August 1, 2002

Health science center researchers have documented that eligibility for Medicaid has a significant, positive impact on the health of poor children.

Since the 1960s, Medicaid, one of the largest items in the federal budget, has been the primary means of financing health care services for poor children. On several occasions in the late1980s, the federal government expanded Medicaid financial guidelines so more of the nationâ??s children would be eligible for the program.

Kristine Lykens, PhD, assistant professor of health policy at UNT Health Science Center, served as the primary author on a study investigating the link between the Medicaid expansion and the health of children enrolled in the program. The study found a statistically significant relationship between childrenâ??s eligibility for Medicaid and their overall health.

Dr. Lykens said that while a great deal of research has been conducted on how the expansions affected childrenâ??s access to health care, there has been little investigation into how they influenced the childrenâ??s actual health. The only previous studies measured mortality rates, which is not the best way to accurately measure the impact of the Medicaid expansions on the state of the eligible childrenâ??s health, she said.

Dr. Lykens and her collaborator, Paul A. Jargowsky, PhD, of the University of Texas at Dallas, used data that the National Center for Health Statistics in the Department of Health and Human Services collects in its annual surveys of randomly selected households in 48 states. The surveys ask questions about the health of one randomly selected child in the household. Drs. Lykens and Jargowsky used survey results from a four-year period between 1988 and 1991 and restricted their sample of data to children who were under 15 and eligible for Medicaid, based on household income.

The survey results included data on the number of acute illnesses, such as asthma and ear infections, a child had; the number of school days missed due to illness; how many days a child was confined to bed; and how long a child was restricted from normal activity during the two-week period before the respondents received the surveys. These are generally good indicators of how children are faring overall, and they demonstrate how illness impacts the childrenâ??s daily lives, Dr. Lykens said.

Drs. Lykens and Jargowsky showed that in addition to improving access to health care, the Medicaid expansions did have a significant, positive effect on the eligible childrenâ??s overall health. The study also showed that, while black and Hispanic children did benefit from the Medicaid expansions, those benefits were statistically more significant for white children. Dr. Lykens said this disparity in the findings might be attributed in part to a smaller sample of minorities in the households randomly surveyed by NCHS.

Drs. Lykens and Jargowsky also hypothesize that, due to the fact that many rural and inner city neighborhoods face a shortage of pediatricians, minorities may experience difficulties finding physicians in their area who accept Medicaid. Therefore, parents of children in those areas use the emergency room for the majority of their medical care, Dr. Lykens said. â??This reduces the improvement in childrenâ??s health because of a lack of continuity in their healthcare providers.â?

Dr. Lykens said Medicaid expansions â??added more than a million children to the program during the period of the study.â? However, she continued, â??We need to reduce the disparities, especially in access.â? She and Dr. Jargowsky recommend that more emphasis be placed on provider access, ensuring that children have physicians in their neighborhoods who accept Medicaid. They said this is especially important for minorities. The complete findings from this study are available in the spring 2002 issue of the Journal of Policy Analysis and Management.

Dr. Lykens said she plans to continue her investigation into the relationship between childrenâ??s health and public programs with an examination of the Childrenâ??s Health Insurance Program. CHIP, a federal program enacted two years ago, provides health insurance for children whose families do not qualify for Medicaid and lack private health insurance.

Dr. Lykens is a longtime researcher into health care policy and its effects. Before joining the health science center, she was a policy analyst for the Department of Health and Human Services in the Office of the Inspector General, where she evaluated the implementation of the CHIP program and the impact of HMOs on their beneficiaries.


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