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1、ImprovedAccessandQualityofCareAfterEnrollmentintheNewYorkStateChildren’sHealthInsuranceProgram(SCHIP)PeterG.Szilagyi,MD,MPH*‡;AndrewW.Dick,PhD‡;JonathanD.Klein,MD,MPH*‡;LauraP.Shone,MSW,DrPH*;JackZwanziger,PhD§;andThomasMcInerny,MD*ABSTRACT.Background.Althoughmanystudiesinsuranc
2、e),access(usualsourceofcare[USC]andunmethavenotedthatuninsuredchildrenhavepooreraccessneedsforhealthcare),utilization(visitsforspecificandqualityofhealthcarethandoinsuredchildren,fewhealthservices),andquality(continuitywithUSCandstudieshavebeenabletodemonstratethedirectbenefitsm
3、easuresofprimarycareinteractions).Analysesin-ofprovidinghealthinsurancetopreviouslyuninsuredcludedbivariatetests,comparingthepre-SCHIPperiodchildren.TheStateChildren’sHealthInsuranceProgramtothe1-yearperiodafterenrollmentinSCHIP.Multivar-(SCHIP),enactedasTitleXXIoftheSocialSecur
4、ityAct,iatemodelswerecomputedtogeneratestandardizedwasintendedtoimproveinsurancecoverageandaccesspopulationscomprisedofkeycharacteristicsofthesam-tohealthcareforlow-income,uninsuredchildren.Withpletotestfordifferencesinmeasures(afterSCHIPver-limitedstateandfederalresourcesforhea
5、lthcare,con-susbeforeSCHIP),controllingfordemographiccharac-tinuedfundingofSCHIPrequiresdemonstrationofsuc-teristics.cessoftheprogram.Asyet,littleisknownabouttheResults.Ofthe2644study-groupchildrenwhocom-effectivenessofSCHIPonimprovingaccessandqualitypletedtheinitialinterview,22
6、90(87%)completedtheofcaretoenrollees.follow-upinterview.Keymeasuresforthepre-SCHIPObjectives.TomeasuretheimpactoftheNewYorkperiodandshort-term“postenrollment”measuresfortheState(NYS)SCHIPonaccess,utilization,andqualityofstudygroupwerenotstatisticallydifferentfrommea-healthservic
7、esforenrolledchildren.suresforthecomparisongroup,suggestingnomajorDesignSetting.NYS,stratifiedinto4regions.Theseculartrends.NYSSCHIPismodeledoncommercialinsurance(32Participantswerenon-Hispanicwhite(25%),non-His-managedcareplans)andatthetimeofthestudyhad18%panicblack(31%),andHis
8、panic(45%).Fifty-onepercentofSCHIPenrolleesnati