title: The impact of the Iowa S-SCHIP program on access, health status, and the family environment.
abstract: OBJECTIVE
  To determine the effect of the Iowa Separate State Child Health Insurance Program (S-SCHIP) on need for services, utilization and access to care, child health status, and the family environment.
  
  
  METHODS
  A longitudinal pretest-posttest panel survey was used to evaluate differences in children's access to health care, health status, and family environment at the beginning of the program and after 1 year. Written surveys with telephone follow-up calls were used to collect the data. Pre- and postquestionnaire results for 463 children were matched and compared using the McNemar test for correlated proportions and the Wilcoxon signed rank test. Approximately 71% of families responded to both surveys.
  
  
  RESULTS
  Similar rates of perceived need for each of 6 service areas were found after being in the program for a year as before. Unmet need was significantly reduced among those needing services: medical care (27% before, 6% after), specialty care (40% before, 13% after), dental care (30% before, 10% after), vision care (46% before, 12% after), behavioral and emotional care (42% before, 18% after), and prescription medications (21% before, 13% after). Overall health status was rated significantly better (ie, excellent: 37% before, 42% after). Ninety-five percent of families reported a reduction in family stress, and there was significantly less worry about the ability to pay for their child's health care (92% before, 57% after). The activities of fewer children were limited because of potential health care costs.
  
  
  CONCLUSIONS
  The Iowa S-SCHIP program improved access to care and the family environment for children enrolled during the first year without a change in perceived need for services.
authors.affiliation: Public Policy Center, University of Iowa, Iowa City, Iowa 52242, USA. peter-damiano@uiowa.edu
authors.forename: Peter C
authors.initials: PC
authors.lastname: Damiano
authors.forename: Jean C
authors.initials: JC
authors.lastname: Willard
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Momany
authors.forename: Jyoti
authors.initials: J
authors.lastname: Chowdhury
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D003695:Delivery of Health Care; D003729:Dental Care; D005260:Female; D006304:Health Status; D006801:Humans; D007223:Infant; D007348:Insurance, Health; D007484:Iowa; D008137:Longitudinal Studies; D008297:Male; D008484:Medicaid; D008511:Medicine; D011320:Primary Health Care; D011787:Quality of Health Care; D013038:Specialization; D013222:State Medicine