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Innovative program improves children's health
The innovative Children's Health Initiative in Santa Clara, CA, has been shown to increase children's access to and use of medical and dental care and to improve their health status, according to a program evaluation conducted by the Urban Institute's Embry Howell and Mathematica's Christopher Trenholm.
The program has two parts—a Healthy Kids insurance product that covers children in households with income up to 300% of the federal poverty level who are ineligible for the Medi-Cal and Healthy Families insurance programs, and a comprehensive outreach campaign that finds uninsured children and enrolls them in the appropriate program.
The evaluators say there have been few studies directly addressing the relationship between children's health insurance and health status. One reason is that children generally are healthy and much of the care they receive is geared toward preventing future illness. "Still," they say, "by ensuring that children receive needed medical and dental care on a timely basis, health insurance coverage can provide some immediate benefits to their health."
An earlier program evaluation found that Healthy Kids dramatically increased children's access to and use of medical and dental care. Overall, the proportion of children receiving a medical visit in the past six months rose from 32% without Healthy Kids to 54% with the program. That increase reflected a near doubling of the proportion of children who received a preventive visit (25% to 43%) and who received a sick visit (18% to 30%), and a doubling in those who received a specialist visit (5% to 11%). That evaluation also found that Healthy Kids significantly improved children's access and use of dental care, reduced their unmet needs, and raised parents' confidence that their children could receive needed care.
To determine whether the documented gains in medical care translated into health status improvements, the researchers examined Healthy Kids' effect on three children's health measures as reported by parents: 1) children's health status, ranging from poor or fair to good or excellent; 2) whether children had health problems limiting their ability to function normally; and 3) the number of school days the children missed in the past month (for ages 5 and older). To have the most confidence that any gains seen in children's health were due to the program, the researchers limited their findings to children who did not enroll in Healthy Kids specifically because of an illness or some other type of immediate medical need.
They found that even among children who enrolled in Healthy Kids for a nonmedical reason, the program led to significant improvements in health. After participating in the program for one year, the proportion of children reported by their parents to be in fair or poor health fell by one-third, from 18% to 12%. And Healthy Kids significantly reduced the number of missed school days. Thus, the proportion of children missing three or more school days in the past month fell from 11% without Healthy Kids to just 5% with the program. However, Healthy Kids did not reduce the proportion of these children with a functional limitation caused by health, although that group was just 3% of children who enrolled in Healthy Kids for a non-medical reason.
The researchers said the study shows that providing health insurance to very disadvantaged children has improved the health status of those children in Santa Clara County in a short period of time, according to reports from the children's parents. Many of the children never had coverage before enrolling. "As a result of providing comprehensive coverage, the program has improved the current health status and school attendance of some of California's most vulnerable children," the evaluation said. "The study adds to a small but growing body of evidence concerning the potential short-term benefits of health insurance coverage for children's health."