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The Impact of the Iowa S-SCHIP Program on Access, Health Status, and the Family Environment

      Objectives.—To determine the effect of the Iowa Separate State Child Health Insurance Program (S-SCHIP) on need for services, utilization and access to care, child health status, and the family environment.
      Methodology.—A longitudinal pretest-posttest panel survey was used to evaluate differences in children's access to health care, health status, and family environment at the beginning of the program and after 1 year. Written surveys with telephone follow-up calls were used to collect the data. Pre- and postquestionnaire results for 463 children were matched and compared using the McNemar test for correlated proportions and the Wilcoxon signed rank test. Approximately 71% of families responded to both surveys.
      Principal Findings.—Similar rates of perceived need for each of 6 service areas were found after being in the program for a year as before. Unmet need was significantly reduced among those needing services: medical care (27% before, 6% after), specialty care (40% before, 13% after), dental care (30% before, 10% after), vision care (46% before, 12% after), behavioral and emotional care (42% before, 18% after), and prescription medications (21% before, 13% after). Overall health status was rated significantly better (ie, excellent: 37% before, 42% after). Ninety-five percent of families reported a reduction in family stress, and there was significantly less worry about the ability to pay for their child's health care (92% before, 57% after). The activities of fewer children were limited because of potential health care costs.
      Conclusions.—The Iowa S-SCHIP program improved access to care and the family environment for children enrolled during the first year without a change in perceived need for services.

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      REFERENCES

      1. Balanced Budget Act of 1997, Pub L No. 105–33, Subtitle J-State Children's Health Insurance Program (Aug. 5, 1997)

        • US Bureau of the Census.
        Health Insurance Coverage: Consumer Income.
        (Accessed June 25, 2003.)
        • Selden TM
        • Banthin JS
        • Cohen JW
        Waiting in the wings: Eligibility and enrollment in the State Children's Health Insurance Program.
        Health Aff. 1999; 18: 126-132
        • Szilagyi PG
        • Zwanziger J
        • Rodewald LE
        • et al.
        Evaluation of a State Health Insurance Program for Low-Income Children: Implications for State Child Health Insurance Programs.
        Pediatrics. 2000; 105: 363-371
        • Lave JR
        • Keane CR
        • Lin CJ
        • et al.
        Impact of a children's health insurance program on newly enrolled children.
        JAMA. 1998; 279: 1820-1825
        • Keane CR
        • Lave JR
        • Ricci EM
        • LaVallee CP
        The impact of a children's health insurance program by age.
        Pediatrics. 1999; 104: 1051-1058
        • Holl JL
        • Szilagyi PG
        • Rodewald LE
        • et al.
        Evaluation of New York State's Child Health Plus: access, utilization, quality of health care, and health status.
        Pediatrics. 2000; 105: 711-718
      2. US Dept of Health and Human Services. State Child Health Insurance Program Plan Activity Map. Rockville, Md: US Dept of Health and Human Services, Center for Medicare and Medicaid Services Available at: http://www.cms.hhs.gov/schip/chip-map.asp Accessed June 25, 2003.

        • Anderson R
        • Newman J
        Societal and individual determinants of medical care utilization in the United States.
        Milbank Q. 1973; 51: 95-124
        • Anderson R
        • McCutcheon A
        • Aday LA
        • et al.
        Exploring dimensions of access to medical care.
        Health Serv Res. 1983; 18: 50-74
        • Aday L
        • Anderson R
        A framework for the study of access to medical care.
        Health Serv Res. 1974; 9: 208-220
        • Newacheck PW
        • Stoddard JJ
        • Hughes DC
        • Pearl M
        Health insurance and access to primary care for children.
        N Engl J Med. 1998; 338: 513-519
        • Newacheck PW
        • Hughes DC
        • Hung YY
        • et al.
        The unmet health needs of America's children.
        Pediatrics. 2000; 105: 989-997
        • Wirthlin Worldwide.
        Survey of American Families: Comparison of Households With Insured vs. Uninsured Children Eligible for SCHIP/Medicaid Coverage. Wirthlin Worldwide, McLean, Va2001 (Sponsored by the Robert Wood Johnson Foundation) (Accessed June 25, 2003.)
        • Dillman DA
        Mail and Internet Surveys: The Tailored Design Method. 2nd ed. Wiley and Sons, New York2000
        • Centers for Disease Control and Prevention, National Center for Health Statistics.
        National Health Interview Survey. Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, Md1999 (Accessed March 2003)
        • Agency for Health Care Policy and Research.
        CAHPS® 2.0 Survey and Reporting Kit. US Dept of Health and Human Services, Public Health Service, Rockville, Md1999 (AHCPR Publication No. 99–0039H)
        • Crofton C
        • Lubalin J.S.
        • Darby C
        Consumer assessment of health plans study: foreword.
        Med Care. 1999; 37: MS1-MS9
        • American Academy of Pediatrics.
        SCHIP Evaluation Tool. American Academy of Pediatrics, Chicago1998 (Accessed June 25, 2003.)
        • Damiano PC
        • Tyler MT
        • Momany ET
        • Willard JC
        Consumer Assessment of Care in the Medicaid Managed Care Programs: Final Report to the Iowa Department of Human Services. University of Iowa, Public Policy Center, Iowa City, Iowa2000
      3. Haley JM, Kenney GM. Why Aren't More Uninsured Children Enrolled in Medicaid or SCHIP? Urban Institute. Report Number B-35 in the series New Federalism: National Survey of America's Families Available at: http://www.urban.org/url.cfm?ID=310217 Accessed June 25, 2003.

        • National Committee on Quality Assurance.
        Health Plan Employer Data and Information Set (HEDIS). Technical Specifications. National Committee on Quality Assurance, Washington, DC2002