States Will Need to Consider Three Critical Questions in Defining the Problem of  Uninsured Children

• What is the 5-year baseline for uninsured low-income children?
• How does lack of coverage affect access to health services, use of health services, and other aspects of well-being?

Considerations in Estimating the Proportion of Low-Income Children Who Are Uninsured

This estimate should be considered as more than a simple baseline.  It will allow for the development of projections of the number of uninsured children that would be expected in the State in the absence of any other new initiatives.

• Sample surveys are essential in collecting State-specific data.
• National sample surveys may be of limited use for State-specific estimates; since each State represents only a small portion of the overall sample, the error rates will be high.
• Telephone surveys may be helpful.

  • SLAITS, the State and Local Area Integrated Telephone Survey, is a tool being developed by the National Center for Health Statistics for States to use to conduct surveys on health insurance and welfare issues. There is a component which focuses specifically on children's health insurance and access to care for kids.
  • BRFSS, the Behavioral Risk Factor Surveillance System.  Each State health department conducts surveys under the BRFSS which examine health risk factors for the adult population under age 65.  States are now starting to include insurance questions regarding the adult population and there is the potential to add questions on children's health insurance coverage as well.

Developing a Health Insurance Baseline

States will need to develop a clear understanding of the point from which they are starting in order to accurately assess in the future whether the desired changes have been achieved. States should consider what the expected proportion of uninsured children would be over the next 5 years without SCHIP.  Then as the program is implemented assess how the results, in terms of insurance coverage, vary from the coverage level expected without SCHIP.  Factors to consider in developing a health insurance baseline include:

• Effects of welfare reform.
• Trends in employer-sponsored coverage (Is family cost-sharing increasing? Are fewer employers sponsoring coverage?).
• Changes in State and private initiatives.

Determining Effects of Lack of Insurance on Access, Use, and Well-Being

Recent studies have indicated that there are significant differences in access to and use of health services among uninsured families in different parts of the country that cannot be attributed only to health status and socioeconomic characteristics, (Source: Cunningham P. and P. Kemper. September 1998. "Ability to Obtain Medical Care for the Uninsured: How Much Does It Vary Across Communities?" [MEDLINE® Abstract] JAMA 280: 921-927), and that lack of insurance coverage affects families in broader range of ways than just access to services (Source: Lave JR, et al. June 1998. "Impact of a Children's Health Insurance Program on Newly Enrolled Children." [MEDLINE Abstract] JAMA 279(22): 1820-5). Therefore one obvious outcome of SCHIP that States will be interested in measuring will be the effect of SCHIP on access to and use of healthcare and its effect on the well-being of the participants. In order to assess the overall effect of SCHIP on these issues, States will need to include relevant questions in their baseline estimates regarding the degree to which access and well-being is affected by lack of insurance coverage. In developing this aspect of their evaluation system, States will want to consider using:

• Telephone surveys to ask limited number of specific questions related to access and use.

Related Questions

Give me an overall context

• What Are the Methods of Data Collection for SCHIP Evaluations?

Give me details

• Show Me the National Profile - Population Size and Characteristics of Uninsured Children

• Why Do These Children Lack Health Insurance?

• What Are Some Demographic Considerations in Reviewing-Generating Estimates?

Show me other SCHIP Workshop presenter-suggested strategies

• SCHIP Guidance - Strategies Suggested by Presenters

What led to this?

• What Are the Overall Issues Associated with Defining the Problem and the Intervention?

Who presented this material?

• Linda Bilheimer, Ph.D.

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