Download - Quality Improvement/ Disparities/Access
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Quality Improvement/ Disparities/Access
Group IV
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Context• We believe all children should have access to
health care • Health insurance enables access to health care• Currently SCHIP and Medicaid are two public
programs that provide health care coverage for low income children
• 9M children are currently uninsured and out of these 6M qualify for coverage but unenrolled– Medicaid to more individuals below the federal poverty
level ($20,200 for a family of four in 2008) who are parents or caretaker relatives of children eligible for Medicaid. But the states have chosen not to do so.
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All United States
Population
Number (in
thousands)
Employer
Individual
Medicaid/
Other Public
UninsuredSCHIP
Children 78,425 55.40% 4.40% 27.10% 1.40% 11.70%Low-Income Children* 33,340 24.10% 3.60% 51.90% 1.40% 19.10%Parents 67,031 68.30% 4.40% 9.00% 1.50% 16.80%*Low-income" is defined as under 200 percent of the Federal Poverty Level.
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Problem Statement• Two-thirds of uninsured children in
the US are eligible for SCHIP or Medicaid but are NOT enrolled
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Conceptual Framework for Evaluating the Consequences of Uninsurance:
A cascade of effects(IOM 2003)
Focusarea
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Rationale• Parents/families unaware of eligibility
status – Johnnie has a health problem but his
parents are unaware he is eligible for public health insurance coverage
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Rationale• Difficulty in enrollment process
– Johnnie’s parents find the application process too difficult and lacked documentation for the asset test
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Rationale• Difficulty in retention
– Johnnie’s dad gets a small raise and he loses his public health insurance program and is uninsured
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Proposed Solutions• Increase awareness of
SCHIP/Medicaid program– Parents/families of potential enrollees
• Streamline enrollment procedure• Improve retention
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Stakeholders• Interest Groups
– Families USA– Children’s Defense
Fund• Pharma• Taxpayer Associations• Voters• National Governors
Association• National Conference on
State Legislators• Heritage Foundation
• Children• Parents/Families• Health care
providers• State • Education• Day Care• Private Insurers• State Government• Employers
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Stakeholders• How are they impacted?
– Improved access to primary care• Improved health for children• Improved continuity of care• Decreased emergency room visits • Decreased hospitalizations
– Improved workforce productivity for parents– Improved educational performance of children– Increased utilization and cost (+ / -)
• Opportunity cost (+ / -) – State, special interest groups, employers
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Plan of Action• Increase awareness of public health
insurance programs• Promote state-based outreach
activities to increase enrollment– Increase federal match to states for
meeting enrollment targets– Disseminate to states “models of
excellence”
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Plan of Action• Streamline enrollment process
– Link/coordinate enrollment with other federal/state programs
– Develop common application form– Omit asset test (+ /-)– Disseminate “models of excellence”
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Plan of Action• Improve retention of health
insurance coverage for children– Mandate one year continuous
enrollment
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Implementation Strategies• Coalition building
– State Governors– Legislators– Special interest groups
• Identify champions in Congress– Senator Rockefeller
• Media coverage/moving public opinion
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Johnnie now has health insurance
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Resources• http://ccf.georgetown.edu/index/data
-healthcoverage#us• http://www.kff.org/medicaid/upload/2
177_06.pdf• Hidden Costs, Value Lost:
Uninsurance in America http://www.nap.edu/catalog/10719.html