Challenges In Securing Access To Care For Children

Publisher Website
Google Scholar
Abstract
PROLOGUE: The State Children's Health Insurance Program (CHIP) is the most recent concrete step taken by the Clinton administration and Congress toward assisting the growing number of uninsured Americans. Passed in 1997 as part of the Balanced Budget Act (BBA), the program enables states to provide coverage for children in several ways. As states begin implementing their CHIP plans, it is important for policymakers to evaluate how well these plans are improving access to insurance as an important step toward access to appropriate health care. In this paper Neal Halfon and his colleagues present an access pathway model, tracing the various routes by which children can obtain the coverage they need. Using a model such as theirs enables a national evaluation that can take into consideration the heterogeneity of states’ responses. Halfon, a pediatrician, is professor of pediatrics at the School of Medicine and professor of community health sciences at the School of Public Health, University of California, Los Angeles (UCLA). He received his medical degree from UC Davis and a master of public health degree from UC Berkeley. Moira Inkelas, who holds a master of public health degree from UCLA, is a doctoral fellow at the RAND Graduate School. Helen DuPlessis, the second pediatrician on the author team, is associate medical director of LA Care Health Plan. She holds a medical degree from UC San Francisco and previously served as director of student medical services for the Los Angeles Unified School District. Paul Newacheck is professor of health policy and pediatrics at the Institute for Health Policy Studies and Department of Pediatrics, UCSF. Congressional approval of Title XXI of the Social Security Act, which created the State Children's Health Insurance Program (CHIP), is a significant public effort to expand health insurance to children. Experience with the Medicaid program suggests that eligibility does not guarantee children's enrollment or their access to needed services. This paper develops an analytic framework and presents potential indicators to evaluate CHIP's performance and its impact on access, defined broadly to include access to health insurance and access to health services. It also presents options for moving beyond minimal monitoring to an evaluation strategy that would help to improve program outcomes. The policy considerations associated with such a strategy are also discussed.