Evaluation of New York State's Child Health Plus: Access, Utilization, Quality of Health Care, and Health Status

PEDIATRICS ◽  
2000 ◽  
Vol 105 (Supplement_E1) ◽  
pp. 711-718 ◽  
Author(s):  
Jane L. Holl ◽  
Peter G. Szilagyi ◽  
Lance E. Rodewald ◽  
Laura Pollard Shone ◽  
Jack Zwanziger ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
New York ◽  
Health Insurance ◽  
Health Status ◽  
Insurance Coverage ◽  
Health Department ◽  
Patient Records ◽  
Child Health Plus

Background. The recently enacted State Children's Health Insurance Program (SCHIP) is modeled after New York State's Child Health Plus (CHPlus) program. Since 1991, CHPlus has provided health insurance to children 0 to 13 years old whose annual family income was below 222% of the federal poverty level and who were ineligible for Medicaid or did not have equivalent health insurance coverage. CHPlus covered the costs for ambulatory, emergency, and specialty care, and prescriptions, but not inpatient services. Objectives. To assess the change associated with CHPlus regarding 1) access to health care; 2) utilization of ambulatory, inpatient, and emergency services; 3) quality of health care; and 4) health status. Setting. Six western New York State counties (including the city of Rochester). Subjects. Children (0–6.99 years old) enrolled for at least 9 consecutive months in CHPlus. Methods. The design was a before-and-after study, comparing individual-level outcomes for the 12 months immediately before CHPlus enrollment and the 12 months immediately after enrollment in CHPlus. Parent telephone interviews and medical chart reviews conducted 12 months after enrollment to gather information. Subjects' primary care charts were located by using interview information; emergency department (ED) charts were identified by searching patient records at all 12 EDs serving children in the study; and health department charts were identified by searching patient records at the 6 county health department clinics. Logistic regression and Poisson regression were used to compare the means of dependent measures with and without CHPlus coverage, while controlling for age, prior insurance type, and gap in insurance coverage before CHPlus. Results. Complete data were obtained for 1730 children. Coverage by CHPlus was associated with a significant improvement in access to care as measured by the proportion of children reported as having a usual source of care (preventive care: +1.9% improvement during CHPlus and sick care: +2.7%). CHPlus was associated, among children 1 to 5 years old, with a significant increase in utilization of preventive care (+.23 visits/child/year) and sick care (+.91 visits/child/year) but no measurable change in utilization of specialty, emergency, or inpatient care. CHPlus was also associated, among children 1 to 5 years old, with significantly higher immunization rates (up-to-date for immunizations: 76% vs 71%), and screening rates for anemia (+11% increased proportion screened/year), lead (+9%), vision (+11%), and hearing (+7%). For 25% of the children, a parent reported that their child's health was improved as a result of having CHPlus. Conclusion. After enrollment in CHPlus, access to and utilization of primary care increased, continuity of care improved, and many quality of care measures were improved while utilization of emergency and specialty care did not change. Many parents reported improved health status of their child as a result of enrollment in CHPlus. Implication. This evaluation suggests that SCHIP programs are likely to improve access to, quality of, and participation in primary care significantly and may not be associated with significant changes in specialty or emergency care.

Evaluation of New York State's Child Health Plus: Children Who Have Asthma

PEDIATRICS ◽  
2000 ◽  
Vol 105 (Supplement_E1) ◽  
pp. 719-727 ◽  
Author(s):  
Peter G. Szilagyi ◽  
Jane L. Holl ◽  
Lance E. Rodewald ◽  
Lorrie Yoos ◽  
Jack Zwanziger ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
Quality Of Care ◽  
Health Insurance ◽  
Acute Asthma ◽  
Insurance Coverage ◽  
Asthma Severity ◽  
Asthma Care ◽  
Uninsured Children

Background. Little is known about the impact of providing health insurance to uninsured children who have asthma or other chronic diseases. Objectives. To evaluate the association between health insurance and the utilization of health care and the quality of care among children who have asthma. Design. Before-and-during study of children for a 1-year period before and a 1-year period immediately after enrollment in a state-funded health insurance plan. Intervention. In 1991 New York State implemented Child Health Plus (CHPlus), a health insurance program providing ambulatory and ED (ED), but not hospitalization coverage for children 0 to 12.99 years old whose family incomes were below 222% of the federal poverty level and who were not enrolled in Medicaid. Subjects. A total of 187 children (2–12.99 years old) who had asthma and enrolled in CHPlus between November 1, 1991 and August 1, 1993. Main Outcome Measures. Rates of primary care visits (preventive, acute, asthma-specific), ED visits, hospitalizations, number of specialists seen, and quality of care measures (parent reports of the effect of CHPlus on quality of asthma care, and rates of recommended asthma therapies). The effect of CHPlus was assessed by comparing outcome measures for each child for the year before versus the year after CHPlus enrollment, controlling for age, insurance coverage before CHPlus, and asthma severity. Data Ascertainment. Parent telephone interviews and medical chart reviews at primary care offices, EDs, and public health clinics. Main Results. Visit rates to primary care providers were significantly higher during CHPlus compared with before CHPlus for chronic illness care (.995 visits before CHPlus vs 1.34 visits per year during CHPlus), follow-up visits (.86 visits vs 1.32 visits per year), total visits (5.69 visits vs 7.11 visits per year), and for acute asthma exacerbations (.61 visits vs 0.84 visits per year). There were no significant associations between CHPlus coverage and ED visits or hospitalizations, although specialty utilization increased (30% vs 40%; P = .02). According to parents, CHPlus reduced asthma severity for 55% of children (no change in severity for 44% and worsening severity for 1%). Similarly, CHPlus was reported to have improved overall health status for 45% of children (no change in 53% and worse in 1%), primarily attributable to coverage for office visits and asthma medications. CHPlus was associated with more asthma tune-up visits (48% before CHPlus vs 63% during CHPlus). There was no statistically significant effect of CHPlus on several other quality of care measures such as follow-up after acute exacerbations, receipt of influenza vaccination, or use of bronchodilators or antiinflammatory medications. Conclusions. Health insurance for uninsured children who have asthma helped overcome financial barriers that prevented children from receiving care for acute asthma exacerbations and for chronic asthma care. Health insurance was associated with increased utilization of primary care for asthma and improved parent perception of quality of care and asthma severity, but not with some quality indicators. Although more intensive interventions beyond health insurance are needed to optimize quality of asthma care, health insurance coverage substantially improves the health care for children who have asthma.

Evaluating Child Health Plus in Upstate New York: How Much Does Providing Health Insurance to Uninsured Children Increase Health Care Costs?

PEDIATRICS ◽  
2000 ◽  
Vol 105 (Supplement_E1) ◽  
pp. 728-732 ◽  
Author(s):  
Jack Zwanziger ◽  
Dana B. Mukamel ◽  
Peter G. Szilagyi ◽  
Sarah Trafton ◽  
Andrew W. Dick ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
New York ◽  
Health Insurance ◽  
Care Utilization ◽  
Average Change ◽  
Uninsured Children ◽  
Primary Care Utilization ◽  
Care Costs ◽  
Child Health Plus

Background. In response to the increase in the number of American children without health insurance, new federal and state programs have been established to expand health insurance coverage for children. However, the presence of insurance reduces the price of care for families participating in these programs and stimulates the use of medical services, which leads to an increase in health care costs. In this article, we identified the additional expenditures associated with the provision of health insurance to previously uninsured children. Methods. We estimated the expenditures on additional services using data from a study of children living in the Rochester, New York, area who were enrolled in the New York State Child Health Plus (CHPlus) program. CHPlus was designed specifically for low-income children without health insurance who were not eligible for Medicaid. The study sample consisted of 1910 children under the age of 6 who were initially enrolled in CHPlus between November 1, 1991 and August 1, 1993 and who had been enrolled for at least 9 continuous months. We used medical chart reviews to determine the level of primary care utilization, parent interviews for demographic information, as well as specialty care utilization, and we used claims data submitted to CHPlus for the year after enrollment to calculate health care expenditures. Using this information, we estimated a multivariate regression model to compute the average change in expenditures associated with a unit of utilization for a cross-section of service types while controlling for other factors that independently influenced total outpatient expenditures. Results. Expenditures for outpatient services were closely related to primary care utilization—more utilization tended to increase expenditures. Age and the presence of a chronic condition both affected expenditures. Children with chronic conditions and infants tended to have more visits, but these visits were, on average, less expensive. Applying the average change in expenditures to the change in utilization that resulted from the presence of insurance, we estimated that the total increase in expenditures associated with CHPlus was $71.85 per child in the year after enrollment, or a 23% increase in expenditures. The cost increase was almost entirely associated with the provision of primary care. Almost three-quarters of the increase in outpatient expenditures was associated with increased acute and well-child care visits. Conclusions. CHPlus was associated with a modest increase in expenditures, mostly from additional outpatient utilization. Because the additional primary care provided to young children often has substantial long-term benefits, the relatively modest expenditure increases associated with the provision of insurance may be viewed as an investment in the future.

Evaluation of Children's Health Insurance: From New York State's Child Health Plus to SCHIP

PEDIATRICS ◽  
2000 ◽  
Vol 105 (Supplement_E1) ◽  
pp. 687-691 ◽  
Author(s):  
Peter G. Szilagyi ◽  
Jane L. Holl ◽  
Lance E. Rodewald ◽  
Laura Pollard Shone ◽  
Jack Zwanziger ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
New York ◽  
Quality Of Care ◽  
Health Insurance ◽  
Child Health ◽  
Children's Health ◽  
Children’S Health ◽  
Uninsured Children

Background.  The legislation and funding of the State Children's Health Insurance Program (SCHIP) in 1997 resulted in the largest public investment in child health care in 30 years. The program was designed to provide health insurance for the estimated 11 million uninsured children in the United States. In 1991 New York State implemented a state-funded program—Child Health Plus (CHPlus)—intended to provide health insurance for uninsured children who were ineligible for Medicaid. The program became one of the prototypes for SCHIP. This study was designed to measure the association between CHPlus and access to care, utilization of care, quality of care, and health care costs to understand the potential impact of one type of prototype SCHIP program. Methods. The study took place in the 6-county region of upstate New York around and including the city of Rochester. A before-and-during design was used to compare children's health care for the year before they enrolled in CHPlus versus the first year during enrollment in CHPlus. The study included 1828 children (ages 0–6.99 years at enrollment) who enrolled between November 1, 1991 and August 1, 1993. A substudy involved 187 children 2 to 12.99 years old who had asthma. Data collection involved: 1) interviews of parents to obtain information about demographics, sources of health care, experience and satisfaction with CHPlus, and perceived impact of CHPlus; 2) medical chart reviews at all primary care offices, emergency departments, and health department clinics in the 6-county region to measure utilization of health services; 3) claims analysis to assess costs of care during CHPlus and to impute costs before CHPlus; and 4) analyses of existing datasets including the Current Population Survey, National Health Interview Survey, and statewide hospitalization datasets to anchor the study in relation to the statewide CHPlus population and to assess secular trends in child health care. Logistic regression and Poisson regression were used to compare the means of dependent measures with and without CHPlus coverage, while controlling for age, prior insurance type, and gap in insurance coverage before CHPlus. Results. Enrollment: Only one third of CHPlus-eligible children throughout New York State had enrolled in the program by 1993. Lower enrollment rates occurred among Hispanic and black children than among white children, and among children from lowest income levels. Profile of CHPlus Enrollees: Most enrollees were either previously uninsured, had Medicaid but were no longer eligible, or had parents who either lost a job and related private insurance coverage or could no longer afford commercial or private insurance. Most families heard about CHPlus from a friend, physician, or insurer. Television, radio, and newspaper advertisements were not major sources of information. Nearly all families had at least 1 employed parent. Two thirds of the children resided in 2-parent households. Parents reported that most children were in excellent or good health and only a few were in poor health. The enrolled population was thus a relatively low-risk, generally healthy group of children in low-income, working families. Access and Utilization of Health Care: Utilization of primary care increased dramatically after enrollment in CHPlus, compared with before CHPlus. Visits to primary care medical homes for preventive, acute, and chronic care increased markedly. Visits to medical homes also increased for children with asthma. There was, however, no significant association between enrollment in CHPlus and changes in utilization of emergency departments, specialty services, or inpatient care. Quality of Care: CHPlus was associated with improvements in many measures involving quality of primary care, including preventive visits, immunization rates, use of the medical home for health care, compliance with preventive guidelines, and parent-reported health status of the child. For children with asthma, CHPlus was associated with improvements in several indicators of quality of care such as asthma tune-up visits, parental perception of asthma severity, and parent-reported quality of asthma care. Health Care Costs: Enrollment in CHPlus was associated with modest additional health care expenditures in the short term—$71.85 per child per year—primarily for preventive and acute care services delivered in primary care settings. Conclusions. Overall, children benefited substantially from enrollment in CHPlus. For a modest short-term cost, children experienced improved access to primary care, which translated into improved utilization of primary care and use of medical homes. Children also received higher quality of health care, and parents perceived these improvements to be very important. Nevertheless, CHPlus was not associated with ideal quality of care, as evidenced by suboptimal immunization rates and receipt of preventive or asthma care even during CHPlus coverage. Thus, interventions beyond health insurance are needed to achieve optimal quality of health care. This study implemented methods to evaluate the association between enrollment in a health insurance program and children's health care. These methods may be useful for additional evaluations of SCHIP. Implications: Based on this study of the CHPlus experience, it appears that millions of uninsured children in the United States will benefit substantially from SCHIP programs.

The Role of Race and Ethnicity in the State Children’s Health Insurance Program (SCHIP) in Four States: Are There Baseline Disparities, and What Do They Mean for SCHIP?

PEDIATRICS ◽  
2003 ◽  
Vol 112 (Supplement_E1) ◽  
pp. e521-e532
Author(s):  
Laura P. Shone ◽  
Andrew W. Dick ◽  
Cindy Brach ◽  
Kim S. Kimminau ◽  
Barbara J. LaClair ◽  
...  
Keyword(s):  
Health Care ◽  
New York ◽  
Health Insurance ◽  
Health Status ◽  
Race And Ethnicity ◽  
Minority Groups ◽  
Ethnic Disparities ◽  
Racial And Ethnic Disparities ◽  
Hispanic Children ◽  
White Children

Background. Elimination of racial and ethnic disparities in health has become a major national goal. The State Children’s Health Insurance Program (SCHIP) has the potential to reduce disparities among the children who enroll if they exhibit the same disparities that have been documented in previous studies of low-income children. To determine the potential impact of SCHIP on racial and ethnic disparities, it is critical to assess baseline levels of health disparities among children enrolling in SCHIP. Objective. To use data from the Child Health Insurance Research Initiative (CHIRI) to 1) describe the sociodemographic profile of new enrollees in SCHIP in Alabama, Florida, Kansas, and New York; 2) determine if there were differences in health insurance and health care experiences among white, black, and Hispanic SCHIP enrollees before enrollment in SCHIP; and 3) explore whether race or ethnicity, controlled for other factors, affected pre-SCHIP access to health coverage and health care. Setting. SCHIP programs in Alabama, Florida, Kansas, and New York, which together include 26% of SCHIP enrollees nationwide. Design. Telephone interview (mailed survey in Alabama) about the child’s health, health insurance, and health care experiences conducted shortly after SCHIP enrollment to assess experience during the time period before SCHIP. Sample. New SCHIP enrollees (0–17.9 years old in Alabama, Kansas, and New York and 11.5–17.9 years old in Florida). Stratified sampling was performed in Kansas and New York, with results weighted to reflect statewide populations of new SCHIP enrollees. Measures. Sociodemographic characteristics including income, education, employment, and other characteristics of the child and the family, race and ethnicity (white non-Hispanic, black non-Hispanic, and Hispanic [any race]), prior health insurance, health care access and utilization, and health status. Analyses. Bivariate analyses were used to compare baseline measures upon enrollment for white, black, and Hispanic SCHIP enrollees. Multivariate analyses were performed to assess health status and health care access measures (prior insurance, presence of a usual source of care (USC), and use of preventive care), controlling for demographic factors described above. Weighted analyses (where appropriate) were performed by using SPSS, STATA, or SUDAAN. Results. Racial and ethnic composition varied across the SCHIP cohorts studied, with black and Hispanic children comprising the following proportion of enrollees, respectively: Alabama, 33% and <1%; Florida, 16% and 26%; Kansas, 12% and 15%; and New York, 24% and 36%. Black and Hispanic children were more likely to reside in single-parent and lower-income families. With some variation by state, children from minority groups were more likely to report poorer health status than were white children. Relative to white children, children from minority groups in Florida and New York were more likely to have been uninsured for the entire year before SCHIP enrollment. In all states, children from minority groups who had prior coverage were more likely to have previously been enrolled in Medicaid than in private health insurance and were less likely to have had employer-sponsored coverage compared with white children. Except in Alabama, there was a difference in having a USC, with children from minority groups less likely to have had a USC before SCHIP enrollment compared with white children. No consistent pattern of health care utilization before SCHIP was noted across states with respect to race or ethnicity. Findings from multivariate analyses, controlling for sociodemographic factors, generally confirmed that black and Hispanic children were more likely to have lacked insurance or a USC before enrollment in SCHIP and to have poorer health status compared with white children. Conclusions. SCHIP is enrolling substantial numbers of racial and ethnic minority children. There are baseline racial and ethnic disparities among new enrollees in SCHIP, with black and Hispanic children faring worse than white children on many sociodemographic and health system measures, and there are differences among states in the prevalence and magnitude of these disparities. After controlling for sociodemographic factors, these disparities persisted. Implications for Monitoring and Improving SCHIP. SCHIP has the potential to play a critical role in efforts to eliminate racial and ethnic disparities in health among the children it serves. However, study findings indicate that programmatic efforts are necessary to ensure that disparities are not perpetuated. Program effectiveness and outcomes should be monitored by race and ethnicity to ensure equity in access, use, and outcomes across all racial and ethnic groups. Assessing the health characteristics and needs of new SCHIP enrollees can provide a benchmark for evaluating the program’s impact on eliminating racial and ethnic disparities in health and inform service delivery enhancements.

Family-Based Health Insurance for Informal Sector Workers in Vietnam: Why Does Enrolment Remain Low?

2018 ◽  
Vol 30 (8) ◽  
pp. 699-707 ◽  
Author(s):  
Nguyen Thi Thuy Nga ◽  
Gerard FitzGerald ◽  
Michael Dunne
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Insurance ◽  
Informal Sector ◽  
Health Care Services ◽  
Insurance Coverage ◽  
Social Health Insurance ◽  
Primary Health ◽  
Family Based

Providing financial protection to the whole population is a top health policy priority of many countries. However, expanding social health insurance coverage to the “informal sector worker” is a challenge in many developing countries. This study analyzed the reasons for the limited coverage of health insurance for informal sector workers. Direct interviews were carried out with 391 uninsured households in Vietnam, followed by in-depth interviews with 11 key stakeholders. The study offers several possible explanations for the low enrollment in family-based health insurance scheme at both the demand and supply sides, such as inability to pay the premium, lack of information, perceived poor quality of primary health care services, and complicated enrollment procedures. The study suggests that a partial government subsidy and improvement in the quality of primary health care are crucial strategies for health insurance expansion for the informal sector workers and their families.

scholarly journals Quantifying Overinsurance Tied to the Tax Exclusion for Employment-Based Health Insurance and Its Variation by Health Status

2019 ◽  
Vol 56 ◽  
pp. 004695801989385
Author(s):  
Bradley Herring ◽  
Erin Trish
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Status ◽  
Expected Utility ◽  
Low Income ◽  
Health Care Services ◽  
Medical Expenditure Panel Survey ◽  
Insurance Coverage ◽  
Medical Expenditure ◽  
Health Care Spending

The exclusion of employment-based health insurance from income and payroll taxes is thought to increase the generosity of insurance coverage and, in turn, increase the overutilization of low-value health care services. We examine this inefficiency of overinsurance by quantifying the change in expected utility across 4 benchmark plans varying in actuarial value (AV) and focus on the distribution of each of these estimates across different groups of people varying in health status. Specifically, we quantify the changes in health care spending due to moral hazard and the changes in uncertainty tied to risk aversion using data from the nationally representative sample of adults with employment-based coverage from the 2007-2016 Medical Expenditure Panel Survey, and produce estimates of expected utility for 24 groups of people based on their age, gender, and preexisting conditions. Our model suggests an average preferred AV of 78% without the tax exclusion, with 29.0% of the population preferring a 60% AV, 6.5% preferring a 70% AV, 18.1% preferring an 80% AV, and 46.4% preferring a 90% AV. When incorporating the distortionary effect of the employment-based tax exclusion, the preferred plan increases to an 83% AV for low-income people (with 71.0% of the population preferring a 90% AV) and an 84% AV for high-income people (with 76.0% of the population preferring a 90% AV). We estimate that policy changes to make subsidies independent of a plan’s AV could result in increases in utility equal to about 2.7% of total health care spending, but with those net gains concentrated among the healthy.

scholarly journals Health, United States, 2019

2021 ◽  
Author(s):  
Renee Gindi ◽  
Keyword(s):  
United States ◽  
Health Care ◽  
Health Insurance ◽  
Health Status ◽  
Insurance Coverage ◽  
Health Care Expenditures ◽  
The United States ◽  
Care Utilization ◽  
Personal Health ◽  
Health Statistics

Health, United States, 2019 is the 43rd report on the health status of the nation and is submitted by the Secretary of the Department of Health and Human Services to the President and the Congress of the United States in compliance with Section 308 of the Public Health Service Act. This report was compiled by the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC). The Health, United States series presents an annual overview of national trends in key health indicators. The 2019 report presents trends and current information on selected measures of morbidity, mortality, health care utilization and access, health risk factors, prevention, health insurance, and personal health care expenditures in a 20-figure chartbook. The Health, United States, 2019 Chartbook is supplemented by several other products including Trend Tables, an At-a-Glance table, and Appendixes available for download on the Health, United States website at: https://www.cdc.gov/nchs/hus/ index.htm. The Health, United States, 2019 Chartbook contains 20 figures and 20 tables on health and health care in the United States. Examining trends in health informs the development, implementation, and evaluation of health policies and programs. The first section (Figures 1–13) focuses on health status and determinants: life expectancy, infant mortality, selected causes of death, overdose deaths, suicide, maternal mortality, teen births, preterm births, use of tobacco products, asthma, hypertension, heart disease and cancer, and functional limitations. The second section (Figures 14–15) presents trends in health care utilization: use of mammography and colorectal tests and unmet medical needs. The third section (Figures 16–17) focuses on health care resources: availability of physicians and dentists. The fourth section (Figures 18–20) describes trends in personal health care expenditures, health insurance coverage, and supplemental insurance coverage among Medicare beneficiaries. The Highlights section summarizes major findings from the Chartbook. Suggested citation: National Center for Health Statistics. Health, United States, 2019. Hyattsville, MD. 2021.

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