title: Preventable hospitalizations among children in California counties after child health insurance expansion initiatives.
abstract: BACKGROUND
  California has expanded health insurance to children in low- and middle-income families. Currently, Children's Health Initiatives (CHIs) have been developed in 26 counties to supplement Medi-Cal and Healthy Families (SCHIP). Yet, as coverage expands, we know little about the impact of these programs on child health outcomes.
  
  
  METHODS
  Child hospitalizations for ambulatory care sensitive conditions (ACSC) is a widely adopted measure of health outcomes. We compare rates of total ACSC hospitalizations among children ages 0-18 years in 9 operational CHI counties prior to CHI implementation to rates after the CHIs became operational. As a comparison group, we stratify the analyses by family income level and compare children in lower-income to higher-income families.
  
  
  RESULTS
  Between 2000 and 2005, there were 281,000 total preventable hospital pediatric admissions. After adjusting for the effects of time and county, the rate of ACSC hospitalizations was 19% lower postimplementation of CHIs versus preimplementation for children of lower-income families (rate ratio of 0.81, P = 0.0001), but not for children of higher-income families (rate ratio of 0.99, P = 0.93).We estimate that 6324 ACSC hospitalizations may have already been prevented in existing CHI counties after implementation, saving about $6.7 million over the 6 years, assuming $7000 per child hospitalization.
  
  
  CONCLUSIONS
  With health insurance coverage available for all children, and families financially able to connect with an ongoing source of primary care, some of the potential benefits of reduced ACSC hospitalizations may help to offset premium costs associated with assuring that all children have coverage.
authors.affiliation: From the Department of Family Medicine, University of Southern California, Keck School of Medicine, Center for Community Health Studies, Los Angeles, California 90007, USA. cousinea@usc.edu
authors.forename: Michael R
authors.initials: MR
authors.lastname: Cousineau
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Stevens
authors.forename: Trevor A
authors.initials: TA
authors.lastname: Pickering
mesh_terms: D000293:Adolescent; D000385:Aid to Families with Dependent Children; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D002140:California; D002648:Child; D002662:Child Health Services / Q000191:economics*; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006284:Health Plan Implementation; D006300:Health Services Misuse / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000145:classification; D007223:Infant; D007231:Infant, Newborn; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D012044:Regression Analysis; D014481:United States; D019472:Universal Health Insurance / Q000331:legislation & jurisprudence*