the family that one might not ordinarily consider. Obviously, the asthma-related hospitalization data does not prove that quality of life is improved. But, Ferguson said, in the absence of that specific data, we need to be able to make some inferences from the health data. It is clear that when you intervene and provide health coverage, there are better outcomes. Another study showed that children’s average school performance also increased within the year after enrolling in SCHIP as measured by ability to pay attention in class and to keep up with assignments (Managed Risk Medical Insurance Board, 2002). More of this type of data is needed, Ferguson said, to aid the policy-making process and to help make the case that health care interventions have a very wide-ranging impact on a child’s life.

Another study found that areas with greater Medicaid coverage experienced lower rates of preventable hospitalizations for children than areas with less Medicaid coverage. Children covered by Medicaid or SCHIP were equally as likely as children covered by private insurance to have had one or more visits to the doctor or health professional in the previous year, while uninsured children were 25 percent less likely. And approximately 3 percent of children with Medicaid/SCHIP delayed seeking medical care due to costs, only slightly higher than the 2 percent of children in private insurance. In comparison, 17 percent of uninsured children delayed medical care due to cost (Ku et al., 2007).

A fourth study Ferguson highlighted showed that children who had private insurance for either part of or the full year had about one more visit to the doctor each year than did uninsured children. Medicaid eligibility increased the probability of having at least one physician visit each year by about 10 percent. Compared to uninsured children, children covered with private insurance have more primary care visits, more preventive care visits, and more sick care visits each year; these visits translate into statistically significant improvements in immunization rates and an increased percentage of children screened for anemia, lead, and hearing and vision problems (Buchmueller et al., 2005).

Rhode Island RIte Care

From a commonsense perspective, Ferguson said, one of the best ways to ensure that pregnant women on Medicaid receive good prenatal care is to make sure that they have the same level of access to obstetrical/gynecological (OB/GYN) services that privately insured women have. This type of access was one of the quality improvements that were built into RIte Care, the Medicaid managed care program in Rhode Island implemented in the early 1990s, during the time Ferguson led the Department of Human Services (DHS) there.

Within a year and a half of implementation of the RIte Care program in



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