Study Shows Child Health Plus Eases Access, But Some Barriers Remain

May 03, 1998

While state-funded health insurance for children of the working poor can reduce financial barriers to access, non-financial barriers continue to discourage the use of services for minority groups. That is among the key findings of a study conducted by a team of researchers at the University of Rochester Medical Center that is being presented today at the 1998 Pediatric Societies' annual meeting.

The researchers studied the impact of Child Health Plus on access, utilization and satisfaction for racial and ethnic minority groups. Child Health Plus is a New York State-funded health insurance program for low-income families that was introduced in 1991.

The 18-month study involved extensive telephone interviews with more than 1,800 Child Health Plus enrollees, parents or guardians of children ages 0-13 years who enrolled in the program between July 1992 and July 1993 and who had been covered by the program for at least nine months. Participants were asked a number of questions about demographics, family size, and income as well as use of health care services during the 12 months prior to Child Health Plus coverage and the first 12 months following their enrollment.

In addition to establishing whether or not the participants had a "medical home" and how they used it, researchers gathered information on travel time, distance, hours of availability, ease of use and other variables. They compared these factors both before and after enrolling in Child Health Plus. Interviewers also asked participants about their level of satisfaction with Child Health Plus. The evaluation study was funded by the Department of Health as part of its initial legislation to create the program.

"Child Health Plus appears to have leveled the playing field in terms of having a medical home," said Laura Pollard Shone, MSW, principal investigator for the study. "However, there are still some racial and ethnic disparities with regard to the reported ease of use, such as the ability to get an appointment."

Among the study's key findings:
Before Child Health Plus, having a medical home varied by race and ethnicity, a fact which dissolved following the introduction of the program, after which 98% reported having a medical home. Despite significant increases within all racial and ethnic groups after Child Health Plus, differences persisted for 24-hour phone coverage and in the participants' use of their medical home for acute care, with Black, Asian and Hispanic enrollees remaining the lowest rates. During Child Health Plus, minorities found it harder to get an appointment, with Hispanic and Black twice as likely as non-Hispanics and Whites to report a problem. Hispanics were twice as likely as non-Hispanics to have trouble getting to or reaching their physician's office by phone. All groups reported high satisfaction with Child Health Plus and their physicians.

Shone and her colleagues theorize that even though Child Health Plus has effectively eliminated the financial barriers to health care for children of the working poor, a number of non-financial barriers, such as transportation, day care, and others continue to prevent these children from receiving appropriate care. Nonetheless, nearly all of those interviewed reported being satisfied with the program.

"Satisfaction with Child Health Plus was universally high," said Pollard Shone. "They like their doctors and they are comfortable with their insurance plan." According to Pollard Shone, this indicates that satisfaction rates, used alone, are not necessarily a valid measure of the effectiveness of state-funded insurance.

"As more states begin to use federal block grants to implement their own insurance products for the poor we need to build in methods to address these barriers," Pollard Shone said.

Other researchers in the study included Peter G. Szilagyi, Sarah H. Trafton, Lance E. rodeWald, Jane L. Holl, Richard F. Raubertas, Dana M. Mukamel, Andrew Dick and Jack Zwanziger.

University of Rochester

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