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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Adequate Insurance.

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Strategy. Health Reform Legislation

Approach. Support legislative changes to reduce uninsurance and improve access to care for children

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Overview. In 2006, Massachusetts passed major health reform legislation, including an individual mandate for adults. (who were required to purchase insurance for face a penalty); Medicaid expansion. (i.e., children’s eligibility for the state’s Medicaid-CHIP increased from 200 to 300% of the FPL and adult eligibility for Medicaid increased to 100% FPL), and minimum essential benefits for private insurance (e.g., coverage of basic specialty services, no copay for deductible for preventive care visits). Massachusetts health reform, the model for the ACA, reduced uninsurance and improved access to some types of care for children in the state.

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for healthcare services.
  • Social Determinants of Health. This strategy advances economic, social, and environmental factors that affect health outcomes. SDOH include the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.
  • Health Outcomes. This strategy helps contribute to reducing avoidable differences among socioeconomic and demographic groups or geographical areas in health status and health outcomes such as disease, disability, or mortality.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of health reform bills introduced in the state legislature that address children's health insurance and access to care. (Measures the policy development process)
  • Number of public hearings for forums held to gather input on proposed health reform policies for children. (Reflects efforts to engage the community in policy design)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of state legislators who vote in favor of health reform legislation for children. (Measures political support for the policy changes)
  • Percent of families with children who are aware of the health insurance options and benefits available through health reform. (Evaluates the success of public education efforts)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of partnerships established between state agencies, health care providers, and community organizations to support health reform implementation. (Engages key community partners in ensuring success)
  • Number of outreach and enrollment events held in communities experiencing barriers to care to promote children's coverage options under health reform. (Reflects tailored efforts to reach populations)

OUTCOME MEASURES:

  • Number of well-child visits and immunizations provided to children after implementation of health reform. (Shows the impact on preventive care utilization)
  • Number of children with chronic conditions who have a regular source of care and receive care coordination post-reform. (Measures the impact on access to patient-centered care)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of children in the state who are uninsured before and after implementation of health reform legislation. (Provides a population-level measure of the policy impact)
  • Percent of state budget allocated to support children's health insurance coverage and access initiatives under health reform. (Shows the level of public investment in child health)

OUTCOME MEASURES:

  • Percent reduction in the number of children who have unmet health care needs for delayed care due to cost. (Evaluates the impact on reducing financial barriers to care)
  • Percent increase in the number of children meeting age-appropriate health and developmental milestones post-reform. (Reflects the ultimate goal of supporting healthy child development)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.