Published online February 1, 2005
PEDIATRICS Vol. 115 No. 2 February 2005, pp. 364-371 (doi:10.1542/peds.2004-0475)
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Changes in Access, Utilization, and Quality of Care After Enrollment Into a State Child Health Insurance Plan

Allison Kempe, MD, MPH*, Brenda L. Beaty, MSPH{ddagger}, Lori A. Crane, PhD, MPH§, Johan Stokstad, MHS||, Jennifer Barrow, MSPH||, Shira Belman, MD, MSPH* and John F. Steiner, MD, MPH{ddagger},¶

* Department of Pediatrics, University of Colorado Health Sciences Center, and the Children's Outcomes Research Program, Children's Hospital, Denver, Colorado
{ddagger} Colorado Health Outcomes Program
§ Department of Preventive Medicine and Biometrics
Division of General Internal Medicine, University of Colorado Health Sciences Center, Denver, Colorado
|| Health Advocates, Denver, Colorado

Background. There currently are few published data evaluating the effect of State Children's Health Insurance Programs on health care outcome measures in children. Colorado's Child Health Plan Plus (CHP+) is a non-Medicaid State Children's Health Insurance Program that began enrollment in April 1998. The objectives of this study were to compare reported (1) access to care, (2) utilization of health care, and (3) quality of care during the year before and the first year after enrollment into CHP+.

Methods. We interviewed 480 randomly selected families by telephone 2 months after their first enrollment into CHP+ (September 1999 to January 2000) and, again, 1 year later. We used generalized linear models to examine the effect of enrollment on health care access, utilization, and quality while controlling for type of previous insurance, length of time uninsured before enrollment, race/ethnicity, and age.

Results. Regarding access to care, the percentage of families who reported a usual site of preventive care did not change significantly, but families reported more often being able to see providers as soon as desired for routine care (incidence ratio [IR]: 2.03; 95% confidence interval [CI]: 1.37–3.02]), for care when sick or injured (IR: 2.77; 95% CI: 1.85–4.16), for specialty care (IR: 1.96; 95% CI: 1.16–3.32), and for all health care (IR: 2.35; 95% CI: 1.81–3.07). Unmet medical needs decreased after versus before enrollment for prescription medications (IR: 0.38; 95% CI: 0.26–0.55), mental health care (IR: 0.63; 95% CI: 0.40–0.97), prescription glasses (IR: 0.44; 95% CI: 0.29–0.65), and dental care (IR: 0.59; 95% CI: 0.47–0.76). Regarding utilization, the proportion who saw a provider for routine care in the past year increased (IR: 1.39; 95% CI: 1.06–1.83), but reported visits for sick, specialty, and emergency department care and hospitalizations did not increase. Regarding quality of care, the proportion who rated their health care as "best" increased (RI: 1.31; 95% CI: 1.04–1.66) after versus before enrollment.

Conclusions. Families who were newly enrolled into CHP+ perceived dramatic increases in access to all types of care and decreases in unmet medical needs, no increase in utilization of emergency department or hospitalization services, and improved overall quality of care in the year after enrollment into CHP+.

Key Words: SCHIP • access to health care • health insurance • quality of health care

Abbreviations: SCHIP, State Children's Health Insurance Program • CHP+, Child Health Plan Plus • FPL, federal poverty level

Accepted Jul 22, 2004.




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