Toward estimating the impact of changes in immigrants' insurance eligibility on hospital expenditures for uncompensated care

BACKGROUND: The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 gave states the option to withdraw Medicaid coverage of nonemergency care from most legal immigrants. Our goal was to assess the effect of PRWORA on hospital uncompensated care in the United States. METHODS: We collected the following state-level data for the period from 1994 through 1999: foreign-born, noncitizen population and health uninsurance rates (US Census Current Population Survey); percentage of teaching hospitals (American Hospital Association Annual Survey of Hospitals); and each state's decision whether to implement the PRWORA Medicaid bar for legal permanent residents or to continue offering nonemergency Medicaid coverage using state-only funds (Urban Institute). We modeled uncompensated care expenditures by state (also from the Annual Survey of Hospitals) in both univariate and multivariable regression analyses. RESULTS: When measured at the state level, there was no significant relationship between uncompensated care expenditures and states' percentage of noncitizen immigrants. Uninsurance rates were the only significant factor in predicting uncompensated hospital care expenditures by state. CONCLUSIONS: Reducing the number of uninsured patients would most surely reduce hospital expenditures for uncompensated care. However, data limitations hampered our efforts to obtain a monetary estimate of hospitals' financial losses due specifically to the immigrant eligibility changes in PRWORA. Quantifying the impact of these provisions on hospitals will require better data sources

Bridging Theory And Practice: Conceptual Understanding Of Treatments For Children With Attention Deficit Hyperactivity Disorder (Adhd), Obsessive-Compulsive Disorder (Ocd), Autism, And Depression

Serves as an introduction to a special edition of the journal on bridging theory and clinical practice for childhood disorders. Issues concerning the current trend of developing and evaluating new treatments devoid of a theoretical perspective are discussed. A conceptual model of child psychopathology is presented to illustrate the relevance and interplay between theory and the design and evaluation of treatments with particular emphasis on the selection and measurement of target behaviors. The means by which theory and empirical evidence interact and their relevance to understanding particular childhood disorders are discussed and emphasize the need for theoretical and conceptual models that describe the linkages among hypothesized brain substrates, cognitive function, behavior, and the environment to augment the development of potent biological and psychological interventions

Attention Deficit/Hyperactivity Disorder And Methylphenidate: A Review Of Height/Weight, Cardiovascular, And Somatic Complaint Side Effects

Three classes (height/weight, cardiovascular, and somatic complaints) of treatment emergent symptoms (side effects) associated with methylphenidate (MPH) therapy for children with attention deficit/hyperactivity disorder (ADHD) are reviewed. The more easily quantifiable side effects (e.g., blood pressure [BP], heart rate [HR], height/weight) are mostly transient, dose-dependent, easily rectified with dosage adjustments, and considered minor from a clinical perspective considering the breadth and level of improvement in behavior and cognitive functioning observed in most children. Previously reported somatic complaints associated with psychostimulant therapy may reflect symptoms occurring prior to initiation of treatment and require additional study. © 2002 Elsevier Science Ltd. All rights reserved

Attention-Deficit/Hyperactivity Disorder And Methylphenidate: A Dose-Response Analysis And Parent-Child Comparison Of Somatic Complaints

The authors examined parent and child ratings of somatic complaints in 65 children with Attention-Deficit/Hyperactivity Disorder (ADHD) who received four doses (5 mg, 10 mg, 15 mg, 20 mg) of methylphenidate (MPH) in the context of a double-blind, placebo controlled, within-subject (crossover) experimental design. Results indicated that parent and child ratings of somatic complaints decreased in a linear fashion from baseline levels as a function of increasing MPH dose and showed minimal variation across MPH conditions. Statistical comparisons of specific somatic complaints indicated minimal agreement between parents and children in contrast to the nearly identical parent-child dose-response curves. The paradoxical findings of fewer somatic complaints associated with MPH, importance of obtaining children\u27s perceptions of MPH treatment, and implications for measuring somatic complaints are discussed

Upgrading The Science And Technology Of Assessment And Diagnosis: Laboratory And Clinic-Based Assessment Of Children With Adhd

Reviews the usefulness of clinic-based and laboratory-based instruments and paradigms for diagnosing attention deficit hyperactivity disorder (ADHD) and monitoring treatment effects. Extant literature examining the performance of normal children and those with ADHD on an extensive range ofneurocognitive tests, tasks, and experimental paradigms indicates that particular types of instruments may be more reliable than others with respect to detecting between-group differences. We review task parameters that may distinguish the more reliable from less reliable instruments. The value of clinic-based and laboratory-based instruments for monitoring treatment response in children with ADHD is questionable when evaluated in the context of ecologically relevant variables such as classroom behavior and academic functioning. We present a general conceptual model to highlight conceptual issues relevant to designing clinic-based and laboratory-based instruments for the purposes of diagnosing and monitoring treatment effects in children with ADHD. Application of the model to currently conceptualized core variables indicates that attention and impulsivity-hyperactivity may represent correlative rather than core features of the disorder. We discuss implications of these findings for designing the next generation of clinic-based and laboratory-based instruments

Attention-Deficit/Hyperactivity Disorder

Attention-Deficit/Hyperactivity Disorder (ADHD) is a complex and chronic disorder of brain, behavior, and development whose behavioral and cognitive consequences pervade multiple areas of functioning in an estimated 3% to 5% of school-age children. Consummating a diagnosis of ADHD in children is a multifaceted, time consuming endeavor, which is complicated by multiple factors. Expert guidelines in psychiatry and psychology recommend that a qualified clinician conduct a comprehensive diagnostic evaluation utilizing multiple assessment instruments. These range from subjective measures such as ratings scales and clinical interviews to increasingly objective measures such as direct observation and sophisticated actigraphs. The process must also include careful review of psychoeducational test data and the child\u27s social developmental, medical, educational, psychiatric, familial, and treatment histories. There are no stand-alone instruments, diagnostic tests, or experimental paradigms that can reliably yield a diagnosis. Epidemiological and developmental studies indicate that ADHD-related behavior problems typically emerge by 3-3.5 years of age and worsen significantly when children enter a structured environment that requires them to pay attention to and complete academic tasks for age-appropriate time intervals. Socialization processes are also strained at this time. A psychoeducational assessment, comprehensive clinical evaluation, intensive historical review, and advanced knowledge concerning differences between and among common clinical child disorders with overlapping symptom presentations is needed to accurately distinguish ADHD from other clinical disorders. Renewed efforts to challenge and explore potential underlying core deficits associated with ADHD, such as working memory, will stimulate the creation of valid assessment instruments for diagnosing ADHD. © 2006 Copyright © 2006 Elsevier Inc. All rights reserved.