Context.— Although there is considerable interest in decreasing the number of
US children who do not have health insurance, there is little information
on the effect that health insurance has on children and their families.
Objective.— To determine the impact of children's health insurance programs on access
to health care and on other aspects of the lives of the children and their
Design.— A before-after design with a control group. The families of newly enrolled
children were interviewed by telephone using an identical survey instrument
at baseline, at 6 months, and at 12 months after enrollment into the program.
A second group of families of newly enrolled children were interviewed 12
months after the initial interviews to form a comparison sample.
Setting.— The 29 counties of western Pennsylvania, an area with a population of
4.1 million people.
Subjects.— A total of 887 families of newly enrolled children were randomly selected
to be interviewed; 88.3% agreed to participate. Of these, 659 (84%) responded
to all 3 interviews. The study population consists of 1031 newly enrolled
children. The children were further classified into those who were continuously
enrolled in the programs. The 330 comparison families had 460 newly enrolled
Main Outcome Measures.— The following access measures were examined: whether the child had a
usual source of medical or dental care; the number of physician visits, emergency
department visits, and dentist visits; and whether the child had experienced
unmet need, delayed care, or both for 6 types of care. Other indicators were
restrictions on the child's usual activities and the impact of being insured
or uninsured on the families.
Results.— Access to health care services after enrollment in the program improved:
at 12 months after enrollment, 99% of the children had a regular source of
medical care, and 85% had a regular dentist, up from 89% and 60%, respectively,
at baseline. The proportion of children reporting any unmet need or delayed
care in the past 6 months decreased from 57% at baseline to 16% at 12 months.
The proportion of children seeing a physician increased from 59% to 64%, while
the proportion visiting an emergency department decreased from 22% to 17%.
Since the comparison children were similar to the newly enrolled children
at enrollment into the insurance programs, these findings can be attributed
to the program. Restrictions on childhood activities because of lack of health
insurance were eliminated. Parents reported that having health insurance reduced
the amount of family stress, enabled children to get the care they needed,
and eased family burdens.
Conclusions.— Extending health insurance to uninsured children had a major positive
impact on children and their families. In western Pennsylvania, health insurance
did not lead to excessive utilization but to more appropriate utilization.