title: Improving children's healthcare through state health insurance programs: an emerging need.
abstract: OBJECTIVE
  State Children's Health Insurance Program (SCHIP) in the USA plays a critical role in healthcare service utilization. This study assesses children's needs for healthcare services among the variations of SCHIP.
  
  
  METHODS
  This study applies the PRECEDE-PROCEED behavioral model to analyze the behavior of children with healthcare needs and unmet healthcare needs by using the National Survey of Children with Special Healthcare Needs of the USA.
  
  
  RESULTS
  Children who were previously under a Medicaid program are apt to enroll in SCHIP programs. SCHIP children with healthcare needs are more likely than comparable non-SCHIP children to use hospital outpatient departments instead of using doctors' offices and health centers. Children under the SCHIP single and SCHIP combination programs are more likely to use doctors' offices and health centers than those in the Medicaid expansion program. SCHIP combination or SCHIP Medicaid expansion states are significantly less likely to have unmet healthcare needs than children in SCHIP single states.
  
  
  CONCLUSIONS
  Medicaid has a significant impact on the SCHIP program. There is a substitution of healthcare service facilities between hospital outpatient departments and either the doctors' offices or health centers.
authors: Department of Epidemiology and Community Health, School of Health Sciences & Practice, New York Medical College, NY 10595, USA. ChiaChing Chen@nymc.edu
authors: Chia-Ching
authors: CC
authors: Chen
authors: Tetsuji
authors: T
authors: Yamada
authors: John
authors: J
authors: Smith
authors: I-Ming
authors: IM
authors: Chiu
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000592:standards; D002669:Child Welfare; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D019458:Insurance Coverage / Q000331:legislation & jurisprudence*; D007348:Insurance, Health / Q000331:legislation & jurisprudence*; D008297:Male; D008484:Medicaid; D011785:Quality Assurance, Health Care; D013219:State Government; D014481:United States