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

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

Symposium: Status on Children’s Health Symposium: Status on Children’s Health in Santa Clara Countyin Santa Clara County

May 4, 2011May 4, 2011Christopher TrenholmChristopher Trenholm

What Have We Learned About Healthy Kids?

Impact of Santa Clara Healthy Kids After Children’s First Year of Coverage

Longer-Term Outcomes for Santa Clara Healthy Kids Children

Impact of Healthy Kids Programs Beyond Santa Clara County

Impact of the Santa Clara Healthy Kids Program

(First Year of Coverage)

How Did We Measure These Effects?

Household survey conducted in 2003-2004– Demographics of HK children and their families– Children’s health and health care outcomes

Interviewed parents of two groups of children:– 625 “established enrollees”: on HK for about 1 yr– 609 “new enrollees”: new to/waiting to join HK

Measured Healthy Kids’ effects by comparing outcomes (access, etc) for these two groups

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

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

***

***

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

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

***

***

***

***

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



***

***

Percentage


Healthy Kids Reduced Levels of Unmet Need

24

10

21

9

0

25

50

Unmet Medical Need Unmet Dental Need



*** ***

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


*** ***

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

12 115

0

25

50

Child In Fair/Poor Health Child Missed 3+ School Days FromIllness


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

*

*

Longer-Term Outcomes of Healthy Kids Children

How Did We Measure These Longer-Term Outcomes?

Followup survey conducted in 2006-2007 – Approximately three years after initial survey

Focused on 405 “established enrollees” who remained covered by Healthy Kids– Completed interviews with 372 (92%) of them

Compared outcomes of these children between the two surveys

Percentage

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

Access to Care Remains High

90 8883

90

0

25

50

75

100

Has Usual Source for Medical Care 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


Medical Care:Checkups Rose 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


Multiple Sick Visits Declined

6776

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 Continues to 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


Children Remain Healthy

1510

7 7

0

25

50

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


Comparisons With Privately Insured Children

Percentage

SOURCE: Tabulations from 2006-2007 Survey of Healthy Kids Enrollees and 2005 California Health Interview Survey

Healthy Kids Children Have Similar Access to Privately Insured

99 93

70

83

0

25

50

75

100

Age 5-11 Age 12-17

Privately Insured Healthy KIds

Percentage


Well Child Visits Are Similar Too

50 53

0

25

50

75

100

Age 12-17

Privately Insured Healthy Kids

Percentage


And Younger Healthy Kids Children Visit The Dentist More Often

59

7565 66

0

25

50

75

100

Age 5-11 Age 12-17

Privately Insured Healthy KIds

Impact of Healthy Kids Beyond Santa Clara County

How Were Outcomes Beyond Santa Clara Studied?

Healthy Kids expanded rapidly from Santa Clara to counties throughout California– 2005 (9 programs); 2007 (25); 2008 (30)

Two studies examined additional Healthy Kids programs: Los Angeles and San Mateo– Led by The Urban Institute

Similar approach to Santa Clara study– LA survey (2005); San Mateo survey (2006-07)– Compared outcomes of established and new enrollees

Percentage

49

89

58

90

76

91

0

25

50

75

100

Santa ClaraHealthy Kids

San MateoHealthy Kids

Los AngelesHealthy Kids


Persistent Gains in Access to Care…

*** *** ***

**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

Has a Usual Source of Medical Care

Percentage

32

5442

5970

76

0

25

50

75

100





**

******

***/** Difference is statistically significant at p-value < 0.01/0.05Los Angeles reflects children ages 0 to 5; San Mateo and Santa Clara reflect children ages 0 to 18

…And in Medical Care Use…

Had Recent Medical Visit (last 6 mos)

16

44

15

46

0

25

50

75

100

Santa Clara Healthy Kids San Mateo Healthy Kids


*** ***

***Difference is statistically significant at p-value < 0.01. San Mateo study includes children ages 4 to 18; Santa Clara includes ages 3 to 18.

..and Critical Dental Care..

PercentageHad Cavity Filled or Tooth Extracted (last 6 mos)

***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

24

10

27

16

32

19

0

25

50





All Leads to Persistent Reductions in Unmet Need

******

***

PercentageHad an Unmet Medical Need (last 6 mos

Healthy Kids: Takeaways

Overwhelming evidence that Healthy Kids has improved the well-being of children and families in Santa Clara County and throughout the state

Health reform will not address the lack of other coverage options for the vast majority of children covered by Healthy Kids

For More Information

Christopher Trenholm– [email protected]

CHI Evaluation Webpage– www.mathematica-mpr.com/Health/chi.asp

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

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