone shortly after SCHIP enrollment, and 16 percent of 2,310 children had asthma at the follow-up interview a year later. After enrollment in SCHIP, the number of children lacking a usual source of care (USC) decreased from 5 to 1 percent, unmet health needs decreased from 48 to 21 percent, and problems getting to the USC for asthma dropped from 13 to 4 percent. Also, children had fewer asthma-related attacks (a decline from an average of 9.5 to 3.8), medical visits (3.0 to 1.5), and hospitalizations (11 to 3 percent).

Finally, the quality of asthma care improved for general measures. The number of children who made most or all of their visits to their USC rose from 53 to 94 percent and the average rating of the provider rose from 7.9 to 8.8. Quality of care for asthma-specific measures improved as well. Problems getting to the USC for asthma care when the child was well declined from 13 to 1 percent. At followup interviews, more than two-thirds of parents reported that both quality of asthma care and asthma severity were "better or much better" than at baseline. They attributed this to SCHIP insurance coverage or lower costs of medications and medical care.

More details are in "Improved asthma care after enrollment in the state children's health insurance program in New York," by Peter G. Szilagy, M.D., M.P.H., Andrew W. Dick, Ph.D., Jonathan D. Klein, M.D., M.P.H., and others in the February 2006 Pediatrics 117(2), pp. 486-496.

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