CHIPRA Mandated Evaluation of the Children's Health Insurance Program: Final Findings. Finding 6 (Chapter VIII)

08/01/2014

Finding 6 (Chapter VIII): Compared to being uninsured, children in Medicaid and CHIP experienced better access to care, fewer unmet needs, and greater financial protection. Compared to having private insurance, CHIP enrollees had better access to dental benefits and their families had much lower financial burdens and stress in meeting the child’s health care needs. CHIP enrollees were less likely than children with private insurance to have a regular source of medical care and nighttime or weekend access to a provider at that source of care.

Overall, CHIP enrollees experienced good access to providers; nearly all had seen a medical and dental provider within the past year, and parents of CHIP enrollees reported being very confident that their child is able to get needed health care. More than 85 percent of children enrolled in CHIP had seen a doctor or health care professional in the past 12 months, and 80 percent had a well-child visit. Parents of CHIP enrollees also reported positive care experiences with their child’s providers at high rates on most aspects of patient-centered care, though only 47 percent of parents of CHIP enrollees reported positive care experiences on all six dimensions of family-centered care. Most parents (96 percent) of CHIP enrollees reported being confident that they could get health care to meet their child’s needs, with more than 80 percent reporting having little or no stress about meeting these needs. In addition, only 8 percent of parents reported that they had any problem paying their child’s medical care bills in the past year.

A large majority (89 percent) of parents reported they did not have trouble finding a dentist to see their child, and 90 percent of CHIP enrollees had a usual source of dental care. More than 80 percent of CHIP enrollees had received a dental cleaning or checkup in the past year, and 54 percent of children over age 6 were reported to have had dental sealants placed on their back teeth—a rate exceeding “Healthy People 2020” targets (US DHHS).

CHIP enrollees had better access and service use outcomes, and the financial burden on their families was lower than for children who were uninsured.

Compared to being uninsured, the experiences of children enrolled in CHIP were more positive in nearly all areas examined. The parents of children enrolled in CHIP reported substantially more confidence in their ability to get needed health care for their children, their children were more likely to have received a range of health services, and they reported fewer financial burdens associated with the child’s health care. The largest positive differences were found for having a usual source of dental care and a dental checkup or cleaning, obtaining referrals when needed, lower stress and greater confidence about meeting the child’s health care needs, fewer problems paying medical bills for the child’s care, and receipt of preventive care or well-child checkup. Rates of use for emergency department (ED) care and hospital stays were comparable among children enrolled in CHIP and uninsured children, and children in CHIP were just as likely as uninsured children to have had a dental procedure after a dentist recommended dental follow-up care.

Compared with private coverage, access and service use for CHIP enrollees was comparable for many measures but not as good for some. Financial burdens were substantially lower and dental access was better in CHIP.

CHIP enrollees were more likely than children with private coverage to have dental benefits and a regular source of dental care and to have their medical care coordinated effectively. The parents of children enrolled in CHIP also reported having had substantially less trouble paying their child’s medical bills and much lower out-of-pocket spending levels. The greater financial protection provided by CHIP coverage likely contributed to findings that parents of CHIP enrollees reported being more confident about meeting their children’s health care needs and feeling less stress about doing than parents of children with private insurance. CHIP enrollees were less likely than children with private insurance to have a regular source of medical care and access to that source of care at night or on weekends.

Greater improvements could be achieved in a few areas.

Only 28 percent of CHIP enrollees had a usual source of care that offered appointments at night or on the weekend, and only 37 percent had after-hours access to a provider at their usual source of care. Nearly 25 percent of CHIP enrollees had some type of unmet need, most commonly for dental care (12 percent) and physician services, prescription drugs, or specialty care (5 percent). Also, many children were not receiving recommended health screenings and anticipatory guidance. For example, 60 percent had their vision screened in the past year, but slightly less than half received a flu vaccination and only about one-third received anticipatory guidance on all four key health topics examined, or a developmental screening (among children under age 6). Finally, a substantial share (68 percent) of CHIP enrollees did not get follow-up dental treatment when it was recommended by a dentist. Similar gaps in care were also found among children with private coverage, which suggests that there are broader issues with systems of care serving children.

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