OCTOBER 2006 HOT TOPICS

SCHIP improves access, children's quality of life

Next year, the State Children's Health Initiative Program (SCHIP) will be up for reauthorization in Congress. SCHIP is a federal-state partnership that provides health insurance to low-income children whose families do not qualify for Medicaid but cannot afford private insurance. SCHIP is federally funded but administered by individual states.

A recent groundbreaking study led by RAND researcher Michael Seid examined how realized access to care—getting care when needed—affects the health-related quality of life for children enrolled in California's SCHIP. The study found that enrollment in SCHIP improves realized access to care among low-income children in California. Furthermore, enrollment in SCHIP also substantially reduces ethnic and racial disparities in realized access.

In addition, these improvements translated into gains in health-related quality of life. To gauge children's health-related quality of life, analysts used the PedsQL, a scale that measures a range of outcomes—physical, social, emotional, and school-related—that are affected by health. Children enrolled in SCHIP who reported always receiving care when needed had significantly higher scores on the quality-of-life scale than children who reported that they had forgone needed care during the two-year study period.

This research is the first to document that enrollment in SCHIP can improve children's quality of life, and this should be taken into consideration by policymakers in deciding whether to reauthorize or expand the program.

Read the Research Brief »

Access to primary care for vulnerable children: Obtaining needed care from a regular provider is even more important than insurance

Children need access to primary care. However, access is a complex phenomenon: Insurance coverage (which provides financial access) is only one part of the solution. Two other aspects are also critical: potential access (the child has a regular health care provider) and realized access (the child actually receives care when it is needed). A series of recent studies led by RAND examined children's access to primary care across these dimensions, focusing on vulnerable children and their experiences with primary care.

The studies showed that many children who are eligible for SCHIP remain uninsured, that having a regular doctor and getting care when it is needed are essential in for health insurance coverage to have a beneficial effect, and that having a regular doctor and access to needed care in a language parents can understand substantially reduces disparities in primary-care quality. These variables are important for policymakers to consider when reauthorizing SCHIP in 2007.

The first study examined enrollment in SCHIP. It found that, nationwide, about 35 percent of children who are eligible for SCHIP are not enrolled in the program. Researchers identified three reasons for this underenrollment. First, program design matters. Some states integrate SCHIP with Medicaid, while others have set up their SCHIP as a freestanding program. Children in states that treat SCHIP as an expansion of Medicaid are four more times more likely to be enrolled than children in states with free-standing SCHIPs. Second, children are less likely to be enrolled if they live in a household in which English is a second language. Third, many parents have misperceptions that create barriers to enrollment. Some, for example, believe SCHIP is too costly, even though it is free or very inexpensive.

A second study examined the primary-care experiences of children. Researchers focused on parents of elementary-school children in a large urban district in California. Participants came from diverse ethnic, racial, socioeconomic, and linguistic backgrounds. The study measured parents' experiences with their children's primary care. The study found that all three components of access—financial, potential, and realized access—were vital to receiving high-quality primary care. However, lack of potential access (e.g., the child had no regular provider) and lack of realized access (e.g., the child needed care but didn't get it) were more important than the absence of insurance in determining the quality of primary care received by children. The study also found that disparities in care across racial and ethnic groups virtually disappear when accounting for the effects of having a regular provider, getting care when needed, and parents' primary language.

A third study focused on the primary-care experiences of high-risk children. The research team studied primary-care experiences in relation to five risk factors: the child's race/ethnicity, household poverty status, parents' education, the child's insurance, and the child's primary language. The results showed that children with multiple risk factors have poorer health and are less likely to have a regular provider. As noted, having a regular provider is an important factor in receiving good primary care. Taken together, the findings show that children with the greatest health care needs also have the greatest difficulty in obtaining primary care.

Read the Fact Sheet »

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