wow-inequalities/02-data/intermediate/wos_sample/176a25a89925292a0c3978274571acd7-dick-aw-and-klein/info.yaml

abstract: 'Background. The State Children''s Health Insurance Program ( SCHIP) has

  been operating for > 5 years. Policy makers are interested in the

  characteristics of children who have enrolled and changes in the health

  care needs of enrolled children as programs mature. New York State''s

  SCHIP evolved from a similar statewide health insurance program that was

  developed in 1991 ( Child Health Plus {[} CHPlus]). Understanding how

  current SCHIP enrollees differ from early CHPlus enrollees together with

  how program features changed during the period may shed light on how

  best to serve the evolving SCHIP population.

  Objective. To 1) describe changes in the characteristics of children

  enrolled in 1994 CHPlus and 2001 SCHIP; 2) determine if changes in the

  near- poor, age- eligible population during the time period could

  account for the evolution of enrollment; and 3) describe changes in the

  program during the period that could be responsible for the enrollment

  changes.

  Setting. New York State, stratified into 4 regions: New York City, New

  York City environs, upstate urban counties, and upstate rural counties.

  Design. Retrospective telephone interviews of parents of 2 cohorts of

  CHPlus enrollees: 1) children who enrolled in CHPlus in 1993 to 1994 and

  2) children who enrolled in New York''s SCHIP in 2000 to 2001. The

  Current Population Survey ( CPS) 1992 to 1994 and 1999 to 2001 were used

  to identify secular trends that could explain differences in the CHPlus

  and SCHIP enrollees.

  Program Characteristics. 1994 CHPlus and 2001 SCHIP were similar in

  design, both limiting eligibility by age, family income, and insurance

  status. SCHIP 2001 included 1) expansion of eligibility to adolescents

  13 to 19 years old; 2) expansion of benefits to include

  hospitalizations, mental health, and dental benefits; 3) changes in

  premium contributions; 4) more participating insurance plans, limited to

  managed care; 5) expansions in marketing and outreach; and 6) a combined

  enrollment application for SCHIP and several low- income programs

  including Medicaid.

  Sample. Cohort 1 included 2126 new CHPlus enrollees 0 to 13 years old

  who were enrolled for at least 9 months, stratified by geographic

  region. Cohort 2 included 1100 new SCHIP enrollees 0 to 13 years old who

  were enrolled for at least 9 months, stratified by geographic region,

  age, race, and ethnicity. Results were weighted to be representative of

  statewide CHPlus or SCHIP new enrollees who met the sampling criteria.

  Samples of age- and income- eligible children from New York State were

  drawn from the CPS and pooled and reweighted ( 1992 - 1994 and 1999 -

  2001) to generate a comparison group of children targeted by CHPlus and

  SCHIP.

  Measures. Sociodemographic characteristics, race and ethnicity ( white

  non- Hispanic, black non- Hispanic, and Hispanic), prior health

  insurance, health care access, and first source of information about the

  program.

  Analyses. Weighted bivariate analyses ( comparisons of means and rates)

  adjusted for the complex sampling design to compare measures between the

  2 program cohorts and between the 2 CPS samples. We tested for

  equivalence by using chi(2) statistics.

  Results. As the program evolved from CHPlus to SCHIP, relatively more

  black and Hispanic children enrolled ( 9\% to 30\% black from 1994 to

  2001, and 16\% to 48\% Hispanic), more New York City residents ( 46\% to

  69\% from 1994 to 2001), more children with parents who had less than a

  high school education ( 10\% to 25\%), more children from lower income

  families ( 59\% to 75\% below 150\% of the federal poverty level), and

  more children from families with parents not working ( 7\% to 20\%)

  enrolled. These socioeconomic and demographic changes were not reflected

  in the underlying age- and income-eligible population. A greater

  proportion of 2001 enrollees were uninsured for some time immediately

  before enrollment ( 57\% to 76\% had an uninsured gap), were insured by

  Medicaid during the year before enrollment ( 23\% to 48\%), and lacked a

  USC ( 5\% to 14\%). Although `` word of mouth{''''} was the most common

  means by which families heard about both programs, a greater proportion

  of 2001 enrollees learned about SCHIP from marketing or outreach

  sources.

  Conclusion. As New York programs for the uninsured evolved, more

  children from minority groups, with lower family incomes and education,

  and having less baseline access to health care were enrolled. Although

  changes in the underlying population were relatively small,

  progressively increased marketing and outreach, particularly in New York

  City, the introduction of a single application form for SCHIP and

  Medicaid, and expansions in the benefit package may have accounted, in

  part, for the large change in the characteristics of enrollees.'
affiliation: 'Dick, AW (Corresponding Author), Univ Rochester, Sch Med \& Dent, Dept
  Community \& Prevent Med, Div Hlth Serv Res \& Policy, 601 Elmwood Ave, Rochester,
  NY 14642 USA.

  Univ Rochester, Sch Med \& Dent, Dept Community \& Prevent Med, Div Hlth Serv Res
  \& Policy, Rochester, NY 14642 USA.

  Univ Rochester, Sch Med \& Dent, Dept Pediat, Strong Childrens Res Ctr, Rochester,
  NY 14642 USA.

  Univ Illinois, Chicago, IL USA.'
author: Dick, AW and Klein, JD and Shone, LP and Zwanziger, J and Yu, H and Szilagyi,
  PG
author-email: adick@rochester.rr.com
author_list:
- family: Dick
  given: AW
- family: Klein
  given: JD
- family: Shone
  given: LP
- family: Zwanziger
  given: J
- family: Yu
  given: H
- family: Szilagyi
  given: PG
da: '2023-09-28'
eissn: 1098-4275
files: []
issn: 0031-4005
journal: PEDIATRICS
keywords: 'access to health care; health insurance; children; New York State;

  disparities; race; ethnicity; SCHIP'
keywords-plus: MEDICARE; SELECTION; CARE; HMOS
language: English
month: DEC
number: 6, S
number-of-cited-references: '42'
orcid-numbers: Klein, Jonathan/0000-0003-4185-1998
pages: E542-E550
papis_id: 57fc181267dc75d7d35082336451978c
ref: Dick2003evolutionstate
times-cited: '16'
title: 'The evolution of the State Children''s Health Insurance Program (SCHIP) in
  New York: Changing program features and enrollee characteristics'
type: article
unique-id: WOS:000186957700006
usage-count-last-180-days: '0'
usage-count-since-2013: '5'
volume: '112'
web-of-science-categories: Pediatrics
year: '2003'