quality improvement/ disparities/access

Quality Improvement/ Disparities/Access

Group IV

Context• We believe all children should have access to

health care • Health insurance enables access to health care• Currently SCHIP and Medicaid are two public

programs that provide health care coverage for low income children

• 9M children are currently uninsured and out of these 6M qualify for coverage but unenrolled– Medicaid to more individuals below the federal poverty

level ($20,200 for a family of four in 2008) who are parents or caretaker relatives of children eligible for Medicaid. But the states have chosen not to do so.

All United States

Population

Number (in

thousands)

Employer

Individual

Medicaid/

Other Public

UninsuredSCHIP

Children 78,425 55.40% 4.40% 27.10% 1.40% 11.70%Low-Income Children* 33,340 24.10% 3.60% 51.90% 1.40% 19.10%Parents 67,031 68.30% 4.40% 9.00% 1.50% 16.80%*Low-income" is defined as under 200 percent of the Federal Poverty Level.

Problem Statement• Two-thirds of uninsured children in

the US are eligible for SCHIP or Medicaid but are NOT enrolled

Conceptual Framework for Evaluating the Consequences of Uninsurance:

A cascade of effects(IOM 2003)

Focusarea

Rationale• Parents/families unaware of eligibility

status – Johnnie has a health problem but his

parents are unaware he is eligible for public health insurance coverage

Rationale• Difficulty in enrollment process

– Johnnie’s parents find the application process too difficult and lacked documentation for the asset test

Rationale• Difficulty in retention

– Johnnie’s dad gets a small raise and he loses his public health insurance program and is uninsured

Proposed Solutions• Increase awareness of

SCHIP/Medicaid program– Parents/families of potential enrollees

• Streamline enrollment procedure• Improve retention

Stakeholders• Interest Groups

– Families USA– Children’s Defense

Fund• Pharma• Taxpayer Associations• Voters• National Governors

Association• National Conference on

State Legislators• Heritage Foundation

• Children• Parents/Families• Health care

providers• State • Education• Day Care• Private Insurers• State Government• Employers

Stakeholders• How are they impacted?

– Improved access to primary care• Improved health for children• Improved continuity of care• Decreased emergency room visits • Decreased hospitalizations

– Improved workforce productivity for parents– Improved educational performance of children– Increased utilization and cost (+ / -)

• Opportunity cost (+ / -) – State, special interest groups, employers

Plan of Action• Increase awareness of public health

insurance programs• Promote state-based outreach

activities to increase enrollment– Increase federal match to states for

meeting enrollment targets– Disseminate to states “models of

excellence”

Plan of Action• Streamline enrollment process

– Link/coordinate enrollment with other federal/state programs

– Develop common application form– Omit asset test (+ /-)– Disseminate “models of excellence”

Plan of Action• Improve retention of health

insurance coverage for children– Mandate one year continuous

enrollment

Implementation Strategies• Coalition building

– State Governors– Legislators– Special interest groups

• Identify champions in Congress– Senator Rockefeller

• Media coverage/moving public opinion

Johnnie now has health insurance

Resources• http://ccf.georgetown.edu/index/data

-healthcoverage#us• http://www.kff.org/medicaid/upload/2

177_06.pdf• Hidden Costs, Value Lost:

Uninsurance in America http://www.nap.edu/catalog/10719.html