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

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)
type: article
unique-id: WOS:000186957700002
usage-count-last-180-days: '0'
usage-count-since-2013: '3'
volume: '112'
web-of-science-categories: Pediatrics
year: '2003'