Children’s Health Insurance Matters: Findings from Surveys of Healthy Kids Participants...

Children’s Health Insurance Matters:Findings from Surveys of Healthy Kids Participants

Grantmakers in Health Grantmakers in Health Site Visit MeetingSite Visit Meeting

Christopher TrenholmChristopher TrenholmMathematica Policy ResearchMathematica Policy Research

September 25, 2008September 25, 2008

Presentation Will Focus on:

Overview of Healthy Kids Surveys - Focus on Santa Clara County (for clarity)

Impacts of Healthy Kids After Children’s First Year of Coverage – Findings for Santa Clara County– Findings for other rigorously evaluated programs

San Mateo CountyLos Angeles County

Changes in Outcomes For Children Who Remained Enrolled For Several (~4) Years

Healthy Kids Surveys(Santa Clara County)

Initial Survey

Conducted in 2003-2004

Interviewed parents of two groups of children:– 625 “established” children: enrolled in HK for about 1 yr– 609 “new” children: newly enrolled/waitlisted for HK

Measured Healthy Kids’ impact by comparing outcomes (access, etc) for these two groups:– Established children: focused on past 6 months with HK– New children: focused on 6 months before (without) HK

Followup Survey

Conducted in 2006-2007 (approx 3 years later)

Focused on 405 of the original 625 “established” children who remained enrolled– 225 had disenrolled (mostly due to age or relocating)

Completed interviews with parents of 372 of these 405 children (92%)

Examined changes in outcomes for these children by comparing initial & followup survey data

Demographics of Health Kids Participants

(based on initial survey)

Percentage

SOURCE: Tabulations from 2003-04 Survey of Santa Clara County Healthy Kids Enrollees

Most Healthy Kids Children Are From Two Parent Working Families

19

54

3

19

5

0

25

50

75

100

2 Parents,Both Work

2 Parents,One Works

2 Parents,None Work

1 Parent,Works

1 Parent, Not Working

Percentage


Typical Enrollee Family Has Lived in Santa Clara For Years

35

148

43

0

25

50

75

100

<1 Year 1-2 Years 2-3 Years 3+ Years

Years Residing in Santa Clara at Enrollment

Most Children Were Uninsured For At Least Six Months Before Enrolling

63

13 168

0

25

50

75

100

Uninsured (all six months)

Emergency Medi-Cal

Private Other

Percentage


Coverage in (any) of the six months before enrolling

Impact of Healthy Kids After Children’s

First Year of Coverage(based on initial survey)

Percentage


Healthy Kids Sharply Increased Access to a Usual Source of Care (USC)

49

89

30

81

0

25

50

75

100

Medical USC Dental USC

Without Healthy Kids With Healthy Kids

*** Difference is statistically significant at p-value < .01

***

***

Santa Clara Healthy Kids

Percentage with a Usual Medical Source

49

89

58

90

76

91

0

25

50

75

100

Santa ClaraHealthy Kids

San MateoHealthy Kids

Los AngelesHealthy Kids


Large USC Gains Also Evident in San Mateo and LA Programs

*** *** ***

***Difference is statistically significant at p-value < 0.01.

Los Angeles reflects children ages 0 to 5; San Mateo and Santa Clara reflect children ages 0 to 18

Percentage


Healthy Kids Significantly Increased Medical Care Visits

32

54

25

43

18

30

511

0

25

50

75

100

Any Visit Well Child Visit Sick Child Visit Specialist Visit

Without Healthy Kid With Healthy Kids


***

***

***

***


Percentage with a Medical Visit in Past Six Months

32

54

42

59

7076

0

25

50

75

100





**

******

***/** Difference is statistically significant at p-value < 0.01/0.05


Gains in Medical Care Use Also Evident in San Mateo and LA Programs

Percentage


Healthy Kids Also Sharply Increased the Use of Dental Services

22

61

16

44

0

25

50

75

100

Preventive Dental Visit Dental Treatment Visit



***

***


22

61

25

65

0

25

50

75

100

Santa Clara Healthy Kids San Mateo Healthy Kids


Gains in Preventive Dental Care Also Evident in San Mateo Program..

******


San Mateo study includes children ages 4 to 18; Santa Clara includes ages 3 to 18.

Percentage with a Dental Checkup in Past Six Months

16

44

15

46

0

25

50

75

100

Santa Clara Healthy Kids San Mateo Healthy Kids


*** ***


San Mateo study includes children ages 4 to 18; Santa Clara includes ages 3 to 18.

..Along With the Major Increase in Dental Treatments

Percentage with a Cavity Filling or Tooth Extraction in Past Six Months

Percentage


Healthy Kids Reduced Levels of Unmet Need

24

10

21

9

0

25

50

Unmet Medical Need Unmet Dental Need



*** ***




24

10

27

16

32

19

0

25

50





Reductions in Unmet Need Also Evident in San Mateo and LA Programs

***

******

Percentage with an Unmet Medical Need in Past Six Months

Percentage


Healthy Kids IncreasedConfidence and Satisfaction

*** Difference in statistically significant at p-value < .01

41

75

48

78

0

25

50

75

100

Confident Child Can Get Care AsNeeded

Very Satisfied with Care Quality


*** ***


41

75

42

66

28

55

0

25

50

75

100





Gains in Well-Being Also Evident in San Mateo and LA Programs

**

**

**

**Difference is statistically significant at p-value < 0.01.


Percentage of Parents Reporting Being Very Confident Child Can Get Needed Care

Percentage

SOURCE: Tabulations from 2003-04 Survey of Santa Clara County Healthy Kids Enrollees (limited to children who

enrolled for a reason other than unmet need)

And There Is Evidence Healthy Kids Improved the Children’s Health

18

12 11

5

0

25

50

Child In Fair/Poor Health Child Missed 3+ School Days From Illness


* difference is statistically significant at p-value < .05

*

*


Changes in Outcomes With Continued Healthy Kids

Coverage(from initial & followup surveys)

Percentage

SOURCE: Tabulations from 2003-04 and 2006-2007 Surveys of Santa Clara County Healthy Kids Enrollees

Access to Care Remains High

90 8883

90

0

25

50

75

100

Has Usual Source for Medical Care (non-ED) Has Usual Source for Dental Care

After One Year on HK After Four Years on HK

*

* difference is statistically significant at p-value < 0.10


Percentage


Most Children Have a Recent Health Care Visit (Last Six Months)

53

6267

73

0

25

50

75

100

Any Medical Visit (non-ED/Hosp) Any Dental Visit



Percentage


Medical Care:Checkups Rise Significantly..

42

53

3325

11 14

0

25

50

75

100

Well Visit (Checkup) Sick Visit Specialist Visit


* difference is statistically significant at p-value < 0.10

*


Percentage


..And Multiple Sick Visits Decline

67

76

13 1420

10

0

25

50

75

100

No Sick Visits One Sick Visit Two or More Sick Visits


** difference is statistically significant at p-value <0.05

**


Percentage


Dental Care: Dental Treatments Remain Common

6571

4348

0

25

50

75

100

Dental Check-up Dental Treatment (Cavity Filled or Tooth Pulled)



Percentage


Unmet Need Shows A Pattern of Decline

117

12

7

22

12

0

25

50

Medical Unmet Need Dental Unmet Need Any Unmet Need


** difference is statistically significant at p-value <0.05

**


Percentage


Parents’ Well-Being Continues to Improve

7984

61

38

29

20

0

25

50

75

100

Very Confident Child CanGet Needed Care

Worried About Meeting Child's Health Care Needs

Worried That Child's NeedsCreate Financial Difficulty


*** difference is statistically significant at p-value < .01; * at p-value < 0.10

*

***


Percentage


Most Children Remain Healthy

15

107 7

0

25

50

Fair/Poor Health Missed 3+ School Days in Past Month(Due to Illness)



Summary

Nearly all families on Healthy Kids are working and most have lived in their counties for years

Healthy Kids dramatically improved the outcomes of children after just one year – Huge gains in access to and use of health care – Large reductions in unmet needs– Evidence of improved health, fewer missed school days

Gains continued as children remained enrolled in Healthy Kids

Children’s Health Insurance Matters: Findings from Surveys of Healthy Kids Participants...

Documents

Transcript of Children’s Health Insurance Matters: Findings from Surveys of Healthy Kids Participants...