A timely new study published in JAMA Pediatrics compares how effective coverage under arrangements in Medicaid, CHIP, and private coverage are in meeting children’s health needs. With our recent report out on children’s uninsurance rates in the nation and all 50 states, this data provides insight into access, quality, and cost of health care services for insured children.

In Quality of Health Insurance Coverage and Access to Care for Children in Low-Income Families, researchers used data from the 2003, 2007, and 2011-2012 National Survey of Children’s Health to analyze parent and caregiver-reported outcomes regarding access to primary and specialty care, unmet needs, out-of-pocket costs, care coordination, and satisfaction with care – among other measures of adequacy – for children (under age 18) with incomes between 100 and 300 percent of the Federal Poverty Level (FPL).* In other words, researchers asked:

• How does Medicaid, CHIP, and private coverage compare in meeting the needs of low- and moderate-income children and families?
• How do vulnerable children – children with special health needs and young children under age 5 – with low- and moderate-incomes fare depending on what type of coverage they have?

CHIP and Medicaid are often better, or on par, with private coverage in terms of meeting the health needs for children.

More detailed information that includes confidence intervals, significance, and breakouts by income group are available in the study’s supplement.

• Children with Medicaid and CHIP were more likely than children with private insurance to receive a preventive medical visit (88% in Medicaid, 88% in CHIP, 83% in private coverage) as well as a preventive dental visit (80% in Medicaid, 77% in CHIP, 73% in private coverage). Children with Medicaid and CHIP were also more likely to have insurance that always met a child’s health care needs (78% in Medicaid and CHIP, 73% in private coverage).
• Children with Medicaid, CHIP, and private coverage fared equally in terms of having a personal physician or nurse (89% across the board), having a usual source of care (93-94%), having insurance that always allows a child to see needed health care providers (82-84%), receiving effective care coordination when needed (68-72%), and receiving family-centered care (66-67%).

Regardless of coverage type, about one in four families had difficulty accessing specialists, however children with CHIP reported the greatest difficulty.

• Children with CHIP more often reported problems seeing a specialist (23% in Medicaid, 28% in CHIP, 22% in private coverage), obtaining a referral (18% in Medicaid, 23% in CHIP, 15% in private coverage), and feeling frustrated obtaining health care services (20% in Medicaid, 26% in CHIP, 23% in private coverage).

Caregivers with children in private coverage were far more likely to pay out-of-pocket for health care.

• Children in Medicaid and CHIP are far less likely to report having out-of-pocket costs compared to privately insured children (26% in Medicaid, 38% in CHIP, and 77% in private coverage).

These results were more pronounced for children with special health care needs, who reported higher levels of frustration obtaining health care services in private coverage (36%) compared to Medicaid (28%) and CHIP (33%).

As we have noted elsewhere, children with health coverage are more likely to grow up to be healthier and more economically successful, and, in doing so, provide a return on investment for government-sponsored programs. The results of this study confirm that children with public and private health coverage are able to access vital preventive care services, but work remains to ensure children have access to specialty providers and affordable services.

* Note that respondents in the survey indicated that they had Medicaid or CHIP. Authors imputed coverage in Medicaid versus CHIP based on respondents’ income and state eligibility policies, which can potentially lead to error. Out-of-pocket costs do not include premiums and the amount of money spent.