SCHIP: Expanding Access to Health Care Improves Children's Lives

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Figure 1
Forgone Care and Problems Obtaining Care Decreased After Two Years of SCHIP Enrollment

Forgone Care and Problems Obtaining Care Decreased After Two Years of SCHIP Enrollment

Figure 2
Children with Forgone Care Before SCHIP Enrollment Experienced Improved Quality of Life, Whereas Continued Forgone Care Led to Declines

Children with Forgone Care Before SCHIP Enrollment Experienced Improved Quality of Life, Whereas Continued Forgone Care Led to Declines

SOURCE: Seid M, Varni JW, Cummings L, and Schonlau M, "Improving Access to Needed Health Care Improves Low-Income Children's Quality of Life," RB9210, RAND, 2006.

The State Children's Health Insurance Program (SCHIP) is a federal-state partnership created in 1997 that provides health insurance to low-income children whose families do not qualify for Medicaid but cannot afford private insurance. Studies have shown that SCHIP has increased children's access to doctors and other health services. Less is known, however, about the program's broader effects on children's lives.

A RAND study examined how "realized" access to care—getting care when needed—affected the health-related quality of life for children enrolled California's federally funded SCHIP program. Results showed that:

  • Low-income children in California who were enrolled in SCHIP had fewer problems getting care when needed and were less likely to forgo needed care than children who were not enrolled (figure 1);
  • Enrollment in SCHIP also substantially reduced ethnic and racial disparities in realized access to care.
  • These improvements in access translated into gains in health-related quality of life: Children enrolled in SCHIP who reported always receiving care when needed had significantly higher scores on a quality-of-life scale than children who reported that they had forgone needed care during the two-year study period (figure 2).

This research was the first to document that enrollment in SCHIP can improve children's health-related quality of life. RAND research helped to inform congressional deliberations in 2007, when SCHIP was reauthorized, and also subsequent debate over an expansion to SCHIP, enacted in 2009. 

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