Published online April 2, 2007
PEDIATRICS Vol. 119 No. 4 April 2007, pp. e885-e892 (doi:10.1542/peds.2006-1953)
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ARTICLE

Impact of the State Children's Health Insurance Program on Adolescents in New York

Jonathan D. Klein, MD, MPHa,b, Laura P. Shone, DrPH, MSWa, Peter G. Szilagyi, MD, MPHa,b, Alina Bajorska, MSb, Karen Wilson, MD, MPHa and Andrew W. Dick, PhDb

a Departments of Pediatrics
b Community and Preventive Medicine, Strong Children's Research Center, University of Rochester School of Medicine and Dentistry, Rochester, New York

OBJECTIVES. Adolescents face financial and nonfinancial barriers to health care. Little is known about the impact of health insurance on health care for adolescents. We assessed the impact of New York's State Children's Health Insurance Program on access, use, and quality of care for adolescents.

METHODS. Adolescents and their parents from a stratified random sample of new enrollees in New York's State Children's Health Insurance Program were interviewed by telephone shortly after enrollment (baseline, n = 1118 adolescents and their parents) and 1 year later (follow-up, n = 970). Outcome measures included access (having a usual source of care and reported unmet health needs), use (preventive care and other types of visits), and quality (satisfaction with care, receipt of confidential care and preventive counseling). Outcomes were assessed at baseline (year before the State Children's Health Insurance Program) versus follow-up (year during the State Children's Health Insurance Program).

RESULTS. The proportion of adolescents who reported having a usual source of care increased during State Children's Health Insurance Program compared with before (69.9% to 87.1%). The proportion with any unmet health care need (54.3% to 42.1%) or with unmet need for preventive care (53.8% to 40.6%) decreased, with elimination of racial disparities that existed before the State Children's Health Insurance Program. After enrollment in the State Children's Health Insurance Program, more adolescents reported having had a preventive care visit (65.9% to 74.2%); emergency department use did not change. No differences in satisfaction were noted, although significant increases were noted in both parent- and adolescent-reported rates of having received confidential care and preventive counseling.

CONCLUSIONS. Adolescents who enrolled in New York's State Children's Health Insurance Program experienced improved access, use, and quality of care. These findings suggest that the provision of health insurance can help to improve health care for adolescents.

Key Words: SCHIP • health insurance • adolescents • access • quality

Abbreviations: SCHIP—State Children's Health Insurance Program • FPL—federal poverty level • CAHMI—Child and Adolescent Health Measurement Initiative • YAHCS—Young Adult Health Care Survey • USC—usual source of care • ED—emergency department

Accepted Oct 18, 2006.