Interim Evaluation Report: Congressionally Mandated Evaluation of the State Children’s Health Insurance Program. D. Focus Group Study Design


As indicated earlier, the survey of enrollees and disenrollees, which will be the principal source of data and analysis on families' experience of SCHIP and Medicaid, could not be fielded in time to meet the due date for the report to Congress. To provide preliminary information on this subject for this report, ASPE contracted for a focus group study, which was conducted during the summer of 2001. Focus groups were held in nine states, of which the six marked with asterisks are also included in the overall ten-state study: California*, Colorado*, Florida*, Georgia, Maryland, Missouri*, New York*, Ohio, and Texas*. A total of 51 focus groups was convened with parents of SCHIP and Medicaid enrollees and disenrollees and with parents of low-income uninsured and privately insured children. Nineteen focus groups included parents of children enrolled in SCHIP and Medicaid; 14 groups included parents of children who had disenrolled from one of the two programs; 13 groups included the parents of eligible but not enrolled low-income children; and five focus groups were with the parents of privately insured children in low-income families. Ethnicity, race, and language spoken at home were also factors used to define the focus groups, so as to capture the experience of important subpopulations. In total, 367 parents participated. 11 These parents are described throughout the report as focus group participants. Appendix B shows the distribution of focus groups by the insurance status of the child and other selection criteria.

The focus groups addressed the following key topics: parents' perceptions of the SCHIP and Medicaid programs; barriers to enrolling children in SCHIP and Medicaid; family attitudes toward and experience of cost-sharing (premiums and copayments) in SCHIP; access to services, benefits used; parents' experiences with private insurance; the effect of outreach efforts and messages on parents' awareness and understanding of the programs; and parents' attitudes toward enrolling their children.

To organize and synthesize the information collected, transcripts from the focus groups were coded uniformly using software, designed for analyzing qualitative data, that allows all passages related to a specific theme to be retrieved for synthesis and comparison across groups. The study findings, reported in full in Bellamy et al. (2002), are incorporated in Part 2 of this report.

It should be noted that the findings from focus groups represent only the views of those individuals who participated in the focus groups and thus cannot be generalized to the broader population. While recognizing the limitations of this study methodology, ASPE believed it was important to include the beneficiary perspective in this first report on the evaluation. The quantitative analyses of the enrollee and disenrollee survey data and SLAITS data will explore in more detail and with greater rigor the issues raised by the focus groups.

11. The contractor worked with the states to identify enrolled and disenrolled families and with local groups to identify privately-insured and eligible but not enrolled families. Community agencies such as community health centers and women, infants, and children (WIC) programs also were a supplemental source of families.

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