Impact of State Children's Health Insurance Program (SCHIP) on children's access to primary care in South Carolina: A study of hospitalizations with ambulatory care sensitive conditions (ACSC)

This study examined the effect of SCHIP on children's health as measured by the incidence of hospitalizations with Ambulatory Care Sensitive Conditions (ACSC). For the study, hospital discharge data for children aged 0 to 18 years old in South Carolina was used. To see the effectiveness of SCHIP, data was asked for the period of 1995 to 2001. This study focused on: (i) report the trends of ACSC hospitalizations, (ii) examine the association of the proportion of ACSC with sociodemographic/socioeconomic characteristics, (iii) identify most common ACSC in South Carolina, (iv) assess impact of SCHIP on ACSC admissions.; Logistic regression was used, to find out likelihood of being hospitalized for ACSC, by sociodemographic factors. The study also used Generalized Estimating Equations (GEE) with a negative binomial model to investigate differences in rates of ACSC admissions across time. As results, 269,403 hospital discharges were detected during study period (1995∼2001). Of those, 77,339 discharges (28.7%) were with ACSC. Male, African-American, younger children, and those living in rural counties were more likely to be hospitalized with ACSC. These findings are consistent with many previous studies. Unlike results from previous studies, however, children enrolled in Medicaid were less likely than those with other payment categories to be in hospital beds for ACSC. Although the number of uninsured children declined after SCHIP introduced, no program effect was found on rates of ACSC over time. During study period, bacterial pneumonia, asthma, and dehydration were most prevalent pediatric ACSC in South Carolina.; Despite the results for effectiveness of SCHIP on ACSC rates, hospital discharge data is a great source to investigate trends and risk factors of preventable hospitalizations. The result for likelihood of hospitalizations with ACSC from Medicaid children can be an implication to policymaker. In addition, negative association of number of community health centers (CHC) in area with the ACSC admission rates implies needs of CHC to improve children's health, particularly in rural areas.