Tags

Type your tag names separated by a space and hit enter

Evaluation of New York State's Child Health Plus: access, utilization, quality of health care, and health status.
Pediatrics. 2000 Mar; 105(3 Suppl E):711-8.Ped

Abstract

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.

Authors+Show Affiliations

Children's Memorial Hospital, Department of Pediatrics and Institute for Health Services, Research and Policy Studies, Northwestern University School of Medicine, Chicago, Illinois 60611, USA. j-holl@nwu.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10699149

Citation

Holl, J L., et al. "Evaluation of New York State's Child Health Plus: Access, Utilization, Quality of Health Care, and Health Status." Pediatrics, vol. 105, no. 3 Suppl E, 2000, pp. 711-8.
Holl JL, Szilagyi PG, Rodewald LE, et al. Evaluation of New York State's Child Health Plus: access, utilization, quality of health care, and health status. Pediatrics. 2000;105(3 Suppl E):711-8.
Holl, J. L., Szilagyi, P. G., Rodewald, L. E., Shone, L. P., Zwanziger, J., Mukamel, D. B., Trafton, S., Dick, A. W., Barth, R., & Raubertas, R. F. (2000). Evaluation of New York State's Child Health Plus: access, utilization, quality of health care, and health status. Pediatrics, 105(3 Suppl E), 711-8.
Holl JL, et al. Evaluation of New York State's Child Health Plus: Access, Utilization, Quality of Health Care, and Health Status. Pediatrics. 2000;105(3 Suppl E):711-8. PubMed PMID: 10699149.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of New York State's Child Health Plus: access, utilization, quality of health care, and health status. AU - Holl,J L, AU - Szilagyi,P G, AU - Rodewald,L E, AU - Shone,L P, AU - Zwanziger,J, AU - Mukamel,D B, AU - Trafton,S, AU - Dick,A W, AU - Barth,R, AU - Raubertas,R F, PY - 2000/3/4/pubmed PY - 2000/3/18/medline PY - 2000/3/4/entrez SP - 711 EP - 8 JF - Pediatrics JO - Pediatrics VL - 105 IS - 3 Suppl E N2 - 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. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/10699149/Evaluation_of_New_York_State's_Child_Health_Plus:_access_utilization_quality_of_health_care_and_health_status_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=10699149 DB - PRIME DP - Unbound Medicine ER -