In the fall of 1998, North Carolina implemented its State Children Health Insurance Program, North Carolina Health Choice for Children (NCHC). This stand-alone, fee-for-service program quickly enrolled large numbers of children and has been considered one of the State Children Health Insurance Program success stories.
To explore the perceptions of parents of children enrolled in NCHC regarding their children's access to health care services before and after enrollment in the NCHC.
Design and Setting
Qualitative and quantitative data analyses are combined to assess program effectiveness. Two waves of surveys were fielded. A baseline survey asked parents of children newly enrolled in NCHC questions about their child's health experiences before enrollment in NCHC. Parents who responded with baseline data were resurveyed 1 year later to collect information on their child's experiences while insured by NCHC.
Parents of 987 children newly enrolled in NCHC in the summer of 2000, randomly chosen within 3 age group strata.
The NCHC has been successful in improving access to health care for low-income children. Parents reported that the program helped make health services financially accessible to their children, enabling them to get needed physician's care, eyeglasses, or prescription drugs. A significantly higher percentage of children received care in the private sector, increasing from 62% to 75% for well-child care visits and 67% to 78% for acute care. The percentage of children with unmet medical needs dropped significantly from 20% to just 2% after enrollment in NCHC. The improvement in access to care is much more striking for the older age groups and for children who were uninsured prior to NCHC enrollment (rather than those who graduated from Medicaid into the program). Despite these gains, there are still substantial numbers of children who are not receiving age-appropriate well-child care.
The NCHC has successfully improved access to care for its enrollees.