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Lisa Dubay, ScM, Genevieve Kenney, PhD, and Amy J. Davidoff, PhD. Health Policy Center, Urban Institute, 2100 M Street, NW, Washington, DC 20037, 202-261-5667, ldubay@ui.urban.org
Research Objectives: To estimate the effects of the SCHIP program on access to care and use of health services among children eligible for SCHIP coverage.
Study design: We used a pre-post design, with a comparison group, comparing changes in access and use of services before and after SCHIP implementation. The treatment group consisted of newly (SCHIP) eligible children and the comparison group included children with incomes slightly above the eligibility thresholds for SCHIP. Estimated difference-in-difference regression models controlled for observable child, family, and area characteristics. Data were from the 1996, 1999, and 2002 National Survey of America’s Families (NSAF) and the 1997 and 2001 National Health Interview Survey (NHIS). Treatment and comparison groups were identified using an algorithm that incorporates federal and state specific SCHIP eligibility requirements to replicate the eligibility determination process.
Population Studied: Children aged 0-17 years.
Results: Estimates indicate that among eligible children, the SCHIP expansions were associated with a 4 to 6 percentage point increase in the probability of having a dental visit (NHIS, NSAF), a 4 percentage point increase in the probability of an eye care visit within the year (NHIS), lower unmet medical needs (NSAF), and less out-of-pocket spending (NHIS). The impacts implied by these estimates for children who were directly affected by the expansions are substantially greater since many eligible children maintained their private coverage over this period. We did not find effects on use of other health services.
Conclusions: The eligibility expansions improved some measures of access for children, but gaps remain for other components of access. Further progress in improving access to care for SCHIP eligible children requires addressing enrollment barriers and access issues among enrolled children. Such changes are increasingly unlikely, given the dire fiscal situation in many states. Under the current policy environment, the recent improvements in access documented in this study are at risk of being reversed.
Funding Source: The Robert Wood Johnson Foundation and the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services.
Learning Objectives:
Keywords: Access, Insurance
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.