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PEDIATRICS Vol. 111 No. 4 April 2003, pp. 735-740

The First 2 Years of a State Child Health Insurance Plan: Whom Are We Reaching?

Allison Kempe, MD, MPH*, Brenda Renfrew, MSPH*, Jennifer Barrow, MSPH{ddagger}, Darci Cherry, MPH§, Arnold Levinson, PhD|| and John F. Steiner, MD, MPH

* Departments of Pediatrics and Preventive Medicine and Biometrics and University of Colorado HSC, Denver, Colorado, and the Children’s Outcomes Research Program, Children’s Hospital, Denver, Colorado
{ddagger} Child Health Advocates, Denver, Colorado
§ Department of Public Health and the Environment, Denver, Colorado
|| AMC Cancer Research Center, Denver, Colorado
Department of General Internal Medicine and Colorado Health Outcomes Program, University of Colorado HSC, Denver, Colorado

--> Objective. The Colorado Child Health Plan Plus is a non-Medicaid state Child Health Insurance Plan. The objective of this study was to compare early enrolling (EE) children with uninsured children in low-income families (ULI) with respect to 1) sociodemographic factors and previous insurance, 2) health status, and 3) previous health care access and utilization.

Methods. Cross-sectional telephone surveys were conducted during 1999 of 1) randomly selected EE children (n = 711) and 2) ULI children identified by random-dial survey (n = 105).

Results. Enrolling children were less likely to be Hispanic (32.7% vs 55.2%); 5.5% of EE versus 27.6% of ULI children had never been insured. Prevalence of chronic conditions was similar (16.2% of EE vs 13.5% of ULI children), but learning/behavioral difficulties (9.7% of EE vs 18.6% of ULI) and fair/poor health (5.4% of EE vs 17.2% of ULI) were higher for uninsured children. In the previous year, 88.2% of EE versus 66.1% of ULI children had a usual source of care. The mean number of preventive visits was similar (1.4 vs 1.2), but the EE group reported a higher mean number of sick visits (2.0 vs 1.1), emergency visits (0.48 vs 0.15), and hospitalizations (0.09 vs 0.02).

Conclusions. In the first 2 years of the program, Child Health Plan Plus is not yet reaching the "hard-to-reach" but, rather, disproportionately high numbers of non-Hispanic children who already have a usual source of care and recent insurance. EE children did not have higher rates of chronic conditions but did demonstrate higher utilization before enrollment, possibly reflecting patterns of enrollment into the program.

Key Words: health insurance • state child health insurance plan • health care access

Abbreviations: CHIP, Children’s Health Insurance Program • CHP+, Child Health Plan Plus • EE, early enrolling • ULI, uninsured low-income • BRFSS, Behavioral Risk Factor Surveillance System

Received for publication Apr 17, 2002; Accepted Sep 25, 2002.




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