By Joe Touschner

As part of its comparison of CHIP to private coverage, the Government Accountability Office (GAO) was charged with evaluating CHIP enrollees’ access to care.  At a high level, GAO’s findings confirm previous studies of access to care in public and private coverage:  enrollees of both report having good access when asked if they have a usual source of care or whether they can get an appointment when needed.  And like other studies, it found that publicly-covered children are somewhat less likely to receive dental care and somewhat more likely to visit emergency departments than privately insured children, though the study does not investigate the appropriateness of any type of service use.

But the GAO study takes important new steps to provide a more detailed look at how access in CHIP—not public coverage generally—compares to other coverage sources.  Drawing precise conclusions about access in CHIP has historically been difficult for a couple of reasons.  First, the main data source for access questions, the Medical Expenditure Panel Survey (MEPS), lumps CHIP together with other public coverage.  In addition, making direct comparisons on access between those in public and private coverage can be misleading.  CHIP and Medicaid serve different people than does private coverage.  The population of those with public coverage has a different composition in terms of age, income level, parent education, English proficiency, and other factors and these factors may also contribute to access challenges independently of the source of coverage.

GAO analysts, though, worked to overcome both of these confounding factors.  They assessed which MEPS respondents were likely to enroll their children in CHIP rather than Medicaid, allowing for distinct looks at CHIP, Medicaid, and private insurance.  Before controlling for other variables, they found that parents of CHIP enrollees reported similar ease of accessing care to those in Medicaid and private insurance.  And they found some variation in service use across coverage types, with CHIP and Medicaid enrollees less likely to receive dental care and more likely to visit emergency departments than those with private coverage.  Service use, as expected, was higher for those in any coverage source than for the uninsured.

But once they introduced demographic controls for factors like income and English proficiency, GAO found that children enrolled in CHIP were MORE likely to both visit a dentist and visit the emergency department.  They were less likely to report ease in getting needed care and to make orthodontist visits than the privately insured. (Note that GAO studied MEPS data from 2007 through 2010, largely before CHIPRA made orthodontic coverage a national requirement in CHIP.)

GAO’s report provides us with a more nuanced look at access to care in CHIP than has previously been available.  It confirms previous studies that have found those with public coverage report similar levels of access to care to the privately insured.  It demonstrates that those with coverage of any type use it—they access health services more than the uninsured.  And it suggests one area where CHIP programs could work to improve access—orthodontic care, though more updated data in this area would be helpful.