Designing Accountability Systems

  1. States should begin immediately to design and implement systems to produce meaningful information on SCHIP's effects.

Public Information

  1. Information on SCHIP should be made available by states to the public and should be meaningful in evaluating the program's performance.

Data Collection and Performance Reporting

  1. As much as possible, states should delegate the collection and synthesis of SCHIP information to contracted health plans or provider groups, with requirements for independent auditing of these data.

Performance Incentives and Rewards

  1. States should set conditions for participation in SCHIP, experiment with a variety of incentives to reward health plans for their performance, and develop the technical and analytical capacity to evaluate the impact of incentives on health plan performance.


SCHIP is historic, innovative, and rapidly evolving. It offers an unprecedented opportunity to move from the traditional monitoring and compliance models of health care, which focus on financial performance, to a quality improvement model that fulfills the intent of the SCHIP legislation: to provide insurance coverage for uninsured children, to improve their access to high-quality health care services, and, ultimately, to improve their health.

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