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Evaluation of New York State's Child Health Plus: children who have asthma
P G Szilagyi1, J L Holl, L E Rodewald
1Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA. peter_szilagyi@urmc.rochester.edu
Insights
Providing health insurance to uninsured children with asthma increased primary care visits and improved perceived quality of care. This coverage helped overcome financial barriers, leading to better asthma management and health status for these children.
Area of Science:
- Pediatric Health
- Health Services Research
- Chronic Disease Management
Background:
- Limited understanding of health insurance impact on uninsured children with chronic conditions like asthma.
- Asthma is a prevalent chronic disease in childhood, requiring consistent medical care.
Purpose of the Study:
- To evaluate the association between health insurance and healthcare utilization and quality for children with asthma.
- To assess the impact of a state-funded insurance program on pediatric asthma care.
Main Methods:
- A before-and-during study design evaluated 187 children with asthma enrolled in Child Health Plus (CHPlus).
- Data collected via parent interviews and medical chart reviews over a 1-year period before and after enrollment.
- Compared rates of primary care visits, emergency department visits, hospitalizations, and quality of care measures.
Main Results:
- CHPlus enrollment significantly increased primary care visits for chronic illness, follow-ups, and acute asthma exacerbations.
- Specialty care utilization increased, but no significant changes were observed in emergency department visits or hospitalizations.
- Parents reported reduced asthma severity and improved overall health status, linked to office visits and medication coverage.
Conclusions:
- Health insurance for uninsured children with asthma overcomes financial barriers, enhancing access to care.
- Increased primary care utilization and improved perceived quality of care were associated with insurance coverage.
- While insurance improves overall care, additional interventions are needed to optimize all quality indicators for pediatric asthma management.
Background:
Little is known about the impact of providing health insurance to uninsured children who have asthma or other chronic diseases.
Objectives:
To evaluate the association between health insurance and the utilization of health care and the quality of care among children who have asthma.
Design:
Before-and-during study of children for a 1-year period before and a 1-year period immediately after enrollment in a state-funded health insurance plan.
Intervention:
In 1991 New York State implemented Child Health Plus (CHPlus), a health insurance program providing ambulatory and ED (ED), but not hospitalization coverage for children 0 to 12.99 years old whose family incomes were below 222% of the federal poverty level and who were not enrolled in Medicaid.
Subjects:
A total of 187 children (2-12.99 years old) who had asthma and enrolled in CHPlus between November 1, 1991 and August 1, 1993.
Main Outcome Measures:
Rates of primary care visits (preventive, acute, asthma-specific), ED visits, hospitalizations, number of specialists seen, and quality of care measures (parent reports of the effect of CHPlus on quality of asthma care, and rates of recommended asthma therapies). The effect of CHPlus was assessed by comparing outcome measures for each child for the year before versus the year after CHPlus enrollment, controlling for age, insurance coverage before CHPlus, and asthma severity. DATA ASCERTAINMENT: Parent telephone interviews and medical chart reviews at primary care offices, EDs, and public health clinics.
Main Results:
Visit rates to primary care providers were significantly higher during CHPlus compared with before CHPlus for chronic illness care (.995 visits before CHPlus vs 1.34 visits per year during CHPlus), follow-up visits (.86 visits vs 1.32 visits per year), total visits (5.69 visits vs 7.11 visits per year), and for acute asthma exacerbations (.61 visits vs 0.84 visits per year). There were no significant associations between CHPlus coverage and ED visits or hospitalizations, although specialty utilization increased (30% vs 40%; P =.02). According to parents, CHPlus reduced asthma severity for 55% of children (no change in severity for 44% and worsening severity for 1%). Similarly, CHPlus was reported to have improved overall health status for 45% of children (no change in 53% and worse in 1%), primarily attributable to coverage for office visits and asthma medications. CHPlus was associated with more asthma tune-up visits (48% before CHPlus vs 63% during CHPlus). There was no statistically significant effect of CHPlus on several other quality of care measures such as follow-up after acute exacerbations, receipt of influenza vaccination, or use of bronchodilators or antiinflammatory medications.
Conclusions:
Health insurance for uninsured children who have asthma helped overcome financial barriers that prevented children from receiving care for acute asthma exacerbations and for chronic asthma care. Health insurance was associated with increased utilization of primary care for asthma and improved parent perception of quality of care and asthma severity, but not with some quality indicators. Although more intensive interventions beyond health insurance are needed to optimize quality of asthma care, health insurance coverage substantially improves the health care for children who have asthma.