Children in low-income families experience greater access to preventive medical and dental care under Medicaid or the Children's Health Insurance Program (CHIP) than children covered by private insurance, suggested the PolicyLab study. Researchers also found that for all types of insurance coverage, access to pediatric specialty care was a challenge.
Lead author Amanda Kreider, from the PolicyLab at The Children's Hospital of Philadelphia (CHOP) said, "Amid the shifting landscape of pediatric coverage under the Patient Protection and Affordable Care Act, it is a good time to give renewed attention to the relative quality of these health insurance options for children."
‘For all types of insurance coverage, access to pediatric specialty care was found to be a challenge. Caregivers of children insured by Medicaid or CHIP reported having 88% access to preventive medical care compared to 83% of privately insured children.’
The researchers analyzed experiences reported by family members in a national sample of over 80,000 children from households with low to moderate income. They examined access to and use of health care across four different types of insurance - Medicaid, CHIP, private insurance, and uninsured - for children in households with incomes between 100% and 300% of the federal poverty level. They also measured caregiver-reported outcomes related to access to primary and specialty care, unmet needs, out-of-pocket costs, care coordination, and satisfaction with care.
By studying these outcomes over a 10-year period, the research team was able to capture within-state variation in the income eligibility thresholds for Medicaid and CHIP over time. Caregivers of children enrolled in Medicaid and CHIP reported a greater perception of insurance always meeting their needs (78%) than caregivers of privately insured children (73%). Among children insured by Medicaid or CHIP, 88% had access to preventive medical care compared to 83% of privately insured children. The trend was similar for preventive dental care, in which 80% of children on Medicaid and 77% of those under CHIP had access to care, compared to 73% of privately insured children.
Among children in all coverage types, accessing specialty care was a challenge, with as many as one in four children having difficulty seeing a specialist. However, these challenges were amplified for children insured by CHIP (28%) and for privately insured children with special health care needs (29%). Additionally, caregivers of privately insured children were much more likely to experience out-of-pocket costs (77%) than were caregivers of children insured by CHIP (38%) and Medicaid (26%).
Dr. David Rubin, senior researcher on the study team, said, "I think a lot of people might be surprised to learn that families perceive a greater quality of access to care and lower out-of-pocket costs within Medicaid and CHIP compared to commercial insurance. The value of Medicaid and CHIP for families in this country is frequently debated among our leaders, but the value of this study is the nationally representative data provided by families themselves."
The findings of the study reveal important differences that can help guide future policymaking regarding coverage for families with low to moderate income. The authors said, "These differences will require ongoing evaluation to ensure that policy decisions are responsive to the health coverage needs of children and families."
Kreider said, "While our findings suggest a high quality of coverage for children enrolled in the Medicaid and CHIP programs relative to private insurance, it is important that concerns about specialty access are not overlooked. There has been an erosion in confidence about access to pediatric specialty care, and we need to understand why this is happening and respond accordingly."
Dr. Rubin said, "One way to ensure more comprehensive coverage for children in private plans offered on the exchanges would be to require these plans to match the benefit and cost-sharing provisions that are mandatory in Medicaid. My worry would be that new insurance practices in the commercial market that are now tiering specialty providers as out-of-network for families are prohibiting access for children with special healthcare needs. We may have reached a point at which it is necessary to regulate the commercial insurance market to ensure that the benefits for children are equivalent to our Medicaid and best CHIP plans."
The study appeared online in JAMA Pediatrics