Table 1.

Overview of Studies of Effect of Insurance Expansions on Child Health

Author	Study Date	Place of Study	Data Source	Methods	Conclusions	Issues
Currie and Gruber (1996)	1985–1993	United States	Current Population Survey	Examine trends statewide in mortality for children according to percent of children covered by Medicaid in the state	Child mortality rates fell more rapidly in states with higher increase in Medicaid coverage for children	No individual-level data on mortality. No subgroup analysis
Kaestner, Joyce, and Racine (2001)	1988–1992	United States	Nationwide sample of hospital discharges (Health Cost and Utilization Project)	Rates of admission for Ambulatory Care Sensitive Conditions for children in low income and high income areas compared before and after Medicaid expansions	ACS admissions reduced only for children ages 2–6 in lowest income areas	No individual-level data on insurance status or income
Racine et al. (2001)	1989 and 1995	United States	National Health Interview Survey	Compared changes in restricted activity days before and after Medicaid expansions for poor and nonpoor children	No significant difference in trends in restricted activity days between poor and nonpoor children	Unclear whether rates were adjusted for age
Holl et al. (2000)	1991–1993	Six western New York counties	Telephone survey of parents of children enrolled in new insurance (CH Plus)	Parents of children age 0–5 continuously enrolled for 9 months were asked whether their child's health improved as a result of the program	25% of parents felt their child's health had improved after enrollment	No comparison group
Skarr et al. (2002)	2001–2002	California	Mailed survey to parents of children enrolled in Healthy Families (SCHIP)	Studied changes to health related quality of life from 2001 to 2002, for children in bottom quartile of health related quality of life in 2001	Health related quality of life was higher after 1 year of enrollment	No comparison group. Only 34% of parents responded to both waves of the survey
Damiano et al. (2003)	1999–2000	Iowa	Mail survey (with telephone follow-up) of parents of children enrolled in hawk-i (SCHIP)	Compared perceived health status, school days missed, and functional limitations at time of enrollment in program to year after enrollment	Children's health status improved according to all three measures, after enrollment in hawk-i	No comparison group. Only 21% of parents responded to both waves of the survey
Fox et al. (2003)	1999–2000	Kansas	Mail survey of parents of children enrolled continuously for 1 year in Health Wave (SCHIP), at enrollment and 1 year after enrollment	Compared perceived health status, perception of health improvement, and school days missed, at enrollment and 1 year after enrollment	After 1 year of enrollment children's health status improved and fewer school days were missed due to health. More parents perceived an improvement in their child's health in the past year	No comparison group. Only 48% parents responded to both waves of the survey
Flores et al. (2003)	1997–1998	Boston Medical Center	In-person interview with parents of children admitted with one of 16 conditions. In-person or telephone interview with child's primary care and inpatient physicians	Interviews examined whether problems with access to care led to hospitalization	Uninsured children were almost three times as likely as privately insured children to have an avoidable hospitalization, according to all three respondents	Small sample size: of 554 children in the study, only 16% (88 children) were uninsured