Article Text

  1. A. Sharma1,
  2. B. Lichtenstein2,
  3. J. Wheat2
  1. 1University of Alabama at Birmingham, Birmingham, AL
  2. 2University of Alabama
  3. 3Helsinki University Hospital


Background In 1996, the average number of uninsured children in Bibb County was higher than for the state as a whole. Several key industries had left the area, unemployment had risen, and community-wide effects included declining school performance and child illness. The Bibb County Child Caring Initiative (BCCCI), created by a coalition of interested parties in 1996, coordinated two preexisting federal health plans (Medicaid, All-Kids) and offered insurance to other uninsured children through a state plan. By 2000, the goal of providing health coverage to all children in Bibb County seemed within reach. The present study was conducted as an evaluation of this program.

Objectives To evaluate the BCCCI program using parent satisfaction and community information on saturation levels as the defining measures.

Methods Qualitative research methods were used in this study. In 2003, face-to-face interviews were conducted with 248 parents and with 23 key informants (employers, policy-makers, teachers, physicians, and a school nurse). Additionally, two focus groups of parents were conducted for in-depth information on child health insurance in Bibb County.

Results The total number of uninsured children in Bibb County decreased over the study period and parents were grateful for the opportunity to enroll their children in a health plan. Some discrepancies were reported, such as parents not receiving forms, not knowing about the BCCCI program, lengthy waiting periods, ineligibility, providers who billed patients, and in a few cases, discriminatory practices.

Conclusions The BCCCI apparently improved access to health care for children in Bibb County. Currently, these gains are being threatened by the fiscal crisis affecting states' ability to fund insurance plans, unemployment, and rising premiums that affect parents' ability to provide health insurance for their children.

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