Using Health Status to Measure Quality of Care for Young Children

THE URBAN INSTITUTE Using Health Status to Measure Quality of Care for Young Children Embry Howell, Urban Institute Lisa Dubay, Johns Hopkins University Louise Palmer, Urban Institute Presented to: AcademyHealth Annual Research Meeting June 3, 2007 Background: Purpose of Children’s Health Initiatives • Expand health insurance coverage • Enhance outreach and enrollment for Medi-Cal, Healthy Families, and Healthy Kids • Offer new insurance product, “Healthy Kids,” to children ineligible for Medi-Cal and Healthy Families • Improve health service access and use • Improve health status of enrolled children THE URBAN INSTITUTE Background • Los Angeles Healthy Kids: New insurance program for previously uninsured low income children in county • Ages covered: 0-5 (7/03); 6-18 (4/04) • Income level: <300% of federal poverty level THE URBAN INSTITUTE Evaluation of Los Angeles Healthy Kids • Joint project of the Urban Institute, UCLA, USC, Mathematica Policy Research, and consultant Lisa Dubay • Sponsored by First 5 Los Angeles • Evaluation began in 2004 • Multiple components – Extensive process analysis – Process monitoring – Client survey and analysis THE URBAN INSTITUTE Survey • Wave One: April – December, 2005 • Wave Two: May, 2005 – January, 2006 • Sample Size / Response Rate: – Initial Sample: 1262 children ages 1-5 – Interviewed in Wave One: 1087 (86%) – Interviewed in both Waves: 975 (77%) • Most (88%) interviews in Spanish • Descriptive Wave One results presented in October 2006 report, available on UI website (www.urban.org) THE URBAN INSTITUTE Timing of Enrollment and Interviews for Study Cohorts THE URBAN INSTITUTE Analysis • Two analysis cohorts: – New enrollees: just enrolled at Wave One – Established enrollees: just renewed coverage at Wave One after one year of enrollment • Baseline differences between new and established enrollees • Changes over time for new and established enrollees • Statistical adjustment for differences in two cohorts THE URBAN INSTITUTE 100% Description of Study Cohort: Characteristics at Wave One New Enrollees Established Enrollees 80% Weighted Percents 60% 54.1% 45.2% 42.0% 40% 35.8% 31.2% 23.1% 21.3% 19.4% 28.3% 27.3% 30.7% 20% 10.0% 16.0% 11.3% 2.4% 0% 0.7% 1 2 3 4 5 0-1 2-3 4+ Age THE URBAN INSTITUTE Parent’s Length of Time in LA County (years) Perceived Health Status: Percent of Healthy Kids in Excellent/Very Good Health 100% Regression-Adjusted % In Excellent/VG Health 80% 60% 55.1Δ 43.1 46.8 54.8* 40% 20% 0% New Established New Established WAVE ONE THE URBAN INSTITUTE Δ W1 N < W2 N, p<.01 * W1 E < W2 E, p<.05 WAVE TWO 9 Percent of Healthy Kids in Excellent/VG Health: Children Who Enrolled for Medical Reasons 100% Regression-Adjusted % In Excellent/VG Health 80% 60% 39.1 40% § 45.6 Δ 49.1* 27.1 20% 0% New Established New Established WAVE ONE §: W1 N < W1 E, p<.05 Δ: W1 N < W2 N, p<.01 *: W1 E < W2 E, p<.05 WAVE TWO THE URBAN INSTITUTE 10 Percent of Healthy Kids in Excellent/VG Health: Children Not Enrolled for Medical Reasons 100% Regression-Adjusted % In Excellent/VG Health 80% 62.2Δ 60% 53.1 58.3* 51.4 40% 20% 0% New Established New Established WAVE ONE Δ: W1 N < W2 N, p<.05 *: W1 E < W2 E, p<.10 WAVE TWO THE URBAN INSTITUTE 11 10% Percent of Healthy Kids with Activity Limitations Regression Adjusted % Percent with Activity Limitations 8% 6% 5.3 3.9 3.7 2.2Δ 4% 2% 0% New -2% Established New Established WAVE ONE Δ W1 N > W2 N, p<.01 WAVE TWO THE URBAN INSTITUTE 12 Percent of Healthy Kids with Problem Concerning Parent a Great Deal in Past Month 50% Regression-Adj. % w/Prob. in Past Mo. Concerning Parent 40% 30% 26.4 25.9 17.0Δ 15.4* 20% 10% 0% New Established New Established WAVE ONE THE URBAN INSTITUTE Δ: W1 N > W2 N, p<.01 *: W1 E > W2 E, p<.01 WAVE TWO 13 Percent of Healthy Kids Parents With Any Developmental Concerns 100% Regression-Adjusted % Parents w/ Dev. Concerns 80% 60% 57.9 53.3§ 53.5 51.5 40% 20% 0% New Established New Established WAVE ONE §: W1 N > W1 E, p<.10 WAVE TWO 14 THE URBAN INSTITUTE Conclusions • New health insurance coverage can improve health quickly even in youngest age group. • Improvements occurred in both new and established enrollees. • The health status of children, as perceived by their parents, improved over one year. • Improvements were most pronounced among children who enrolled for medical reasons THE URBAN INSTITUTE Conclusions • Fewer episodic health problems after one year. • Possible reductions in activity limitations and developmental concerns; evidence is weaker. • Possible regression to the mean for new enrollees. • More research needed. THE URBAN INSTITUTE