SCHIP program needs substantial work

When given health insurance through the state children's health insurance program (SCHIP), teens see their doctors more often, racial disparities are eliminated and more preventive care is received.

This often-overlooked age group also received more counseling from their health care providers about guns, smoking, drugs, alcohol and sexuality, all issues that impact their long-term health.

"Adolescents have the worst access to health care among children," said Jonathan Klein, M.D., M.P.H., associate professor of Adolescent Medicine at the University of Rochester Medical Center and author of a paper on the subject in this month's Pediatrics. "But when given access through the state children's health insurance program, or SCHIPs, they receive the preventive care that helps them grow into healthy adults."

The study surveyed about 1,000 adolescents and their parents shortly after enrollment in New York's SCHIP program, Child Health Plus, and again a year later.

Upon enrollment, a significant number of adolescents had fair or poor health status (14 percent). The majority of adolescents were from families living in poverty (83 percent) and most were uninsured before their enrollment (71 percent).

Their parents were more likely to report that their adolescent had a preventive visit (74 percent) than they were before enrolling in SCHIP (66 percent). More parents also reported that their teens, providers had counseled on a variety of preventative health issues while in the program, including guns, smoking, drugs, alcohol and sexuality, which is significant since 14 percent of adolescents reported smoking cigarettes and one-fifth had prior sexual intercourse upon enrollment.

"The increase in access to a usual source of care and reduction of unmet needs are the most important finding of this study. Getting access to care is key to adolescent health," Klein said. Parents also were significantly less likely to say they were worried about their child's health and they said they were more satisfied with their providers and care.

Parents were more likely to report that their adolescent visited a specialist or used prescription medications in the program. Emergency department use and other specialty services use did not change during enrollment, which suggests that the program targets needed access, not merely increased use of all health care.

Another significant finding of the program was the elimination of racial disparities in access to care among adolescents, bringing the percentage of all adolescents in the program seeking care with the same health care professionals up to about 95 percent -- an especially noteworthy boost up from 75 percent of black adolescents and 74 percent of Hispanic adolescents prior to enrollment..

In spite of these improvements, unmet health care needs remained relatively high, with more than 40 percent of adolescents reporting unmet needs even after they had enrolled in SCHIP.

"This study shows that if you give adolescents insurance, it improves their access to care and eliminates disparities while promoting effective use of preventive care," Klein said. "Enrolling adolescents in these state insurance programs is a good investment because with greater access to preventative care, these children will be more likely to learn ways to grow into healthy, productive adults."

New York's child health insurance program, Child Health Plus, was created in 1991 and uses managed care plans. New York children are eligible for coverage between birth and 18 years of age, if they are at or below 230 percent of the federal poverty level, if they have no other insurance and are not eligible for Medicaid. The program was created to cover the gap between families who qualify for Medicaid and families who have private insurance. Child Health Plus served as a model for other state's programs when state children's health insurance was created nationally in 1997. The national program is scheduled to expire at the end of this fiscal year, and its continued federal support is not guaranteed.

Much energy has been spent on maintaining funding and ensuring poor children and families have coverage, but many states do not target adolescents for outreach and enrollment and some states have implemented other policies that have created barriers to adolescents, eligibility.

"The federal government has made adolescent enrollment in these state-run programs a priority, but substantial work remains to ensure all adolescents receive the care they need," Klein said.