Kimberly V. Smith

Community-based health insurance and access to maternal health services: evidence from three West African countries.

Community-based health insurance (CBHI) has been incorporated into the health financing strategies of governments and communities in several Sub-Saharan African countries. Despite the support for and proliferation of CBHI schemes in this region, empirical evidence on how CBHI impacts access to health care, particularly maternal health services, is very limited. We use recent household surveys in three West African countries--Senegal, Mali, and Ghana--to examine the relationship between CBHI membership and access to formal sector maternal health care. We find that membership in a CBHI scheme is positively associated with the use of maternal health services, particularly in areas where utilization rates are very low and for more expensive delivery-related care. Our findings suggest, however, that membership in a CBHI scheme is not sufficient to influence maternal health behaviors - it is the inclusion of maternal health care in the benefits package that makes a difference. While many questions remain about CBHI, this study provides preliminary evidence suggesting that CBHI is a potential demand-side mechanism to increase maternal health care access. However, complementary supply-side interventions to improve quality of and geographic access to health care are also critical for improving health outcomes in this region.

Measuring Health Status: Self-, Interviewer, and Physician Reports of Overall Health

Objective: This study examines and compares respondent, interviewer, and physician ratings of overall health. Method: Data are from the 2006 Social Environment and Biomarkers of Aging Study, a nationally representative survey of older adults in Taiwan. Ordered probit models are used to examine factors associated with self- and external assessments of health and discordant health ratings. Results: Our results suggest similarities and differences in factors influencing health ratings across evaluators but a high level of interevaluator disagreement in ratings. Discrepancies in ratings between physicians and both respondents and interviewers are associated with the greater weight given to functional limitations and psychological well-being in interviewer and respondent ratings and to the importance of clinical measures or risk factors of illness and mortality in physician assessments. Discussion: Interviewer and physician assessments may be complementary to self-assessed health measures. The importance and implications of these findings for future research are discussed.

Children with Special Health Care Needs in CHIP: Access, Use, and Child and Family Outcomes

OBJECTIVE To assess how the Childrens Health Insurance Program (CHIP) affects outcomes for children with special health care needs (CSHCN). METHODS We used data from a survey of parents of recent and established CHIP enrollees conducted from January 2012 through March 2013 as part of a congressionally mandated evaluation of CHIP. We identified CSHCN in the sample using the Child and Adolescent Health Measurement Initiatives CSHCN screener. We compared the health care experiences of established CHIP enrollees to the pre-enrollment experiences of previously uninsured and privately insured recent CHIP enrollees, controlling for observable characteristics. RESULTS Parents of 4142 recent enrollees and 5518 established enrollees responded to the survey (response rates, 46% recent enrollees and 51% established enrollees). In the 10 survey states, about one-fourth of CHIP enrollees had a special health care need. Compared to being uninsured, parents of CSHCN who were established CHIP enrollees reported greater access to and use of medical and dental care, less difficulty meeting their childs health care needs, fewer unmet needs, and better dental health status for their child. Compared to having private insurance, parents of CSHCN who were established CHIP enrollees reported similar levels of access to and use of medical and dental care and unmet needs, and less difficulty meeting their childs health care needs. CONCLUSIONS CHIP has significant benefits for eligible CSHCN and their families compared to being uninsured and appears to have some benefits compared to private insurance.

How Well Is CHIP Addressing Primary and Preventive Care Needs and Access for Children

OBJECTIVE To examine differences in primary care outcomes under the Childrens Health Insurance Program (CHIP) compared to private coverage and being uninsured in 10 states. METHODS We used data from a survey of parents of recent and established CHIP enrollees conducted from January 2012 through March 2013. We compared the primary care experiences of established CHIP enrollees to the preenrollment experiences of previously uninsured and privately insured recent CHIP enrollees to estimate differences in care outcomes. RESULTS Parents of 4142 recent enrollees and 5518 established enrollees responded to the survey (response rates were 46% for recent enrollees and 51% for established enrollees). Compared to being uninsured, CHIP enrollees were more likely to have a well-child visit, receive a range of preventive care services, and have patient-centered care experiences. They were also more likely than uninsured children to have a regular source of care or provider, an easy time making appointments, and shorter wait times for those appointments. Relative to privately insured children, CHIP enrollees received preventive care services at similar rates and to be more likely to receive effective care coordination services. However, CHIP enrollees were less likely than privately insured children to have a regular source of care or provider and nighttime and weekend access to a usual source of care. CONCLUSIONS CHIP continues to provide high levels of access to primary care, especially compared to uninsured children, and to provide benefits comparable to private insurance.