Evaluation of the San Mateo County Children's Health Initiative: First Annual Report

Evaluation of the San Mateo County Children’s Health Initiative: First Annual Report Embry Howell, Urban Institute Dana Hughes, University of California San Francisco Holly Stockdale, Urban Institute Martha Kovac, Mathematica Policy Research April 19, 2004 Submitted to: San Mateo County Children’s Health Initiative Coalition 225 37th Ave. San Mateo, CA 94403 CONTENTS Executive Summary................................................................................. i Introduction...........................................................................................1 San Mateo County...................................................................................2 History of the San Mateo County Children’s Health Initiative ........................... 5 Organization of the CHI........................................................................... 8 Outreach and Enrollment........................................................................10 Outreach Events and Publicity...................................................................10 School-Based Outreach.............................................................................11 Outreach Workers...................................................................................12 The Healthy Kids Program...................................................................... 14 Enrollment Process for Healthy Kids..........................................................15 Benefits.................................................................................................16 Healthy Kids Provider Network.................................................................17 Ongoing Follow-Up with Members............................................................18 Financing the CHI.................................................................................18 Inputs....................................................................................................18 Outputs..................................................................................................19 Early Experience with the CHI.................................................................21 Did health insurance coverage change for children in San Mateo County?........21 Who is served by the San Mateo County CHI?.... ....................................23 What services did Healthy Kids enrollees receive as part of the initiative? Did the CHI affect access to care for children who enrolled? Did the CHI affect where services were received?............................ ..........................................24 Did the CHI affect the cost of care?............................................................26 Did the CHI enhance the delivery and stability of the community health care system?..................................................................................................27 Has the CHI increased community-wide collaboration to address issues of the uninsured?.............................................................................................28 Conclusions from the Evaluation of the First Year of the CHI...........................28 Health Insurance Coverage.......................................................................29 Use of Services and Access to Care............................................................29 Cost of Care and Stability of Public Health Financing...................................30 Factors in Success..................................................................................30 Future Challenges...................................................................................31 A National Perspective............................................................................32 Addendum: Plans for the Second Year of the Evaluation................................34 Process Analysis.....................................................................................34 Descriptive Program Analysis...................................................................34 Provider Analysis....................................................................................36 Table 1: Research Questions for the Evaluation of the San Mateo County CHI .....38 Table 2: Proposed Schedule for San Mateo Evaluation....................................39 Table 3: Demographic Characteristics of Ever-Enrolled Children.....................40 Table 4: Preventive and Non-Preventive Ambulatory Visits..............................41 Table 5: Emergency Room Visits and Hospital Stays.......................................42 Table 6: Average Cost per Eligible Child.....................................................43 Table 7: Admissions and Emergency Room Visits..........................................44 Table 8: Revenues and Uncompe