Kempe A, Beaty B, Englund BP. Quality of care and use of the medical home in a State-funded capitated primary care plan for low-income children. Pediatrics 2000 May; 105(5): 1020-8.
This article can be found at: http://www.aap.org
This study evaluates the quality of care and use of a medical home in the Colorado Child Health Plan (CCHP), a State-funded capitated reimbursement program for primary care services. The authors reported that CCHP provided children from low-income families with preventive, acute, and chronic care services of comparable quantity and quality to those received by children with Medicaid or private insurance. CCHP-enrolled children used their medical home for the majority of acute health needs, as well as preventive care, and were not high utilizers of emergency department or hospital services.
Newacheck PW, Halfon M, Inkelas M. Monitoring expanded health insurance for children: challenges and opportunities [commentary]. Pediatrics 2000 Apr; 105(4 Pt 2); 1004-7.
In this commentary, the authors outline the elements of a comprehensive national monitoring program and discuss how new data collection and evaluation initiatives fit within this framework. According to this article, the four components of an effective monitoring strategy are:
- Taking a comprehensive approach to monitoring.
- Collecting comparable data across States.
- Making effective use of existing data sources.
- Sponsoring new data collection efforts when needed.
The authors discuss the need for Federal leadership in forging these elements into a cohesive monitoring strategy. Without a coordinated approach to monitoring, they believe duplication and inefficiency are inevitable and potential synergies may be lost.
Holl JL, Szilagyi P, Rodewald LE, et al. Evaluation of New York State's Child Health Plus: access, utilization, quality of health care and health status. Pediatrics 2000 Mar; 105(3 Suppl E): 711-8.
The March 2000 supplement of Pediatrics is devoted to the evaluation of Child Health Plus (CHP), New York's SCHIP program. These studies examine the association between providing health insurance to low-income children and their subsequent access to care, utilization of health services and the quality of care. After enrollment in Child Health Plus (CHP), access to and utilization of primary care increased, continuity of care improved, and patient satisfaction improved, while utilization of emergency and specialty care did not change. Many parents reported improved health status of their child as a result of enrollment in CHP. This evaluation suggests that SCHIP programs are likely to improve access to, quality of, and participation in primary care yet may not be associated with significant changes in specialty or emergency care.
Barents Group LLC. Review of the literature on evaluations of outreach for public health insurance and selected other programs. McLean (VA): The Group; Mar 2000.
Very little research has been published on the effectiveness of outreach strategies and activities. Despite an extensive search strategy, only five published studies were identified by Barents. While all studies report positive results, their ability to influence outreach program design for SCHIP and Medicaid may be minimal because of the studies' methodological problems.
Starfield B. Evaluating the State Children's Health Insurance Program: critical considerations. Ann Rev Public Health 2000; 21: 569-85.
This article can be found at: http://publhealth.annualreviews.org.
According to the author, evaluation of the benefits of SCHIP programs should address not only improved coverage by health insurance for eligible children, but also the extent to which children receive high-quality primary care. Topics for evaluation include State activities to:
- Enroll through outreach and develop information systems for tracking.
- Assess the degree of penetration of insurance among low-income children.
- Obtain evidence of improved health status.
This article details approaches that can appropriately be used to address each of these aspects of concern.
Shi L, Oliver TR, Huang V. The Children's Health Insurance Program: expanding the framework to evaluate State goals and performance. Milbank Q 2000; 78(3): 403-6, 340-1.
This white paper examines SCHIP programs to assess methods proposed for SCHIP evaluation within the States. Data indicate that States tend to emphasize program enrollment and basic access to services without stressing quality of those services once children are enrolled. The most common strategic objectives of States, as cited in this study, are to reduce the number and proportion of children who are uninsured. As a means to expand existing SCHIP evaluation design, a broad conceptual framework that emphasizes both health outcomes and administrative processes is offered.
Friedman B, Jee J, Steiner C, et al. Tracking the State Children's Health Insurance Program with hospital data: national baselines, State variations, and some cautions. Med Care Res Rev 1999 Dec; 56(4): 440-55.
The authors evaluated national and State hospital data for nineteen States from the Healthcare Cost and Utilization Project (HCUP) inpatient sample of hospital discharge records for ambulatory care services (ACS). Results show that hospitalizations for ACS conditions increased for uninsured and Medicaid-insured children between 1990 and 1995. During the same period, the hospital admission rates for privately insured children with the same conditions fell by more than one-third. These data can be used by States as a benchmark for their SCHIP programs.
Moore KA. Indicators of child and family well-being: the good, the bad and the ugly. A Presentation to National Institutes of Health Office of Behavioral and Social Sciences Research. Washington (DC): Child Trends; Sept 13 1999.
This report summarizes and discusses a comprehensive set of criteria for indicators of child well-being. The author emphasizes the importance of using well-measured and consistently collected indicators to measure the well-being of children and families over time. The information collected by these indicators influences how the public and health officials form opinions and make decisions.
Halfon N, Inkelas M, Newacheck PW. Enrollment in the State Child Health Insurance Program: a conceptual framework for evaluation and continuous quality improvement. Milbank Q 1999; 77(2): 181-204, 173.
This article can be found at: http://www.milbank.org/quarterly/7702feat.html.
The authors outline an approach to measuring and monitoring several critical dimensions of the enrollment process and describe how access measures for enrollment can be used to characterize States' relative success in recruiting, enrolling, and retaining eligible children in their SCHIP programs. By using their framework, States should be able to develop workable, quasi-experimental evaluation designs tailored to their particular circumstances. Doing so will provide the information needed to improve enrollment processes and to ensure maximum participation of eligible children.
Halfon N, Inkelas M, DuPlessis H, et al. Challenges in securing access to care for children. Health Aff 1999 Mar-Apr; 18(2): 48-63.
In this paper, the authors present an access pathway model, tracing the various routes by which children can obtain the coverage they need. A model such as theirs enables development of a national evaluation strategy that can take into consideration the heterogeneity of States' responses. The paper develops an analytic framework and presents potential indicators to evaluate SCHIP's performance and its impact on access to health insurance and health services. It also presents options for moving beyond minimal monitoring to an evaluation strategy that would help to improve program outcomes.
Riley T. How will we know if CHIP is working? Health Aff 1999 Mar-Apr; 18(2): 64-6.
The author asserts that even if an accurate baseline of uninsured children is found for all States, changes in the health care marketplace, employment trends, welfare reform, and health care costs will affect rates of insurance coverage. Few, if any, States possess the technical capacity to track marketplace trends and draw conclusions about the impact of SCHIP on reducing the rate of the uninsured. Therefore, Congressional expectations may exceed States' ability to measure the effectiveness of SCHIP.
Lave JR, Keane CR, Lin CJ, et al. Impact of a Children's Health Insurance Program on newly enrolled children. JAMA 1998 Jun 10; 279(22): 1820-5.
This study was designed to determine the impact of SCHIP on access to health care and on other aspects of the lives of the children and their families. Results from interviews with newly enrolled families show that access to health care services after enrollment improved and the proportion of children reporting unmet need or delayed care decreased. The authors conclude that extending health insurance to uninsured children has a major positive impact on children and their families and leads to more appropriate utilization, not excessive utilization.
Selden T, Banthin J, Cohen J. Medicaid's problem children: eligible but not enrolled. Health Aff 1998 May-Jun; 17(3): 192-200.
This report uses results from the 1996 Medical Expenditure Panel Survey to explain the importance of and need for the President's priority to improve Medicaid outreach. The authors present estimates of the number of Medicaid-eligible but uninsured children.
States' SCHIP Evaluations.
These SCHIP evaluations can be found at: http://www.cms.hhs.gov/home/schip.asp.
States were required to submit evaluations of their SCHIP program to the Health Care Financing Administration (HCFA), now the Centers for Medicare and Medicaid Services (CMS), by March 31, 2000. These evaluations provide assessments of the effectiveness of the States' SCHIP plans in providing quality health care coverage to children.
American Academy of Pediatrics' SCHIP Evaluations.
These evaluations can be found at: http://www.aap.org/
In an effort to facilitate the sharing of information and perspectives on evaluation of children's health insurance programs, the American Academy of Pediatrics (AAP) created the SCHIP Evaluation Web pages. The site will serve as a clearinghouse for resources on SCHIP evaluation, featuring links to State and Federal evaluation activity information, published evaluations of State children's health insurance programs, indicators under the domains of access, process and outcomes, and child health data and other evaluation resources.
National Academy of State Health Policymakers (NASHP) CHIP Evaluation Clearinghouse
The Clearinghouse can be found at: http://www.nashp.org.
The National Academy of State Health Policymakers (NASHP) designed this Clearinghouse to provide State officials who are responsible for SCHIP implementation with easy access to the evaluation materials being used in States across the country. It provides links to surveys States have used to gather data for evaluation of their SCHIP programs.
American Academy of Pediatrics SCHIP Evaluation Tool
This tool can be found at: http://www.aap.org/research/evaltool.htm.
The SCHIP Evaluation Tool, developed by the American Academy of Pediatrics (AAP), was designed to assist States in their monitoring efforts. It provides 30 indicators that measure the impact of Title XXI on three closely linked dimensions of quality assessment of health care: access, process, and outcomes. These three domains comprise a logical sequence from making health insurance available to achieving improved health status. In adapting these indicators, the AAP encourages States to address populations of children who have special health care needs or who have experienced barriers to access, e.g., children with chronic illness, adolescents, minority populations, and families experiencing language barriers.
Rosenbach ME, Ellwood M, Czajka J, et al. Implementation of the State Children's Health Insurance Program: momentum is increasing after a modest start. Washington (DC): Mathematica Policy Research; Jan 2001.
The report summarizes major findings from the first year of Mathematica's national evaluation of SCHIP. The analysis was based on State SCHIP evaluations mandated under Title XXI, quarterly enrollment data submitted by States, and national data on trends in the number of uninsured children. The five-year evaluation, which is funded by the Health Care Financing Administration (HCFA), now the Centers for Medicare and Medicaid Services (CMS), began in 1999. As new data become available, the researchers will document SCHIP enrollment and disenrollment trends, measure the extent of transfers between SCHIP and Medicaid, analyze SCHIP expenditures and utilization patterns, and track the number of uninsured children.
Monitoring/Eval. 
