The Effect of New Insurance Coverage on the Health Status of Low‐Income Children in Santa Clara County

Abstract

Objective. To examine whether providing health insurance coverage to undocumented children affects the health of those children. Data Sources/Study Setting. The data come from a survey of 1235 parents of enrollees in the new insurance program (“Healthy Kids”) in Santa Clara County, California. The survey was conducted from August 2003 to July 2004. Study Design. Cross‐sectional study using a group of children insured for one year as the study group (N=626) and a group of newly insured children as the comparison group (N=609). Regression analysis is used to adjust for differences in the groups according to a range of characteristics. Data Collection. Parents were interviewed by telephone in either English or Spanish (most responded in Spanish). The response rate was 89 percent. Principal Findings. The study group—who were children continuously insured by Healthy Kids for one year—were significantly less likely to be in fair/poor health and to have functional impairments than the comparison group of newly insured children (15.9 percent versus 28.5 percent and 4.5 percent versus 8.4 percent, respectively). Impacts were largest among children who enrolled for a specific medical reason (such as an illness or injury); indeed, the impact on functional limitations was evident only for this subgroup. The study group also had fewer missed school days than the comparison group, but the difference was significant only among children who did not enroll for a medical reason. Conclusions. Health insurance coverage of undocumented children in Santa Clara County was associated with significant improvements in children's health status. The size of this association could be overstated, since the comparison sample included some children who enrolled because of an illness or other temporary health problem that would have improved even without insurance coverage. However, even after limiting the study sample to children who did not enroll for a medical reason, a significant association remained between children's reported health and their health coverage. We thus cautiously conclude that Healthy Kids had a favorable impact on children's health.

The Health and Cost Impact of Care Delay and the Experimental Impact of Insurance on Reducing Delays

“…Prior studies found insurance coverage improves self-reported perceived health status and reduce activity limitations in children 12,14. We differ from these studies in two aspects.…”

“…These studies have reported changes in utilization at both the national9 and state levels 10-12. They also point to the importance in the continuity in insurance coverage, which in our population was accounted for by looking at access across the three year study period 13.…”

“…Studies focused on children, however, have largely come from quasi experimental settings without a control group (i.e., special insurance programs for children,12,21 expansion of Medicare and Medicaid and other private insurance,6,13-14,22 and more recently, the implementation of various State Children's Health Insurance Programs in the United States 9-11, 23-24…”

“…Initial evaluations in wealthier countries show that insurance programs have been able to improve access by reducing delays in health seeking for newly insured children 9-13. Initial evaluations show that these insurance expansions lead to better subjective health outcomes12, 14 and lowered costs 6. Reductions in delays can improve outcomes as children are brought to health facilities at less severe illness stages.…”

Children in Immigrant Families

“…In a study comparing children continuously insured by Health Kids for 1 year and a group of newly insured children, the study group was significantly less likely to be in fair/poor health and to have functional impairments than the comparison group of newly insured children (15.9% vs 28.5% and 4.5% vs 8.4%, respectively). Impacts were largest among children who enrolled for a specific medical reason [95]. Overall, the fundamental principal of these local initiatives is that children should not be without health insurance because it is a societal responsibility to keep all children healthy and well.…”