Szilagyi P G, Zwanziger J, Rodewald L E, Holl J L, Mukamel D B, Trafton S, Shone L P, Dick A W, Jarrell L, Raubertas R F
Departments of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA.
Pediatrics. 2000 Feb;105(2):363-71. doi: 10.1542/peds.105.2.363.
The State Child Health Insurance Program (SCHIP) is the largest public investment in child health care in 30 years, targeting 11 million uninsured children, yet little is known about the impact of health insurance on uninsured children. In 1991, New York State implemented Child Health Plus (CHPlus), a health insurance program that became a model for SCHIP:
To examine changes in access to care, utilization of services, and quality of care among children enrolled in CHPlus.
A pre-post design was used to evaluate the health care experiences of children in the year before enrollment in CHPlus and during the year after CHPlus enrollment.
New York State, stratified into 4 regions: New York City, urban counties around New York City, upstate urban counties, and upstate rural counties.
A total of 2126 children (0-12.99 years of age) who enrolled in CHPlus in 1992-1993.
Parents were interviewed by telephone, and primary care medical charts were reviewed for 694 children (0-3. 99 years of age).
Access, utilization, and quality of care measures for each child were compared for the year before and the year after CHPlus enrollment, controlling for age, geographic region, previous insurance coverage, and CHPlus plan type (indemnity or managed care).
Enrollment in CHPlus was associated with fewer children lacking a medical home (5% before CHPlus vs 1% during CHPlus), with the greatest change occurring in New York City (11% vs 1%), where access before CHPlus was lowest. CHPlus was also associated with increased primary care visits: by 25% for preventive visits, by 52% for acute visits, and by 42% for total visits. The number of specialists seen during CHPlus was more than twice as high than before CHPlus. CHPlus was not associated with changes in emergency department utilization, although hospitalizations, which were not covered by CHPlus, were 36% lower during CHPlus coverage. Use of public health departments for immunizations declined by 64%, with more immunizations delivered in the medical home during CHPlus coverage. One third of parents reported improved quality of health care for their child as a result of CHPlus, and virtually none noted worse quality of care.
This statewide health insurance program for low-income children was associated with improved access, utilization, and quality of care, suggesting that SCHIP has the potential to improve health care for low-income American children.
州儿童健康保险计划（SCHIP）是30年来对儿童医疗保健的最大公共投资，目标是1100万未参保儿童，但对于健康保险对未参保儿童的影响却知之甚少。1991年，纽约州实施了儿童健康附加计划（CHPlus），这一健康保险计划成为了SCHIP的典范：
研究参加CHPlus的儿童在获得医疗服务、服务利用情况及医疗质量方面的变化。
采用前后对照设计，评估儿童在参加CHPlus之前一年以及参加CHPlus之后一年的医疗保健经历。
纽约州，分为4个地区：纽约市、纽约市周边的城市县、州北部城市县和州北部农村县。
1992 - 1993年参加CHPlus的2126名儿童（0 - 12.99岁）。
通过电话采访家长，并查阅了694名儿童（0 - 3.99岁）的初级保健病历。
比较每个儿童在参加CHPlus之前一年和之后一年的医疗服务可及性、利用情况及质量指标，同时控制年龄、地理区域、先前的保险覆盖情况以及CHPlus计划类型（赔偿型或管理式医疗）。
参加CHPlus与缺乏医疗之家的儿童数量减少相关（参加CHPlus之前为5%，参加CHPlus期间为1%），最大的变化发生在纽约市（从11%降至1%），在那里参加CHPlus之前获得医疗服务的情况最差。CHPlus还与初级保健就诊次数增加相关：预防性就诊增加25%，急性就诊增加52%，总就诊次数增加42%。参加CHPlus期间看专科医生的次数比参加CHPlus之前高出两倍多。CHPlus与急诊部门利用情况的变化无关，尽管CHPlus不涵盖住院费用，但在CHPlus覆盖期间住院率降低了36%。利用公共卫生部门进行免疫接种的情况下降了64%，在CHPlus覆盖期间更多的免疫接种在医疗之家中进行。三分之一的家长报告称，由于CHPlus，其孩子的医疗质量有所提高，几乎没有人指出医疗质量变差。
这项针对低收入儿童的全州性健康保险计划与医疗服务可及性、利用情况及质量的改善相关，这表明SCHIP有潜力改善美国低收入儿童的医疗保健状况。
