implemented in Volusia County, Florida, in 1991, where it wasestimated that. 12 000 or 25% of school-aged children were uninsured.3 The purpose of the.
Public Health Briefs
The School Enrollment-Based Health Insurance Program: Socioeconomic Factors in Enrollees' Use of Health Services Elizabeth Shenkman, PhD, Jane Pendergast, PhD, John Reiss, PhD, Erika Walther, Mstat, Richard Bucciarelli, MD, and Steve Freedman, PhD
Introduction The School Enrollment-Based Health Insurance program provides low-cost health insurance to families who are not Medicaid eligible and cannot afford private insurance.' The program targets families with school-aged children, who represent 66% of the uninsured nationally.' It provides an alternative to employer-based health insurance by using schools as the grouping mechanism to negotiate health insurance policies. The coverage for children is more stable because it will not be disrupted if a parent changes or loses his or her job. A demonstration of this program was implemented in Volusia County, Florida, in 1991, where it was estimated that 12 000 or 25% of school-aged children were uninsured.3 The purpose of the demonstration was to reduce financial barriers to health care for children. Families were offered free or partially subsidized premiums according to a sliding scale (see Table 1). The benefit package included well-child visits and immunizations with no copayment. Minimal copayments were required for inpatient care, mental health services, prescriptions, therapies, and emergency services. School staff marketed the program using brochures and an automatic telephone calling system. A health maintenance organization (HMO) provided care using staff physicians at two clinic sites and contract physicians in private practice throughout the county. Before enrolling the program's population, this HMO provided care only to the commercially insured. Once the population was enrolled, HMO staff sent enrollees written materials about primary care providers, covered benefits, and persons to contact with questions.
The purpose of this study was to determine if any socioeconomic measures differed significantly between program enrollees with at least one health care encounter and those with no health care encounters, after adjusting for the number of months enrolled. We wanted to determine if socioeconomic variables, which were not expected to predict health care use in a private sector children's health program with reduced financial barriers to care, were nevertheless still associated with differing use.
Methods Logistic regression was used to assess the impact of various predictors on the odds that a child would use health care services. The HMO provided childspecific data, including Physician's Current Procedural Terminology codes, from the date of program implementation in March 1992 through December 1993. The children were subdivided into those who had at least one health care encounter, the "users," and those who did not, the 4"nonusers." A health care encounter was defined as the presence of at least one current procedural terminology code during enrollment. Predictor variables included age at enrollment, sex, race, ethnicity, participaElizabeth Shenkman, John Reiss, and Steve Freedman are with the Institute for Child Health Policy and the Department of Pediatrics; Richard Bucciarelli is with the Department of Pediatrics; and Jane Pendergast and Erika Walther are with the Department of Statistics, Division of Biostatistics, all at the University of Florida, Gainesville. Requests for reprints should be sent to Elizabeth Shenkman, PhD, Institute for Child Health Policy, 3700 SW 34th St, Ste 323, Gainesville, FL 32608. This paper was accepted April 23, 1996.
American Journal of Public Health 1791
Public Health Briefs
TABLE 1-Characteristics of School Enrollment-Based Health Insurance Program Enrollees Who Did and Did Not Use the Health Services
Age, y Months enrolled Household size School lunch program, % Full participation Partial participation Sex, % Female Male Race/ethnicity, % White African American Hispanic Asian Indian Plan subsidy level, % Full-Subsidy Plan 1: income below 100% of the FPL Partial-Subsidy Plan 2: income between 101% and 135% of the FPL, $2.50 per child per month Partial-Subsidy Plan 3: income between 136% and 185% of the FPL, $13.00 per child per month No subsidy: income above 186% of the FPL, $46.00 per child per month
Total Group (n = 5848)
Program Users (n = 4368)
Program Nonusers (n = 1480)
10.6 ± 0.90 14.4 ± 0.94 3.89 ± 1.56
10.7 ± 0.89 15.6 ± 0.85 3.89 ± 1.48
10.4 ± 0.90 11.2 ± 0.98 3.89 ± 1.78
84 16
82 18
90 10
52 48
52 48
53 47
66 19 14 1
