The percentage of children without health insurance was 11.4% in 2003, which is down from 12.9% in 1987, but nonetheless stubbornly high despite the large expansions during this period in Medicaid coverage and the introduction of the State Children's Health Insurance Program (SCHIP): the percentage of children eligible for public insurance rose from 17.8% in 1987 to 41.7% in 2000. Most recently, $40 billion in federal matching funds were allocated over ten years beginning in 1998 to fund the SCHIP expansions. The uninsured are forced to depend heavily on """"""""safety net"""""""" providers to meet their health care needs. The health care safety net in most communities is made up of a patchwork of health care providers that include public hospitals, teaching hospitals, community-based clinics, and local health departments among others. The importance of safety net providers has been highlighted by the Bush Administration's proposed five-year $780 million Initiative for Health Centers that would enable the health centers to reach an additional 6.1 million patients by the end of Fiscal Year 2006. While there are numerous studies examining how the uninsured and underinsured affect the health care safety net, comparatively little research has examined the converse: how the health care safety net affects the health of those who use it. Similarly, while a number of studies have attempted to relate Medicaid expansions to child health outcomes, few studies have attempted to relate characteristics and aspects of the health care safety net to children's health outcomes. This application proposes to use national data to examine how the provision of care through the health care safety net affects health outcomes for children. In addition, a related aim to be addressed in this study to determine where marginal dollars are most effectively spent in terms of their impact on child health: on increasing public insurance eligibility or on directly funding or subsidizing the provision of indigent care by the health care safety net. A final area of study will examine how the relationship between the health care safety net and children's health outcomes differs by race and ethnicity.
