During 1997 and 1998, the 14-member Committee on Children, Health Insurance, and Access to Care—appointed by the Institute of Medicine (IOM)—examined the relationship between health insurance coverage and children's access to health care.
A specific focus of the study was to consider how recent changes in safety-net programs and health care policies have influenced such access.
Because the study was undertaken at the same time Congress debated, and ultimately enacted, a major expansion of health insurance coverage for children, the State Children's Health Insurance Program (CHIP), researchers capped the project with a report offering a framework and recommendations for evaluating the impact of this new legislation.
The committee offered the following recommendations in the report Systems of Accountability: Implementing Children's Health Insurance Programs:
- The US Department of Health and Human Services (DHHS) must establish a performance monitoring system for CHIP in collaboration with agencies from other levels of government and with private organizations.
- DHHS must develop systems that improve the availability of national and state-level information on children's insurance coverage, access, utilization, satisfaction, health status, and outcomes, particularly for children with special health care needs.
- States should begin immediately to design and implement systems to produce meaningful information on CHIP's effects.
- States should make information on CHIP available to the public in a form useful to evaluating the program's performance.
- As much as possible, states should delegate the collection and synthesis of CHIP information to contracted health plans or provider groups, with requirements for independent auditing of these data.
- States should set conditions for provider participation in CHIP, 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.