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Assessing SCHIP effects using household survey data: promises and pitfalls.

L Dubay, G Kenney

    Health Services Research
    |September 9, 2005
    PubMed
    Summary

    Household surveys can assess the State Children's Health Insurance Program (SCHIP) effects. Careful analysis, including accurate eligibility modeling and consistent data collection, is crucial for reliable SCHIP impact evaluation.

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    Area of Science:

    • Public Health
    • Health Services Research
    • Survey Methodology

    Background:

    • The State Children's Health Insurance Program (SCHIP) aimed to expand health coverage for low-income children.
    • Assessing the impact of large-scale public health programs like SCHIP presents unique methodological challenges.
    • Household surveys are a primary data source for evaluating such programs, but their effective use requires careful consideration of potential biases.

    Purpose of the Study:

    • To outline the utility of household surveys in evaluating SCHIP's effects.
    • To identify and discuss methodological issues inherent in using household survey data for program evaluation.
    • To propose solutions and best practices for addressing these methodological challenges.

    Main Methods:

    • Utilizing detailed simulation models to accurately identify SCHIP-eligible children.

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  • Employing longitudinal analysis using consistent survey data from pre- and post-SCHIP periods.
  • Addressing potential biases from simplified eligibility criteria and underreporting of public health insurance coverage.

    • Main Results:

    • Inaccurate identification of SCHIP-eligible children, particularly those with incomes between 100-200% of poverty, leads to downward biased estimates of SCHIP's effect.
    • Using the same survey instrument across pre- and post-SCHIP periods is essential for reliable impact estimation.
    • Underreporting of public health insurance coverage and the maturity of the program are critical factors to consider in evaluation.

    Conclusions:

    • Household surveys, despite inherent challenges, are indispensable for evaluating SCHIP's impact.
    • Careful methodological design, including accurate eligibility ascertainment and consistent data collection, is vital for generating valid insights.
    • Rigorous evaluation using household surveys provides information unobtainable through other means.