201 lines
6.4 KiB
YAML
201 lines
6.4 KiB
YAML
abstract: 'Background. The State Children''s Health Insurance Program ( SCHIP) has
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been operating for > 5 years. Policy makers are interested in the
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characteristics of children who have enrolled and changes in the health
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care needs of enrolled children as programs mature. New York State''s
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SCHIP evolved from a similar statewide health insurance program that was
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developed in 1991 ( Child Health Plus {[} CHPlus]). Understanding how
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current SCHIP enrollees differ from early CHPlus enrollees together with
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how program features changed during the period may shed light on how
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best to serve the evolving SCHIP population.
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Objective. To 1) describe changes in the characteristics of children
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enrolled in 1994 CHPlus and 2001 SCHIP; 2) determine if changes in the
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near- poor, age- eligible population during the time period could
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account for the evolution of enrollment; and 3) describe changes in the
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program during the period that could be responsible for the enrollment
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changes.
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Setting. New York State, stratified into 4 regions: New York City, New
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York City environs, upstate urban counties, and upstate rural counties.
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Design. Retrospective telephone interviews of parents of 2 cohorts of
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CHPlus enrollees: 1) children who enrolled in CHPlus in 1993 to 1994 and
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2) children who enrolled in New York''s SCHIP in 2000 to 2001. The
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Current Population Survey ( CPS) 1992 to 1994 and 1999 to 2001 were used
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to identify secular trends that could explain differences in the CHPlus
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and SCHIP enrollees.
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Program Characteristics. 1994 CHPlus and 2001 SCHIP were similar in
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design, both limiting eligibility by age, family income, and insurance
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status. SCHIP 2001 included 1) expansion of eligibility to adolescents
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13 to 19 years old; 2) expansion of benefits to include
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hospitalizations, mental health, and dental benefits; 3) changes in
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premium contributions; 4) more participating insurance plans, limited to
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managed care; 5) expansions in marketing and outreach; and 6) a combined
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enrollment application for SCHIP and several low- income programs
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including Medicaid.
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Sample. Cohort 1 included 2126 new CHPlus enrollees 0 to 13 years old
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who were enrolled for at least 9 months, stratified by geographic
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region. Cohort 2 included 1100 new SCHIP enrollees 0 to 13 years old who
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were enrolled for at least 9 months, stratified by geographic region,
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age, race, and ethnicity. Results were weighted to be representative of
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statewide CHPlus or SCHIP new enrollees who met the sampling criteria.
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Samples of age- and income- eligible children from New York State were
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drawn from the CPS and pooled and reweighted ( 1992 - 1994 and 1999 -
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2001) to generate a comparison group of children targeted by CHPlus and
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SCHIP.
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Measures. Sociodemographic characteristics, race and ethnicity ( white
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non- Hispanic, black non- Hispanic, and Hispanic), prior health
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insurance, health care access, and first source of information about the
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program.
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Analyses. Weighted bivariate analyses ( comparisons of means and rates)
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adjusted for the complex sampling design to compare measures between the
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2 program cohorts and between the 2 CPS samples. We tested for
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equivalence by using chi(2) statistics.
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Results. As the program evolved from CHPlus to SCHIP, relatively more
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black and Hispanic children enrolled ( 9\% to 30\% black from 1994 to
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2001, and 16\% to 48\% Hispanic), more New York City residents ( 46\% to
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69\% from 1994 to 2001), more children with parents who had less than a
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high school education ( 10\% to 25\%), more children from lower income
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families ( 59\% to 75\% below 150\% of the federal poverty level), and
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more children from families with parents not working ( 7\% to 20\%)
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enrolled. These socioeconomic and demographic changes were not reflected
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in the underlying age- and income-eligible population. A greater
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proportion of 2001 enrollees were uninsured for some time immediately
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before enrollment ( 57\% to 76\% had an uninsured gap), were insured by
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Medicaid during the year before enrollment ( 23\% to 48\%), and lacked a
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USC ( 5\% to 14\%). Although `` word of mouth{''''} was the most common
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means by which families heard about both programs, a greater proportion
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of 2001 enrollees learned about SCHIP from marketing or outreach
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sources.
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Conclusion. As New York programs for the uninsured evolved, more
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children from minority groups, with lower family incomes and education,
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and having less baseline access to health care were enrolled. Although
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changes in the underlying population were relatively small,
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progressively increased marketing and outreach, particularly in New York
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City, the introduction of a single application form for SCHIP and
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Medicaid, and expansions in the benefit package may have accounted, in
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part, for the large change in the characteristics of enrollees.'
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affiliation: 'Dick, AW (Corresponding Author), Univ Rochester, Sch Med \& Dent, Dept
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Community \& Prevent Med, Div Hlth Serv Res \& Policy, 601 Elmwood Ave, Rochester,
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NY 14642 USA.
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Univ Rochester, Sch Med \& Dent, Dept Community \& Prevent Med, Div Hlth Serv Res
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\& Policy, Rochester, NY 14642 USA.
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Univ Rochester, Sch Med \& Dent, Dept Pediat, Strong Childrens Res Ctr, Rochester,
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NY 14642 USA.
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Univ Illinois, Chicago, IL USA.'
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author: Dick, AW and Klein, JD and Shone, LP and Zwanziger, J and Yu, H and Szilagyi,
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PG
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author-email: adick@rochester.rr.com
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author_list:
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- family: Dick
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given: AW
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- family: Klein
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given: JD
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- family: Shone
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given: LP
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- family: Zwanziger
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given: J
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- family: Yu
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given: H
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- family: Szilagyi
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given: PG
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da: '2023-09-28'
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eissn: 1098-4275
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files: []
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issn: 0031-4005
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journal: PEDIATRICS
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keywords: 'access to health care; health insurance; children; New York State;
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disparities; race; ethnicity; SCHIP'
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keywords-plus: MEDICARE; SELECTION; CARE; HMOS
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language: English
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month: DEC
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number: 6, S
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number-of-cited-references: '42'
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orcid-numbers: Klein, Jonathan/0000-0003-4185-1998
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pages: E542-E550
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papis_id: 57fc181267dc75d7d35082336451978c
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ref: Dick2003evolutionstate
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times-cited: '16'
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title: 'The evolution of the State Children''s Health Insurance Program (SCHIP) in
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New York: Changing program features and enrollee characteristics'
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type: article
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unique-id: WOS:000186957700006
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usage-count-last-180-days: '0'
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usage-count-since-2013: '5'
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volume: '112'
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web-of-science-categories: Pediatrics
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year: '2003'
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