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

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2023-09-28 14:46:10 +00:00
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'
2023-10-01 08:15:07 +00:00
type: article
2023-09-28 14:46:10 +00:00
unique-id: WOS:000186957700006
usage-count-last-180-days: '0'
usage-count-since-2013: '5'
volume: '112'
web-of-science-categories: Pediatrics
year: '2003'