The Florida KidCare Evaluation: Statistical Analyses Betsy Shenkman, PhD Jana Col, MA Heather Steingraber Christine Bono
Purpose To build from the descriptive reports of past three state and federal fiscal years To examine the complex health, sociodemographic, and community relationships that influence children s health care outcomes
Analyses Sociodemographic characteristics of uninsured eligibles to enrollees Factors influencing disenrollment Factors influencing satisfaction as measured by Consumer Assessment of Health Plans Survey (CAHPS) Health care use analyses
Healthy Kids and Medicaid: Enrolled Compared to Eligible and Uninsured* 80 70 60 50 40 30 20 10 0 White Black Other Hispanic Healthy Kids Enrolled Healthy Kids Eligible Medicaid Enrolled Medicaid Eligible MediKids shows same pattern 4
Disenrollment: Frequency of Events 70 60 50 40 30 20 10 0 None One Two Three Healthy Kids MediKids Medicaid CMS
Significant Factors Related to Disenrollment Age MediKids and Medicaid only Increased risk of disenrollment from Medicaid with increased age Decreased risk of disenrollment with increased age for MediKids (did not count entering Healthy Kids as a disenrollment)
Significant Factors Related to Disenrollment Healthy Kids enrollees with special health care needs were 31% less likely to disenroll than their healthy counterparts Children in Medicaid with special needs 6% more likely to disenroll than healthy counterparts 5% went to CMS 15% went to HealthyKids 6% to MediKids 74% not located
Significant Factors Related to Disenrollment Lower income families less likely to disenroll Urban versus Rural location CMS enrollees in urban areas 21% less likely to disenroll than those in rural areas Healthy Kids enrollees in urban areas 16% less likely to disenroll than those in rural areas Not significant MediKids Marginally significant Medicaid
CAHPS Results Five clusters assessed: Getting needed care Getting care quickly Doctor communication Courtesy of office staff Health plan customer service Asked only of those who had the experience No program differences noted, after controlling for child health and sociodemographic characteristics
CAHPS Results Individual Items % reporting they always got the help or advice needed for child when calling the doctors office. In the last 12 months, did you make any appointments for your child with a doctor or other health care provider for regular or routine health care? % indicating it was not a problem to get care for child that respondent or a doctor believed necessary.
CAHPS Results Individual Items % agreeing that doctors or other health care providers always spent enough time with child. % reporting child s doctors or other health care providers always listened carefully. % reporting office staff at child s doctor s office or clinic was always helpful as they should be. % reporting it was not a problem to get needed help when calling child s health plan s customer service.
CAHPS Results Families with special needs children were about half as satisfied with getting care for their children that they or their doctor believed necessary when compared to families with healthy children. This finding was consistent for all KidCare Program components (i.e., Medicaid, MediKids, Healthy Kids, and CMS).
CAHPS Results In 1999, both CMS and Healthy Kids families were about twice as satisfied with the time that the doctor spent with their child than families in Medicaid. There was no difference found between MediKids and Medicaid participants for this item. There was a similar, though marginal, program effect in 2001, with Healthy Kids more satisfied with the amount of time their doctors spend with their children when compared to Medicaid participants.
Adolescent Preventive Care Focused on content of preventive care visits and counseling for risky behaviors 40% of adolescents in Healthy Kids and Medicaid reported risky behaviors Only about 1/3 received counseling for sexual activities, tobacco, alcohol, and safety issues
Changes in Unmet Health Care Needs - Physician o All established enrollees in Medicaid, MediKids, Healthy Kids, and CMS showed a significant decrease in unmet physician care needs, after considering important covariates such as race/ethnicity, gender, age, and the presence of special health care needs.
Unmet Prescription Needs o Healthy Kids and CMS established enrollees had significantly decreased unmet needs for prescription drugs compared to new enrollees; whereas Medicaid and MediKids enrollees did not. Hispanic families in CMS reported fewer reductions in unmet prescription drug needs when compared to white
Unmet Mental Health Needs Healthy Kids and CMS established enrollees had significantly decreased unmet needs for mental health care; whereas Medicaid and MediKids enrollees did not. Black non-hispanics in CMS and Healthy Kids reported fewer reductions in unmet mental health care needs when compared to white non- Hispanics. Rural residents in CMS, but not in any of the other KidCare Program components, reported fewer reductions in unmet mental health care needs when compared to urban residents.
Unmet Dental Needs CMS established enrollees had significantly reduced unmet dental care needs. Medicaid established enrollees had marginally significant reductions in unmet dental care needs compared to new enrollees (p<0.058) as did Healthy Kids enrollees (p<0.056).
Changes in Health Status Healthy Kids established enrollees showed a significant improvement in the CHQ psychosocial summary scores compared to new enrollees; whereas the other KidCare Program components did not. Whether the child had a special need was most closely related to physical and psychosocial functioning scores.
Children s Access to Care: Primary Care Visits 80 70 60 50 40 30 20 10 0 12-24 months 25 months-6 years 7-11 years Overal Healthy Kids MediKids Medicaid
Incidence of Inpatient Stays and Emergency Room Use for Ambulatory Care Sensitive Conditions 12 10 8 6 4 2 0 Percent of Hospital Stays Percent of ER Visits Healthy Kids MediKids Medicaid CMS
Follow-Up Outpatient Care After Inpatient Mental Health Stay 70 60 50 40 30 20 10 Healthy Kids MediKids Medicaid CMS Overall 0 Percent with Visit