State Children’s Health Insurance Program Cuts Rate of Forgone Care, Increases Quality of Life

Nearly 3,500 low-income California families monitored their children’s health-related quality of life upon enrollment in the State Children’s Health Insurance Program and for two years thereafter. The families were racially, ethnically, and linguistically diverse.

Race/Ethnicity Parental Language

Fewer families from all racial, ethnic, and linguistic groups reported forgone care a year after enrollment than before they enrolled. Nearly all groups reported continued reductions in forgone care as of year two. Demographic disparities in reporting forgone care shrunk substantially by year two. Fewer families reported problems obtaining care as of year one. The disparities had also shrunk among families who reported such problems, except for Asians and Asian-language speakers, who reported continued problems.

Foregone Care Cut in Half Parental Language Legend for Foregone Care Cut in Half and Problems Obtaining Care Reduced

Experiencing both forgone care and problems obtaining care corresponded with a sharp decline in health-related quality of life for children: an average 8-point drop on a 100-point scale. The clinical effect was worse for a child than having a chronic health condition.

Quality of life
NOTES: Statistical correlations are derived from parent responses to the Pediatric Quality of Life Inventory™, a survey tool that produces health-related quality-of-life scores from 0 to 100, with 100 being best. Numbers in the chart indicate the expected change associated with each variable, either raising or lowering a child’s score. Child responses to the survey yielded similar results.

Regardless of the amount of care received or forgone prior to enrollment, each ensuing year of realized access to needed care helped children (raising or roughly maintaining their quality-of-life scores on a 100-point scale), whereas each ensuing year of forgone care hurt (lowering their scores).

Children with foregone care before enrollment
Children with access to care before enrollment
SOURCE: “The Impact of Realized Access to Care on Health-Related Quality of Life: A Two-Year Prospective Cohort Study of Children in the California State Children’s Health Insurance Program,” The Journal of Pediatrics, Vol. 149, No. 3, September 2006, pp. 354–361, Michael Seid, James W. Varni, Lesley Cummings, Matthias Schonlau.