This study evaluates the degree to which features of a mature SCHIP program, New York State's Child Health Plus (CHPlus), affect access and quality of care for low-income children.
Our specific aims are to measure 1) SCHIP enrollee's experience with access, utilization, and quality, by (a) structural health care features (insurance plan type, provider factors, geography), and (b) patient characteristics (minority status, age, special need); 2) SCHIP selection effects by comparing patient characteristics at enrollment across plan types; 3) continuity of insurance by describing enrollment patterns of CHPlus enrollees and by measuring crowd-out of commercial insurance; and 4) two aspects of community impact: changes in hospital uncompensated care in New York State (NYS), and CHPlus penetration in New York City [NYC] areas. Key comparisons are by CHPlus plan type (for-profit IPA; and not-for-profit IPA, center based, staff model), geographic region (NYC, NYC environs, upstate urban or rural), age (adolescent, school-age, preschool), minority status (white, black, Hispanic), and presence of a special health need--asthma. The study design is a prospective T1/T2 interview of parents of CHPlus enrollees (N=1890) and adolescent enrollees (N=780). The T1 interview at CHPlus enrollment will evaluate baseline characteristics and pre-CHPlus experience. The T2 interview, 1 year after enrollment, will evaluate CHPlus experience and pre-post changes. A baseline interview for a control group (N=400) who enrolled 1 year later (T2) will test for secular trends. Study group subjects will be selected by stratified sampling from the 4 CHPlus plan types, 4 geographic regions, 3 age groups, and 3 racial/ethnic groups. 350 children with asthma will be studied. Plan performance will be compared using standard HEDIS and NYS managed care quality indicators and interview data. Enrollment patterns and hospital uncompensated care will be evaluated using statewide databases. Crowd-out will be assessed by the CHPlus enrollee interview and a statewide enrollment questionnaire. Bivariate and multivariate analyses will compare outcomes by CHPlus plan types, geographic regions, and patient subgroups (age, minority status, and asthma diagnosis). The NYS SCHIP Evaluation Team comprises researchers from the University of Rochester, Montefiore Medical Center, Columbia University, the AAP, and the National Opinion Research Center (NORC). These evaluations will assess how well different health care insurance delivery systems work for vulnerable subgroups of low-income children.
| Liu, Hangsheng; Phelps, Charles E; Veazie, Peter J et al. (2009) Managed care quality of care and plan choice in New York SCHIP. Health Serv Res 44:843-61 |
| Liu, Hangsheng; Phelps, Charles E; Veazie, Peter J et al. (2009) Managed care quality and disenrollment in New York SCHIP. Am J Manag Care 15:910-8 |
| Shone, Laura P; Lantz, Paula M; Dick, Andrew W et al. (2008) Crowd-out in the State Children's Health Insurance Program (SCHIP): incidence, enrollee characteristics and experiences, and potential impact on New York's SCHIP. Health Serv Res 43:419-34 |
