Numerous studies indicate that uninsured children have poorer access to health care and poorer quality of care than insured children. However, few studies have examined the impact and benefits of providing health insurance to low-income children. Recent findings from the Child Health Insurance Research Initiative (CHIRI™) project in New York indicate that enrollment in the State Children's Health Insurance Program (SCHIP) improved enrollees' access, continuity, and quality of health care. SCHIP was enacted in 1997 to provide health insurance coverage to low-income, uninsured children who lack private insurance but are ineligible for Medicaid.
Researchers compared demographic and health measures for a group of children (0-18 years of age enrolled in New York SCHIP for the first time) prior to enrollment in SCHIP and 1 year after enrollment. At the time of the study, New York's SCHIP program encompassed 18 percent of SCHIP enrollees nationwide. Nearly one-third of children in the study were non-Hispanic blacks, and almost half were Hispanic. Over 80 percent of enrollees' families had an income less than 160 percent of the Federal poverty level. Nearly two-thirds of children were uninsured for 12 months or more before enrolling in SCHIP. Of those who were insured before SCHIP enrollment, 43 percent had been enrolled in Medicaid.
Researchers found that among New York SCHIP enrollees, the program decreased the proportion of enrollees who did not have a usual source of care (from 14 percent to 3 percent), decreased the proportion of enrollees with any unmet health care needs (31 percent to 19 percent), and reduced unmet need for specific types of care (specialty care, 16 percent), acute and preventive care (10 percent each), and dental and vision care (13 percent each). Enrollment in SCHIP increased the proportion of children with a preventive visit (74 percent to 82 percent) with no significant changes in the number of emergency, specialty, and acute care visits.
The type of usual source of care (USC) sought by enrollees remained nearly constant before and after SCHIP enrollment. Doctor's offices (42 vs. 41 percent), neighborhood health centers (20 vs. 27 percent), and hospital clinics (21 vs. 22 percent) were the main sites for primary care before and after SCHIP enrollment. However, among children with a usual source of care, nearly one-quarter changed their primary care physician shortly after SCHIP enrollment. Surprisingly, this shift did not result in enrollees moving from neighborhood health centers to private doctor's offices. Indeed, neighborhood health centers were the only practice type that experienced statistically significant gains following SCHIP enrollment.
Enrollment in SCHIP also improved children's continuity of care. The proportion of children who used their usual source of care for most or all visits nearly doubled (from 47 percent to 89 percent). In addition, quality of care increased—families gave a higher rating to the benefits and medical care that they received after SCHIP enrollment compared with before enrollment. The authors conclude that enrollment in SCHIP improved the coordination and receipt of primary care, resulting in greater family satisfaction.
This research was supported in part by the Agency for Healthcare Research and Quality (HS10450). The CHIRI™ initiative is cosponsored by AHRQ, the David and Lucile Packard Foundation, and the Health Resources and Services Administration.
See "Improved access and quality of care after enrollment in the New York State Children's Health Insurance Program (SCHIP)," by Peter G. Szilagyi, M.D., M.P.H., Andrew W. Dick, Ph.D., Jonathan D. Klein, M.D., M.P.H., and others in the May 2004 Pediatrics electronic pages 113e(113), pp. e395-e404.
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