Focus on Research January 2013
Focus on Research:
Family's Access to Medical Care & Impact of Insurance Lapses on Children & Youth (FAMILY) Study
By Jennifer DeVoe, MD, DPhil
The Children’s Health Insurance Program (CHIP) has expanded public health insurance programs for children, but the parents of these children have not had the same experience. In 2003 there were cutbacks in the Oregon Health Plan (OHP), the Oregon Medicaid program, and many parents lost coverage. In 2008, a lottery system was created to offer uninsured adults a chance to apply for OHP coverage. The system provided health insurance for about 10% of those who signed up to receive it (about 10,000 adults).
The FAMILY Study is a four year project funded to understand how these changing patterns of family health insurance coverage affect children’s health insurance coverage and their receipt of health care services. In other words, do children whose parents lost health insurance coverage also experience a loss in health insurance coverage? Do these children receive less healthcare services, including fewer well-child visits and fewer immunizations? On the other hand, do the children whose parents gained health insurance coverage gain coverage themselves and receive more of the nationally recommended healthcare services? This project uses several different sources of information to help answer these questions and to get a complete picture of what happened before and after the cutbacks and implementation of the lottery system.
As we enter our final year of this study, we have learned many things. The interviews we conducted with low-income parents in Oregon to ask about their experiences with health insurance coverage and access to health care taught us about families’ actual experiences with OHP and how they were impacted by the health insurance coverage policy changes described above. Parents reported high costs and limited provider availability as barriers to accessing health care for their children, but continuity with a health care provider often helped them overcome these barriers. Parents also described difficult decisions they often made to access care for their children, choosing between maintaining continuity of care, finding available providers, and being able to afford the cost of care depending on their current life circumstances.
Another source of information used in our study is AHRQ’s Medical Expenditure Panel Survey (MEPS) which includes information on access to health insurance, health care, and health care services. MEPS is collected yearly from a representative sample of the US population. From this national survey of families, we found health insurance coverage patterns for child and parent pairs have significantly changed over the last decade for low- and middle-income families, with an increase of families with public coverage for children but not for uninsured parents. In addition, we found parental health insurance continuity integral to maintaining children’s coverage.
We are currently looking at health care insurance claims and OCHIN shared electronic health record (EHR) data before and after the OHP changes in coverage happened. OCHIN is a health information network of safety net clinics with a shared EHR. These data will allow us to find out how changes in adults’ health insurance coverage have affected their children’s health care coverage as well as their receipt of health care services. To assess the receipt of health care services we have been investigating the feasibility of utilizing the Children’s Health Insurance Reauthorization Act (CHIPRA) pediatric quality measures in EHR data. A few select publications from this study are listed below:
- Angier H, DeVoe, JE, Tillotson C, Wallace L, Gold R. 2012. Trends in Health Insurance Status of US Children & Their Parents, 1998-2008. Maternal & Child Health. Sep 27. [Epub ahead of print]
- Gold R, Angier H, Mangione-Smith R, Gallia C, McIntire P, Cowburn S, Tillotson C, DeVoe JE. 2012. Feasibility of Evaluating the CHIPRA Quality Care Measures in Electronic Health Record Data. Pediatrics. 130:139–149.
- DeVoe JE, Tillotson C, Wallace LS, Lesko S, Angier H. 2012. The Effects of Health Insurance and a Usual Source of Care on a Child’s Receipt of Health Care. The Journal of Pediatric Health Care. 26(5): e25-e35.