Elimination of racial and ethnic
disparities : Elimination of racial and ethnic disparities in health has become a major
national goal. The State Children Health
Insurance Program (SCHIP) has the potential to reduce
disparities among the children who enroll if they exhibit the same disparities that have been documented in previous studies of low-income children. To determine the potential impact of SCHIP on racial and ethnic disparities, it is critical to assess baseline levels of health disparities among children enrolling in SCHIP. ----------------------*******************-------------- Objective: To use data from the Child Health Insurance Research Initiative (CHIRI) to 1) describe the sociodemographic profile of new enrollees in SCHIP in Alabama, Florida, Kansas, and New York; 2) determine if there were differences in health insurance and health care experiences among white, black, and Hispanic SCHIP enrollees before enrollment in SCHIP; and 3) explore whether race or ethnicity, controlled for other factors, affected pre-SCHIP access to health coverage and health care. ----------------------***************----------------- SCHIP programs SCHIP programs in Alabama, Florida, Kansas, and New York, which together include 26% of SCHIP enrollees nationwide. ------------------------**************----------------- Design: Telephone interview (mailed survey in Alabama) about the health, health insurance, and health care experiences conducted shortly after SCHIP enrollment to assess experience during the time period before SCHIP. ----------------------***************---------------- Sample: Stratified sampling was performed in Kansas and New York, with results weighted to reflect statewide populations of new SCHIP enrollees. ------------------****************-------------------- Measures: Sociodemographic characteristics including income, education, employment, and other characteristics of the child and the family, race and ethnicity (white non-Hispanic, black non-Hispanic, and Hispanic
), prior health insurance, health care access and utilization, and health status. --------------------************--------------------- Analyses : Bivariate analyses were used to compare baseline measures upon enrollment for white, black, and Hispanic SCHIP enrollees. Multivariate analyses were performed to assess health status and health care access measures (prior insurance, presence of a usual source of care (USC), and use of preventive care), controlling for demographic factors described above. Weighted analyses (where appropriate) were performed by using SPSS, STATA, or SUDAAN. ---------------------**************-------------------- Some Results : Racial and ethnic composition varied across the SCHIP cohorts studied, with black and Hispanic children comprising the following proportion of enrollees, respectively: Black and Hispanic children were more likely to reside in single-parent and lower-income families. The State Children Health Insurance Program (SCHIP), passed in 1997 as Title XXI of the Social Security Act, provides health insurance to low-income uninsured children who do not qualify for Medicaid. 6 Reduction of racial and ethnic disparities was not an explicit goal of SCHIP legislation as enacted by Congress. In the early years of the program, however, state and federal SCHIP leaders became increasingly interested in whether the program impact on access to care and health outcomes is similar for enrollees of different racial and ethnic groups (C. Mann, JD, C. Brach, MPP, and L. P. Shore, MSW, written communication, April, 2003). When final SCHIP regulations were released >2 years after passage of enacting legislation, explicit racial/ethnic data collection and reporting requirements were included.23 Baseline measurement to document whether disparities exist among new SCHIP enrollees is essential to understanding what happens after children enroll in SCHIP. It is possible that SCHIP enrollees do not exhibit the racial and ethnic disparities documented in studies of other low-income populations. SCHIP enrollees may be a relatively homogeneous group because family incomes must fall within a narrow range in order for children to be eligible for SCHIP. Conclusions : SCHIP is enrolling substantial numbers of racial and ethnic minority children. There are baseline racial and ethnic disparities among new enrollees in SCHIP, with black and Hispanic children faring worse than white children on many sociodemographic and health system measures, and there are differences among states in the prevalence and magnitude of these disparities. After controlling for sociodemographic factors, these disparities persisted. Implications for Monitoring and Improving SCHIP. SCHIP has the potential to play a critical role in efforts to eliminate racial and ethnic disparities in health among the children it serves. However, study findings indicate that programmatic efforts are necessary to ensure that disparities are not perpetuated. Program effectiveness and outcomes should be monitored by race and ethnicity to ensure equity in access, use, and outcomes across all racial and ethnic groups. Assessing the health characteristics and needs of new SCHIP enrollees can provide a benchmark for evaluating the impact on eliminating racial and ethnic disparities in health and inform service delivery enhancements.
Abbreviation : USC - usual source of care CHIRI- Child Health Insurance Research Initiative ED - emergency department CSHCN - children with special health care needs ESHI - employer-sponsored health insurance FPL - federal poverty level