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Changes in access, utilization, and quality of care after enrollment into a state child health insurance plan
Allison Kempe1, Brenda L Beaty, Lori A Crane
1Department of Pediatrics, University of Colorado Health Sciences Center, and the Children's Outcomes Research Program, Children's Hospital, Denver, Colorado, USA. kempe.allison@tchden.org
Insights
Enrollment in Colorado
Area of Science:
- Pediatric Health Services Research
- Public Health Policy
- Health Services Administration
Background:
- Limited data exist on the impact of State Children's Health Insurance Programs (SCHIP) on pediatric health outcomes.
- Colorado's Child Health Plan Plus (CHP+) is a non-Medicaid SCHIP initiated in April 1998.
Purpose of the Study:
- To evaluate the effect of CHP+ enrollment on children's access to care, healthcare utilization, and quality of care.
- To compare reported outcomes in the year preceding and the first year following CHP+ enrollment.
Main Methods:
- Telephone interviews were conducted with 480 randomly selected families enrolled in CHP+.
- Data were collected two months post-enrollment and again one year later.
- Generalized linear models were used to analyze the impact of enrollment, controlling for demographic and insurance factors.
Main Results:
- Families reported significantly improved access to routine, sick, and specialty care, with increased ability to see providers promptly.
- Unmet medical needs decreased across prescription medications, mental health services, dental care, and vision care.
- While routine care utilization increased, emergency department visits and hospitalizations did not, indicating efficient care seeking.
- Perceived quality of care rated as "best" significantly increased post-enrollment.
Conclusions:
- CHP+ enrollment led to substantial improvements in perceived access to care and reductions in unmet medical needs for children.
- The program demonstrated effective care management, with no increase in emergency or inpatient utilization.
- Overall quality of care was perceived as improved by families after enrolling in CHP+.
Background:
There currently are few published data evaluating the effect of State Children's Health Insurance Programs on health care outcome measures in children. Colorado's Child Health Plan Plus (CHP+) is a non-Medicaid State Children's Health Insurance Program that began enrollment in April 1998. The objectives of this study were to compare reported (1) access to care, (2) utilization of health care, and (3) quality of care during the year before and the first year after enrollment into CHP+.
Methods:
We interviewed 480 randomly selected families by telephone 2 months after their first enrollment into CHP+ (September 1999 to January 2000) and, again, 1 year later. We used generalized linear models to examine the effect of enrollment on health care access, utilization, and quality while controlling for type of previous insurance, length of time uninsured before enrollment, race/ethnicity, and age.
Results:
Regarding access to care, the percentage of families who reported a usual site of preventive care did not change significantly, but families reported more often being able to see providers as soon as desired for routine care (incidence ratio [IR]: 2.03; 95% confidence interval [CI]: 1.37-3.02]), for care when sick or injured (IR: 2.77; 95% CI: 1.85-4.16), for specialty care (IR: 1.96; 95% CI: 1.16-3.32), and for all health care (IR: 2.35; 95% CI: 1.81-3.07). Unmet medical needs decreased after versus before enrollment for prescription medications (IR: 0.38; 95% CI: 0.26-0.55), mental health care (IR: 0.63; 95% CI: 0.40-0.97), prescription glasses (IR: 0.44; 95% CI: 0.29-0.65), and dental care (IR: 0.59; 95% CI: 0.47-0.76). Regarding utilization, the proportion who saw a provider for routine care in the past year increased (IR: 1.39; 95% CI: 1.06-1.83), but reported visits for sick, specialty, and emergency department care and hospitalizations did not increase. Regarding quality of care, the proportion who rated their health care as "best" increased (RI: 1.31; 95% CI: 1.04-1.66) after versus before enrollment.
Conclusions:
Families who were newly enrolled into CHP+ perceived dramatic increases in access to all types of care and decreases in unmet medical needs, no increase in utilization of emergency department or hospitalization services, and improved overall quality of care in the year after enrollment into CHP+.
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