State Medicaid health maintenance organization policies and special-needs children.

Little research has been done to ascertain what enrollment in a health maintenance organization (HMO) may mean for the care of Medicaid recipients who regularly require specialty health services. This article presents the results of a survey of all State Medicaid agencies regarding their policies for enrolling and serving special-needs children in HMOs. The survey revealed that many States have implemented one or more strategies to protect special-needs Medicaid recipients enrolled in HMOs. The survey results suggest, however, that such strategies are too limited in scope to ensure appropriate access to specialty services for all children with special health needs

When Coverage Expands: Children's Health Insurance Program as a Natural Experiment in Use of Health Care Services

Background Expanding insurance coverage is designed to improve access to primary care and reduce use of emergency department ( ED ) services. Whether expanding coverage achieves this is of paramount importance as the United States prepares for the Affordable Care Act. Objectives Emergency and outpatient department use was examined after the State Children's Health Insurance Program ( CHIP ) coverage expansion, focusing on adolescents (a major target group for CHIP ) versus young adults (not targeted). The hypothesis was that coverage would increase use of outpatient services, and ED use would decrease. Methods Using the National Ambulatory Medical Care Survey ( NAMCS ) and the National Hospital Ambulatory Medical Care Survey ( NHAMCS ), the years 1992–1996 were analyzed as baseline and then compared to use patterns in 1999–2009, after the CHIP launch. Primary outcomes were population‐adjusted annual visits to ED versus nonemergency outpatient settings. Interrupted time series were performed on use rates to ED and outpatient departments between adolescents (11 to 18 years old) and young adults (19 to 29 years old) in the pre‐ CHIP and CHIP periods. Outpatient‐to‐ ED ratios were calculated and compared across time periods. A stratified analysis by payer and sex was also performed. Results The mean number of outpatient adolescent visits increased by 299 visits per 1,000 persons (95% confidence interval [ CI ] = 140 to 457), while there was no statistically significant increase in young adult outpatient visits across time periods. There was no statistically significant change in the mean number of adolescent ED visits across time periods, while young adult ED use increased by 48 visits per 1,000 persons (95% CI  = 24 to 73). The adolescent outpatient‐to‐ ED ratio increased by 1.0 (95% CI  = 0.49 to 1.6), while the young adults ratio decreased by 0.53 across time periods (95% CI  = –0.90 to –0.16). Conclusions Since CHIP , adolescent non‐ ED outpatient visits have increased, while ED visits have remained unchanged. In comparison to young adults, expanding insurance coverage to adolescents improved use of health care services and suggests a shift to non‐ ED settings. Expanding insurance through the Affordable Care Act of 2010 will likely increase use of outpatient services, but may not decrease ED volumes. Resumen Cuando la Cobertura se Amplia: Programa de Seguro Sanitario de Niños como un Experimento Natural en el Uso de los Servicios Sanitarios Introducción La ampliación de la cobertura del seguro se diseñó para mejorar el acceso a la atención primaria y reducir el uso de los servicios de urgencias ( SU ). El que esta ampliación de la cobertura lo consiga es de una importancia capital ya que Estados Unidos se prepara para la Ley del Cuidado de Salud Asequible (Affordable Care Act). Objetivos Se examinó el uso del servicio ambulatorio y de urgencias tras la ampliación de la cobertura del Programa de Seguro Sanitario de los Niños (Children's Health Insurance Program, CHIP ), por parte de los adolescentes (un gran grupo contemplado por el CHIP ) frente a los adultos jóvenes (no contemplado). La hipótesis fue que la cobertura incrementaría el uso de los servicios ambulatorios y disminuiría el de los SU . Metodología Utilizando la National Ambulatory Medical Care Survey y la National Hospital Ambulatory Medical Care Survey, se analizaron los años 1992–1996 como basal y después se compararon con los patrones de uso en 1999–2009, tras la introducción del CHIP . Los resultados principales fueron las visitas anuales a los SU frente a los servicios ambulatorios no urgentes ajustadas por la población. Se realizaron series temporales interrumpidas en las tasas de uso de los SU y los servicios ambulatorios entre adolescentes (11 a 18 años) y adultos jóvenes (19 a 29 años) en los periodos pre‐ CHI y CHIP . Se calcularon los porcentajes ambulatorio‐ SU y se compararon a través de los periodos de tiempo. Se realizó también un análisis estratificado por sexo y pagador. Resultados El número medio de visitas ambulatorias de adolescentes se incrementó 299 visitas por 1.000 personas ( IC 95% = 140 a 457), mientras que no hubo un incremento significativo en las visitas ambulatorias de adultos jóvenes a lo largo de los periodos de tiempo. No hubo cambio estadísticamente significativo en la media de número de visitas al SU de adolescentes a lo largo de los periodos de tiempo, mientras que se incrementó el uso de los SU de los adultos jóvenes, 48 visitas por 1.000 personas ( IC 95% = 24 a 73). La proporción ambulatorio‐ SU del adolescente se incrementó un 1,0 ( IC 95% = 0,49 a 1,6), mientras que la proporción de los adultos jóvenes descendió un 0,53 a lo largo de los periodos de tiempo ( IC 95% = –0,90 a –0,16). Conclusiones Desde el CHIP , las visitas ambulatorias no urgentes de los adolescentes se han incrementado, mientras que las visitas a los SU permanecen sin cambios. En comparación con los adultos jóvenes, la ampliación de la cobertura del seguro a los adolescentes mejoró el uso de los servicios sanitarios y sugiere un cambio hacia los servicios no relacionados con el SU . La ampliación del seguro a través de la Ley de Cuidado de Salud Asequible de 2010 incrementará probablemente el uso de los servicios ambulatorios, pero puede no disminuir los volúmenes del SU .Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/100287/1/acem12236.pd

Geography matters: state-level variation in children's oral health care access and oral health status

To ascertain differences across states in children's oral health care access and oral health status and the factors that contribute to those difference

Differences in risk factors for children with special health care needs (CSHCN) receiving needed specialty care by socioeconomic status

<p>Abstract</p> <p>Background</p> <p>The purpose of this study is to identify factors affecting CSHCN's receiving needed specialty care among different socioeconomic levels. Previous literature has shown that Socioeconomic Status (SES) is a significant factor in CHSHCN receiving access to healthcare. Other literature has shown that factors of insurance, family size, race/ethnicity and sex also have effects on these children's receipt of care. However, this literature does not address whether other factors such as maternal education, geographic location, age, insurance type, severity of condition, or race/ethnicity have different effects on receiving needed specialty care for children in each SES level.</p> <p>Methods</p> <p>Data were obtained from the National Survey of Children with Special Health Care Needs, 2000–2002. The study analyzed the survey which studies whether CHSCN who needed specialty care received it. The analysis included demographic characteristics, geographical location of household, severity of condition, and social factors. Multiple logistic regression models were constructed for SES levels defined by federal poverty level: < 199%; 200–299%; ≥ 300%.</p> <p>Results</p> <p>For the poorest children (,199% FPL) being uninsured had a strong negative effect on receiving all needed specialty care. Being Hispanic was a protective factor. Having more than one adult in the household had a positive impact on receipt of needed specialty care but a larger number of children in the family had a negative impact. For the middle income group of children (200–299% of FPL severity of condition had a strong negative association with receipt of needed specialty care.</p> <p>Children in highest income group (> 300% FPL) were positively impacted by living in the Midwest and were negatively impacted by the mother having only some college compared to a four-year degree.</p> <p>Conclusion</p> <p>Factors affecting CSHCN receiving all needed specialty care differed among socioeconomic groups. These differences should be addressed in policy and practice. Future research should explore the CSHCN population by income groups to better serve this population</p

Effects of insurance status on children's access to specialty care: a systematic review of the literature

<p>Abstract</p> <p>Background</p> <p>The current climate of rising health care costs has led many health insurance programs to limit benefits, which may be problematic for children needing specialty care. Findings from pediatric primary care may not transfer to pediatric specialty care because pediatric specialists are often located in academic medical centers where institutional rules determine accepted insurance. Furthermore, coverage for pediatric specialty care may vary more widely due to systematic differences in inclusion on preferred provider lists, lack of availability in staff model HMOs, and requirements for referral. Our objective was to review the literature on the effects of insurance status on children's access to specialty care.</p> <p>Methods</p> <p>We conducted a systematic review of original research published between January 1, 1992 and July 31, 2006. Searches were performed using Pubmed.</p> <p>Results</p> <p>Of 30 articles identified, the majority use number of specialty visits or referrals to measure access. Uninsured children have poorer access to specialty care than insured children. Children with public coverage have better access to specialty care than uninsured children, but poorer access compared to privately insured children. Findings on the effects of managed care are mixed.</p> <p>Conclusion</p> <p>Insurance coverage is clearly an important factor in children's access to specialty care. However, we cannot determine the structure of insurance that leads to the best use of appropriate, quality care by children. Research about specific characteristics of health plans and effects on health outcomes is needed to determine a structure of insurance coverage that provides optimal access to specialty care for children.</p

Do children with neurological disabilities use more inpatient resources: an observational study.

BACKGROUND: Advances in healthcare have improved the survival of children with neurological disabilities (ND). Studies in the US have shown that children with ND use a substantial proportion of resources in children's hospitals, however, little research has been conducted in the UK. We aimed to test the hypothesis that children with neurological disabilities use more inpatient resources than children without neurological disabilities, and to quantify any significant differences in resource use. METHODS: A retrospective observational study was conducted, looking at the number of hospital admissions, total inpatient days and the reason for admissions for paediatric inpatients from January 1st to March 31st 2015. Inpatients were assigned into one of three groups: children without ND, children with one ND, and children with more than one ND. RESULTS: The sample population included 942 inpatients (mean age 6y 6mo). Children with at least one ND accounted for 15.3% of the inpatients, 17.7% of total hospital inpatient admission episodes, and 27.8% of the total inpatients days. Neurological disability had a statistically significant effect on total hospital admissions (p < 0.001). Neurological disability also had a statistically significant effect on total inpatient days (p < 0.001). Neurological disability increased the length of inpatient stay across medicine, specialties, and surgery. CONCLUSIONS: Children with ND had more frequent hospital admission episode and longer inpatient stays. We identified a smaller group within this population, with arguably more complex neurological disabilities, children with more than one ND. This group had the highest number of admissions and longest inpatient stays. More frequent hospital admissions and longer inpatient stays may place children with ND at greater risk of the adverse effects of hospitalisations. We recommend further investigations looking at each the effects of the different categories of ND on inpatient resource use, and repeat of this study at a national level and over a longer period of time

Parental use of the Internet to seek health information and primary care utilisation for their child: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Using the Internet to seek health information is becoming more common. Its consequences on health care utilisation are hardly known in the general population, in particular among children whose parents seek health information on the Internet. Our objective was to investigate the relationship between parental use of the Internet to seek health information and primary care utilisation for their child.</p> <p>Methods</p> <p>This cross-sectional survey has been carried out in a population of parents of pre-school children in France. The main outcome measure was the self-reported number of primary care consultations for the child, according to parental use of the Internet to seek health information, adjusted for the characteristics of the parents and their child respectively, and parental use of other health information sources.</p> <p>Results</p> <p>A total of 1 068 out of 2 197 questionnaires were returned (response rate of 49%). No association was found between parental use of the Internet to seek health information and the number of consultations within the last 12 months for their child. Variables related to the number of primary care consultations were characteristics of the child (age, medical conditions, homeopathic treatment), parental characteristics (occupation, income, stress level) and consultation of other health information sources (advice from pharmacist, relatives).</p> <p>Conclusion</p> <p>We did not find any relationship between parental use of the Internet to seek health information and primary care utilisation for children. The Internet seems to be used as a supplement to health services rather than as a replacement.</p

Is the onset of disabling chronic conditions in later childhood associated with exposure to social disadvantage in earlier childhood? a prospective cohort study using the ONS Longitudinal Study for England and Wales

Background: The aetiology of disabling chronic conditions in childhood in high income countries is not fully understood, particularly the association with socio-economic status (SES). Very few studies have used longitudinal datasets to examine whether exposure to social disadvantage in early childhood increases the risk of developing chronic conditions in later childhood. Here we examine this association, and its temporal ordering, with onset of all-cause disabling chronic later childhood in children reported as free from disability in early childhood. Methods: The study comprised a prospective cohort study, using data from the Office for National Statistics Longitudinal Study (ONSLS) for England and Wales. The study sample included 52,839 children with complete data born between 1981–1991 with no disabling chronic condition/s in 1991. Index cases were children with disability recorded in 2001. Comparison cases were children with no recorded disability in 1991. A socio-economic disadvantage index (SDI) was constructed from data on social class, housing tenure and car/van access. Associations were explored with logistic regression modelling controlling sequentially for potentially confounding factors; age, gender, ethnicity and lone parenthood. Results: By 2001, 2049 (4%) had at least one disability. Socio-economic disadvantage, age, gender and lone parenthood but not ethnicity were significantly associated with onset of disabling chronic conditions. The SDI showed a finely graded association with onset of disabling chronic conditions in the index group (most disadvantaged OR 2·11 [CI 1·76 to 2·53]; disadvantaged in two domains OR 1·45 [CI 1·20 to 1·75]; disadvantaged in one domain OR 1·14 [CI 0·93 to 1·39] that was unaffected by age, gender and ethnicity and slightly attenuated by lone parenthood. Conclusion: To our knowledge, this is the first study to identify socio-economic disadvantage in earlier childhood as a predisposing factor for onset of all-cause disabling chronic conditions in later childhood. Temporal ordering and gradation of the response indicate socio-economic disadvantage may play a causal role. This suggests that targeting preventative efforts to reduce socio-economic disadvantage in early childhood is likely to be an important public health strategy to decease health inequalities in later childhood and early adulthood