PEDIATRICS Vol. 115 No. 6 June 2005, pp. e697-e705 (doi:10.1542/peds.2004-1726)
ELECTRONIC ARTICLE |
Reduction in Racial and Ethnic Disparities After Enrollment in the State Children's Health Insurance Program
* Department of Pediatrics
Community and Preventive Medicine and Strong Children's Research Center, University of Rochester School of Medicine and Dentistry, Rochester, New York
Department of School of Public Health, University of Illinois, Chicago, Illinois
Background. Racial/ethnic disparities are associated with lack of health insurance. Although the State Children's Health Insurance Program (SCHIP) provides health insurance to low-income children, many of whom are members of racial/ethnic minority groups, little is known about whether SCHIP affects racial/ethnic disparities among children who enroll.
Objectives. The objectives of this study were to (1) describe demographic characteristics and previous health insurance experiences of SCHIP enrollees by race, (2) compare racial/ethnic disparities in medical care access, continuity, and quality before and during SCHIP, and (3) determine whether disparities before or during SCHIP are explained by sociodemographic and health system factors.
Methods. Pre/post–parent telephone survey was conducted just after SCHIP enrollment and 1 year after enrollment of 2290 children who had an enrollment start date in New York State's SCHIP between November 2000 and March 2001, stratified by race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic). The main outcome measures were usual source of care (USC), preventive care use, unmet needs, patterns of USC use, and parent-rated quality of care before versus during SCHIP.
Results. Children were white (25%), black (31%), or Hispanic (44%); 62% were uninsured 
12 months before SCHIP. Before SCHIP, a greater proportion of white children had a USC compared with black or Hispanic children (95%, 86%, and 81%, respectively). Nearly all children had a USC during SCHIP (98%, 95%, and 98%, respectively). Before SCHIP, black children had significantly greater levels of unmet need relative to white children (38% vs 27%), whereas white and Hispanic children did not differ significantly (27% vs 29%). During SCHIP, racial/ethnic disparities in unmet need were eliminated, with unmet need at 19% for all 3 racial/ethnic groups. Before SCHIP, more white children made all/most visits to their USC relative to black or Hispanic children (61%, 54%, and 34%, respectively); all improved during SCHIP with no remaining disparities (87%, 86%, and 92%, respectively). Parent-rated visit quality improved for all groups, but preexisting racial/ethnic disparities remained during SCHIP, with improved yet relatively lower levels of satisfaction among parents of Hispanic children. Sociodemographic and health system factors did not explain disparities in either period.
Conclusions. Enrollment in SCHIP was associated with (1) improvement in access, continuity, and quality of care for all racial/ethnic groups and (2) reduction in preexisting racial/ethnic disparities in access, unmet need, and continuity of care. Racial/ethnic disparities in quality of care remained, despite improvements for all racial groups. Sociodemographic and health system factors did not add to the understanding of racial/ethnic disparities. SCHIP improves care for vulnerable children and reduces preexisting racial/ethnic disparities in health care.
Key Words: New York State • health disparities • health insurance policy • Child Health Plus • public health insurance • SCHIP evaluation
Abbreviations: USC, usual source of care • SCHIP, State Children's Health Insurance Program • FPL, federal poverty level
Accepted Dec 22, 2004.
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  T. L. Cheng and R. R. Jenkins Health Disparities Across the Lifespan: Where Are the Children? JAMA, June 17, 2009; 301(23): 2491 - 2492. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Y. Chen, S. Swonger, G. Kominski, Honghu Liu, Ji Eun Lee, and A. Diamant Cost-Effectiveness of Insuring the Uninsured: The Case of Korean American Children Med Decis Making, January 1, 2009; 29(1): 51 - 60. [Abstract] [PDF]
|
|
|
|
 |
|
 D. X. Vo and M. J. Park Racial/Ethnic Disparities and Culturally Competent Health Care Among Youth and Young Men American Journal of Men's Health, June 1, 2008; 2(2): 192 - 205. [Abstract] [PDF]
|
|
|
|
 |
|
 S. W. Gao, D. K. Oliver, N. Das, F. P. Hurst, K. L. Lentine, L. Y. Agodoa, E. S. Sawyers, and K. C. Abbott Assessment of Racial Disparities in Chronic Kidney Disease Stage 3 and 4 Care in the Department of Defense Health System Clin. J. Am. Soc. Nephrol., March 1, 2008; 3(2): 442 - 449. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. K. Iglehart Insuring All Children -- The New Political Imperative N. Engl. J. Med., July 5, 2007; 357(1): 70 - 76. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Cuttler and G. M. Kenney State Children's Health Insurance Program and Pediatrics: Background, Policy Challenges, and Role in Child Health Care Delivery Arch Pediatr Adolesc Med, July 1, 2007; 161(7): 630 - 633. [Full Text] [PDF]
|
|
|
|
 |
|
 G. Kenney and J. Yee SCHIP At A Crossroads: Experiences To Date And Challenges Ahead Health Aff., March 1, 2007; 26(2): 356 - 369. [Abstract] [Full Text] [PDF]
|
|
