Final Report of the Evaluation of the San Mateo County Children's Health Initiative

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Abstract

In early 2003 San Mateo County, California launched the Children's Health Initiative (CHI), to ensure that all children have access to comprehensive health insurance coverage. Healthy Kids covers uninsured children below 400 percent of poverty and primarily serves poor, undocumented Latino children. A survey of parents of Healthy Kids enrollees found that in the first year of enrollment, children experienced improvements in access to and use of medical and dental care; a reduction in missed school days due to health problems; reduced unmet need; increased parent confidence in getting care and satisfaction with quality; and reduced financial worries.  Moreover, use of preventive and dental services continued to improve during the children’s second and third years of continuous enrollment. 

Introduction

This final report presents results from a five-year evaluation of the San Mateo County Children’s Health Initiative (CHI). The San Mateo CHI has a goal of achieving universal health insurance coverage for all low-income children in the county, thereby improving access to care, use of appropriate services, and health status. A new insurance program, Healthy Kids, was implemented to cover children who have no other source of health insurance and are not eligible for any other public insurance program.

This report summarizes a wide-ranging evaluation of the CHI, beginning in May, 2003, that includes the following activities:

• Three comprehensive one-week site visits in the first three years of the evaluation, with updates in person and by telephone in the last two years, designed to document the implementation of the CHI, including both successes and challenges.
• Two rounds of focus groups with parents of Healthy Kids enrollees. The focus groups were designed to collect in-depth qualitative information on parents’ perceptions of the program.
• In-depth interviews with medical and dental providers, to obtain their views of the program, and with employers, to assess their knowledge of the program and whether Healthy Kids potentially crowds out private insurance.
• Two waves of a parent survey, designed to collect information on the characteristics of enrolled children, their access to care and service use, and their health status. The Wave One survey collected data on a cross-section of enrollees in 2004. The Wave Two survey collected data in 2006 for two groups of children—those just recently enrolled and those enrolled for one year—in order to measure program effects on key outcomes¹.
• Analysis of annual data from the Health Plan of San Mateo, comparing characteristics, use, and cost of Healthy Kids enrollees over time to children of the same age enrolled in Medi-Cal (Medicaid) or Healthy Families (SCHIP).

¹ Wave One results were reported in an earlier evaluation report, so data in this report come from Wave Two. Appendix A provides more detail on the design of the survey and the impact analysis.

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Disclaimer: The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.