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During the 1980s and 1990s there were great increases in health insurance coverage for poor children through the Children's Health Insurance Program (CHIP) and extended Medicaid eligibility. Problems remain for the small number of children with serious medical conditions whose care is a high proportion of total health care expenditures on children. We report on the adequacy of health insurance coverage for a sample of children with serious and rare illnesses treated at the single tertiary care pediatric hospital in Indiana. One third of privately insured children in our data had inadequate insurance. Compared to families with inadequate health insurance, families with adequate insurance were 50% less likely to delay care for themselves and 67% less likely to delay care for a child. Our research identifies policy-relevant deficiencies in private health coverage for seriously ill children ineligible for either Medicaid or CHIP. [ABSTRACT FROM AUTHOR]

Abstract: Claims-based utilization data collected in four Medicaid demonstration programs are used to examine the impact of primary care case management on patterns of reliance on the emergency room as a source of services. The experience of stratified random samples of AFDC (Aid to Families with Dependent Children) adults and children in the demonstration programs is compared with that of ≡ samples from comparison groups in traditional Medicaid programs. Data were analyzed in multivariate models controlling for person characteristics in a pre/post, demonstration/ comparison design. Results indicated large reductions in the proportion of persons with at least one emergency room visit ranging from 27 to 37 per ¢ for children and 30 to 45 per ¢ for adults. Use levels for persons with at least one ER visit are less substantially affected. The findings suggest that gatekeeping designs can alter patterns of enrollee use with respect to the emergency room and some discussion of these implications is presented. [ABSTRACT FROM AUTHOR]