The Relationship Between SCHIP Enrollment and Hospitalizations for Ambulatory Care Sensitive Conditions in California

Department of Health Research and Policy, Stanford University School of Medicine, CA 94305, USA.
Journal of Health Care for the Poor and Underserved (Impact Factor: 1.1). 03/2005; 16(1):96-110. DOI: 10.1353/hpu.2005.0003
Source: PubMed


The State Children's Health Insurance Program (SCHIP) was implemented in 1998, providing new funds for states to cover uninsured children. This study examines the relationship between SCHIP implementation in California and hospitalizations for ambulatory care sensitive conditions (ACSCs), an indicator of primary care access and quality. We use administrative SCHIP enrollment records for urban California counties, linked with corresponding rates of hospitalization for seven ACSCs among children ages 1-18 for 1996-2000. Results from multivariate regression models indicate that increases of 1 percentage point in SCHIP enrollment are associated with reductions of 0.42 ACSC admissions per 100,000 children age 1-18 (p = 0.009). Models that use lagged effects of SCHIP enrollment indicate an even stronger relationship. These are population-level relationships, and translate to much larger effects on the specific population subset that enrolled in SCHIP. These results suggest a strong beneficial effect of SCHIP on primary care among the children covered.

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    • "Several other studies that observe declining rates of hospital visits for ambulatory care sensitive conditions at the same time of insurance expansions have concluded that insurance expansions can reduce use of hospital care for these conditions (Bermudez et al. 2005; Cousineau et al. 2007). These prior studies have examined hospital stays rather than ED use and in some cases examine patterns for all publicly insured children rather than only those directly enrolled in the expansion. "

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    • "However, rising healthcare costs have threatened children with special healthcare needs among the heterogeneous population (Szilagyi et al., 2003; Dick et al., 2004; Mayer, Skinner & Slifkin, 2004). Eisert and Gabow (2002), Bermudez and Baker (2005), and Cunningham (2006) found that children of the Child Health Insurance Program are associated with a reduction in the need for ambulatory care services. SCHIP has another important role; mitigating the problems of the nation's low-income, uninsured children (Carroll, Corman, Noonan, & Reichman, 2007). "
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    ABSTRACT: The Balanced Budget Act of 1997 established the State Children’s Health Insurance Program (SCHIP), which makes health insurance available to children under the age of eighteen who are members of low income families that do not qualify for Medicaid. The recent development in the government outreach strategies of the SCHIP program has contributed to reduce the disparity in healthcare service accessibility to children.
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    ABSTRACT: Despite major efforts to expand public program eligibility to uninsured children, many low-income children remain unenrolled. Some have argued that we should not be as concerned about these eligible, uninsured children because they can and will be become enrolled with they get sick and present for a health care visit. This study addresses the question of whether uninsured low-income children do in fact become insured when they are brought in for care. It uses longitudinal data from two panels of the Medical Expenditure Panel Survey (MEPS) to model the effect of a health care visit on transitions from uninsured to insured among low-income children. An instrumental variable approach, using data on sibling accidents, is employed to overcome problems associated with the endogenous relationship between visits and enrollment. Results suggest that many low-income uninsured children are not becoming enrolled after a health care visit. Outreach efforts such be bolstered and strengthened to address barriers that keep parents from enrolling their children in public coverage.
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