Nearly one-third of children enrolled in the federal Children's Health Insurance Program (CHIP) receive no or very little care, while 72% of the program's spending is concentrated on 10% of children with chronic conditions.
This finding in yesterday's journal Health Affairs suggests that children who get no care may appear healthier than other enrollees, but "they are getting little preventive care, such as well-child visits and dental checkups.
"With so little contact with providers, these children are at increased risk of having health problems that go undiagnosed and untreated," they wrote.
Additionally, children in the zero spending group are disproportionately poor and African American.
The paper focuses on growing discussion in health reform about ways to "bend the curve" of cost growth in public programs, such as increasing cost sharing levels or introducing more high-deductible plans, reducing benefit or eligibility levels or adopting disease management programs.
But the researchers said that policymakers should be careful about raising share-of-costs or premiums for children. In 2008, the median spending level for children enrolled in Medicaid/CHIP for the full year was $226. "This suggests that setting premiums at 'nominal' levels, (say $20 per month per child) could deter some families from enrolling their children in public coverage.
"Indeed, past research indicates that higher public premiums are associated with lower take-up of public programs and higher disenrollment rates, particularly for children with fewer health problems."
Families whose children have no chronic health problems might not view public coverage as cost beneficial, even at fairly low premium levels, they wrote.
The paper was submitted by Genevieve M. Kenney, Joel Ruhter, and Thomas M. Selden. Kenney is a senior fellow at the Urban Institute. Ruhter is a graduate student at the University of Michigan, Ann Arbor. And Tom Selden is an economist with the Agency for Health Research and Quality.