wow-inequalities/02-data/intermediate/wos_sample/7d91f6e13fe0b23f2ae4d589db1005fe-brach-c-and-lewit/info.yaml

282 lines
9.1 KiB
YAML
Raw Normal View History

2023-09-28 14:46:10 +00:00
abstract: 'Background. The State Children''s Health Insurance Program ( SCHIP) was
enacted in 1997 to provide health insurance coverage to uninsured
low-income children from families who earned too much to be eligible for
Medicaid.
Objectives. To develop a `` baseline{''''} portrait of SCHIP enrollees in
5 states ( Alabama, Florida, Kansas, Indiana, and New York) by
examining: 1) SCHIP enrollees'' demographic characteristics and health
care experiences before enrolling in SCHIP, particularly children with
special health care needs ( CSHCN), racial and ethnic minority children,
and adolescents; 2) the quality of the care adolescents received before
enrollment; and 3) the changes in enrollee characteristics as programs
evolve and mature.
Methods. Each of 5 projects from the Child Health Insurance Research
Initiative ( CHIRI) surveyed new SCHIP enrollees as identified by state
enrollment data. CHIRI investigators developed the CHIRI common core ( a
set of survey items from validated instruments), which were largely
incorporated into each survey. Bivariate and multivariate analyses were
conducted to ascertain whether there were racial and ethnic disparities
in access to health care and differences between CSHCN and those
without. Current Population Survey data for New York State were used to
identify secular trends in enrollee characteristics.
Results. Most SCHIP enrollees ( 65\% in Florida to 79\% in New York)
resided in families with incomes less than or equal to 150\% of the
federal poverty level. Almost half of SCHIP enrollees lived in single-
parent households. A majority of SCHIP parents had not had education
beyond high school, and in 2 states ( Alabama and New York) similar to
25\% had not completed high school. The vast majority of children lived
in households with a working adult, and in a substantial proportion of
households both parents worked. Children tended to be either insured for
the entire 12 months or uninsured the entire 12 months before enrolling
in SCHIP. Private insurance was the predominant form of insurance before
enrollment in SCHIP in most states, but 23.3\% to 51.2\% of insured
children had Medicaid as their most recent insurance.
Health Care Use and Unmet Needs Before SCHIP. The vast majority of all
SCHIP enrollees had a usual source of care ( USC) during the year before
SCHIP. The proportion of children who changed their USC after enrolling
in SCHIP ranged from 29\% to 41.3\%. A large proportion of SCHIP
enrollees used health services during the year before SCHIP, with some
variability across states in the use of health care. Nevertheless, 32\%
to almost 50\% of children reported unmet needs.
CSHCN. The prevalence of CSHCN in SCHIP ( between 17\% and 25\%) in the
study states was higher than the prevalence of CSHCN reported in the
general population in those states. In many respects, CSHCN were similar
to children without special health care needs, but CSHCN had poorer
health status, were more likely to have had unmet needs, and were more
likely to use the emergency department, mental health care, specialty
care, and acute care in the year before enrolling in SCHIP than children
without special health care needs.
Race and Ethnicity. A substantial proportion of SCHIP enrollees were
black non- Hispanic or Hispanic children ( Alabama: 34\% and < 1\%;
Florida: 6\% and 26\%; Kansas: 12\% and 15\%; and New York: 31\% and
45\%, respectively). Minority children were poorer, in poorer health,
and less likely to have had a USC or private insurance before enrolling
in SCHIP. The prevalence and magnitude of the disparities varied among
the states.
Quality of Care for Adolescents. Seventy- three percent of adolescent
SCHIP enrollees engaged in one or more risk behaviors ( ie, feeling sad
or blue; alcohol, tobacco, and drug use; having sexual intercourse; and
not wearing seat belts). Although almost 70\% of adolescents reported
having had a preventive care visit the previous year, a majority of them
did not receive counseling in each of 4 counseling areas. Controlling
for other factors, having a private, confidential visit with the
physician was associated with an increased likelihood ( 2 - 3 times more
likely) that the adolescent received counseling for 3 of 4 counseling
areas.
Trends Over Time. New York SCHIP enrollees in 2001, compared with 1994
enrollees in New York''s SCHIP- precursor child health insurance program,
were more likely to be black or Hispanic, older, from New York City, and
from families with lower education, income, and employment levels. A
greater proportion of 2001 enrollees was uninsured for some time in the
year before enrollment, was insured by Medicaid, and lacked a USC.
Secular trends in the low- income population in the state did not seem
to be responsible for these differences. Program modifications during
this time period that may be related to the shift in enrollee
characteristics include changes to benefits, outreach and marketing
efforts, changes in the premium structure, and the advent of a single
application form for multiple public programs.
Conclusions. SCHIP enrollees are a diverse group, and there was
considerable variation among the 5 study states. Overall, SCHIP
enrollees had substantial and wide- ranging health care needs despite
high levels of prior contact with the health care system. A sizable
minority of SCHIP enrollees has special health care needs. There is
racial and ethnic diversity in the composition of enrollees as well,
with racial and ethnic disparities present. The quality of care
adolescents received before enrollment in SCHIP was suboptimal, with
many reporting unmet health care needs and not receiving recommended
counseling. The characteristics of SCHIP enrollees can be expected to
change as SCHIP programs evolve and mature.
Policy Implications. 1) Benefits should be structured to meet the needs
of SCHIP enrollees, which are comparable to Medicaid enrollees'' needs in
many respects. 2) Provider networks will have to be broad if continuity
of care is to be achieved. 3) Multiple outreach strategies should be
used, including using providers to distribute information about SCHIP.
4) The quality of care delivered to vulnerable populations ( eg,
minority children, CSHCN, and adolescents) should be monitored. 5)
States and health plans should actively promote quality health care with
the goal of improving the care received by SCHIP enrollees before
enrollment. 6) States will have to craft policies that fit their local
context. 7) Collecting baseline information on SCHIP enrollees on a
continuous basis is important, because enrollee characteristics and
needs can change, and many vulnerable children are enrolling in SCHIP.'
affiliation: 'Brach, C (Corresponding Author), Agcy Healthcare Res \& Qual, Ctr Delivery
Org \& Markets, 540 Gaither Rd, Rockville, MD 20850 USA.
Agcy Healthcare Res \& Qual, Ctr Delivery Org \& Markets, Rockville, MD 20850 USA.
David \& Lucile Packard Fdn, Los Altos, CA USA.
Agcy Healthcare Res \& Qual, Arlington Hts, IL USA.
Univ Alabama Birmingham, Birmingham, AL USA.
Univ Rochester, Sch Med \& Dent, Dept Community \& Prevent Med, Rochester, NY USA.
Kansas Hlth Inst, Topeka, KS USA.
Univ Florida, Inst Child Hlth Policy, Gainesville, FL USA.
Univ Rochester, Sch Med \& Dent, Dept Pediat, Rochester, NY 14642 USA.
Indiana Univ, Sch Med, Dept Pediat, Indianapolis, IN 46202 USA.
Indiana Univ, Sch Med, Dept Med, Indianapolis, IN 46202 USA.'
author: Brach, C and Lewit, EM and VanLandeghem, K and Bronstein, J and Dick, AW and
Kimminau, KS and LaClair, B and Shenkman, E and Shone, LP and Swigonski, N and Szilagyi,
PG
author-email: cbrach@ahrq.gov
author_list:
- family: Brach
given: C
- family: Lewit
given: EM
- family: VanLandeghem
given: K
- family: Bronstein
given: J
- family: Dick
given: AW
- family: Kimminau
given: KS
- family: LaClair
given: B
- family: Shenkman
given: E
- family: Shone
given: LP
- family: Swigonski
given: N
- family: Szilagyi
given: PG
da: '2023-09-28'
eissn: 1098-4275
files: []
issn: 0031-4005
journal: PEDIATRICS
keywords: 'access; children; children with special health care needs; disparities;
enrollment; ethnicity; insurance; Medicaid; minorities; quality; race;
State Children''s Health Insurance Program'
keywords-plus: 'AMBULATORY-CARE; UNITED-STATES; ACCESS; IMPACT; NEEDS; IDENTIFICATION;
ETHNICITY; RACE'
language: English
month: DEC
number: 6, S
number-of-cited-references: '45'
orcid-numbers: Brach, Cindy/0000-0003-3600-8402
pages: E499-E507
papis_id: 45c96dda9472cb0861b5fdb35c6c459f
ref: Brach2003whosenrolled
times-cited: '41'
title: Who's enrolled in the State Children's Health Insurance Program (SCHIP)? An
overview of findings from the Child Health Insurance Research Initiative (CHIRI)
2023-10-01 08:15:07 +00:00
type: article
2023-09-28 14:46:10 +00:00
unique-id: WOS:000186957700002
usage-count-last-180-days: '0'
usage-count-since-2013: '3'
volume: '112'
web-of-science-categories: Pediatrics
year: '2003'