Impact of the State Children's Health Insurance Program on adolescents in New York.
OBJECTIVE
Adolescents face financial and nonfinancial barriers to health care. Little is known about the impact of health insurance on health care for adolescents. We assessed the impact of New York's State Children's Health Insurance Program on access, use, and quality of care for adolescents.


METHODS
Adolescents and their parents from a stratified random sample of new enrollees in New York's State Children's Health Insurance Program were interviewed by telephone shortly after enrollment (baseline, n = 1118 adolescents and their parents) and 1 year later (follow-up, n = 970). Outcome measures included access (having a usual source of care and reported unmet health needs), use (preventive care and other types of visits), and quality (satisfaction with care, receipt of confidential care and preventive counseling). Outcomes were assessed at baseline (year before the State Children's Health Insurance Program) versus follow-up (year during the State Children's Health Insurance Program).


RESULTS
The proportion of adolescents who reported having a usual source of care increased during State Children's Health Insurance Program compared with before (69.9% to 87.1%). The proportion with any unmet health care need (54.3% to 42.1%) or with unmet need for preventive care (53.8% to 40.6%) decreased, with elimination of racial disparities that existed before the State Children's Health Insurance Program. After enrollment in the State Children's Health Insurance Program, more adolescents reported having had a preventive care visit (65.9% to 74.2%); emergency department use did not change. No differences in satisfaction were noted, although significant increases were noted in both parent- and adolescent-reported rates of having received confidential care and preventive counseling.


CONCLUSIONS
Adolescents who enrolled in New York's State Children's Health Insurance Program experienced improved access, use, and quality of care. These findings suggest that the provision of health insurance can help to improve health care for adolescents.
Klein
Jonathan D
JD
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. jonathan_klein@urmc.rochester.edu
Shone
Laura P
LP
Szilagyi
Peter G
PG
Bajorska
Alina
A
Wilson
Karen
K
Dick
Andrew W
AW
D000293:Adolescent; D016497:Adolescent Health Services / Q000191:economics* / Q000706:statistics & numerical data; D002648:Child; D002662:Child Health Services / Q000191:economics; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics; D006302:Health Services Research; D006801:Humans; D019458:Insurance Coverage / Q000331:legislation & jurisprudence*; D007348:Insurance, Health / Q000331:legislation & jurisprudence*; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D020380:Needs Assessment; D009518:New York; D011336:Probability; D016730:Program Development; D015397:Program Evaluation; D011787:Quality of Health Care; D018570:Risk Assessment; D012959:Socioeconomic Factors; D013221:State Health Plans / Q000191:economics / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D014481:United States